When removing a peripheral IV catheter, how should you withdraw the catheter? A Clinical Guide

October 12, 2025 •

4 min read

Over two billion peripheral intravenous catheters are used globally each year, yet one-third fail before treatment is complete [1.6.1]. Knowing when removing a peripheral IV catheter, how should you withdraw the catheter is crucial for patient safety and preventing complications.

Quick Summary

Properly withdrawing a peripheral IV catheter involves a slow, steady motion, keeping the catheter parallel to the skin to minimize trauma and ensure the device is removed intact. This action prevents complications and ensures patient comfort.

Key Points

Technique is Key: Always withdraw the catheter slowly, steadily, and parallel to the skin to minimize trauma [1.2.2, 1.2.5].
Pressure Timing: Apply firm pressure with sterile gauze only after the catheter has been completely removed from the vein [1.2.6].
Inspect the Catheter: After removal, immediately inspect the catheter to confirm it is intact and no fragments have been left behind [1.2.3].
Handle Resistance Carefully: If you encounter resistance during removal, stop immediately, do not force it, and notify the physician [1.2.5, 1.8.2].
Anticoagulant Awareness: For patients on blood thinners, apply pressure for a longer duration (5-10 minutes) to ensure hemostasis [1.2.2].
Documentation is Crucial: Document the removal, the integrity of the catheter, and the condition of the site in the patient's medical record [1.2.5].
Patient Education: Instruct the patient on site care and what symptoms (bleeding, swelling, pain) to report after discharge [1.7.1, 1.7.4].

The Importance of Correct IV Catheter Removal

Peripheral intravenous catheters (PIVCs) are one of the most common invasive medical devices used in healthcare, with up to 60% of all hospitalized patients receiving one during their stay [1.4.6]. While insertion gets significant attention, the removal process is equally critical for patient safety. Improper removal can lead to complications ranging from minor bruising to rare but serious events like catheter embolism [1.4.7]. Understanding the evidence-based best practices for discontinuing a peripheral IV is a fundamental nursing skill that directly impacts patient outcomes. Studies show that overall PIVC failure rates can be as high as 35-50%, making proper maintenance and removal procedures vital to minimize patient discomfort, treatment delays, and healthcare costs [1.6.3].

Step-by-Step Guide to Withdrawing a Peripheral IV Catheter

Adhering to a systematic process ensures the procedure is safe, efficient, and comfortable for the patient. Always review and follow your specific agency's policy [1.2.2].

1. Preparation and Patient Communication

Verify Orders: Confirm the healthcare provider's order to discontinue the IV [1.2.1].
Perform Hand Hygiene: Wash hands thoroughly and gather supplies on a clean surface. This prevents the transmission of microorganisms [1.2.6].
Gather Supplies: You will need clean, non-sterile gloves, sterile 2x2 gauze pads, and tape or a bandage [1.2.2, 1.2.3].
Patient Identification and Explanation: Identify the patient using two identifiers (e.g., name and date of birth). Explain the procedure, letting them know it is usually quick and involves minimal discomfort. This reduces anxiety and ensures cooperation [1.2.2].

2. The Removal Procedure

Stop the Infusion: If an infusion is running, turn off the IV pump and clamp the tubing to prevent fluid from leaking [1.2.3].
Don Gloves and Loosen Dressing: Perform hand hygiene again and put on clean gloves. Carefully and gently loosen the edges of the transparent dressing and tape, peeling them back towards the insertion site to avoid accidentally dislodging the catheter prematurely [1.2.2, 1.2.3]. An alcohol pad may help loosen stubborn adhesive [1.2.7].
Position Gauze: Place a piece of sterile gauze above or slightly over the insertion site, but do not apply pressure yet. Applying pressure while the catheter is still in the vein can be painful for the patient [1.2.6].
Withdraw the Catheter: Stabilize the patient's limb. With your other hand, pull the catheter straight out using a slow and steady motion, keeping it low and parallel to the skin [1.2.2, 1.2.5]. This angle minimizes trauma to the vein wall and surrounding tissue.

3. Immediate Post-Removal Actions

Apply Pressure: As soon as the catheter tip is out of the skin, apply firm but gentle pressure to the site with the sterile gauze [1.2.1]. Hold pressure for 2-3 minutes. If the patient is on anticoagulants or has a known bleeding disorder, you may need to apply pressure for 5-10 minutes [1.2.2].
Inspect the Catheter: Immediately inspect the removed catheter to ensure it is fully intact. Check that the tip is smooth and not jagged or shortened. This is a critical safety step to verify that no part of the catheter has broken off and embolized in the bloodstream [1.2.3, 1.2.5].
Dress the Site: Once hemostasis is achieved, assess the site for signs of infection such as redness, swelling, or drainage. Apply a clean gauze pad or bandage over the site [1.2.2].

4. Final Steps and Documentation

Dispose of Materials: Dispose of the used catheter in a puncture-resistant sharps container and other materials in the appropriate receptacle [1.2.2].
Patient Education: Instruct the patient to keep the bandage on for at least an hour and to report any bleeding, pain, swelling, or redness at the site [1.7.2]. Advise them to avoid heavy lifting with that arm for a few hours [1.7.1].
Documentation: Document the date, time, the fact that the catheter was removed intact, the condition of the insertion site, and any patient education provided, according to facility policy [1.2.2, 1.2.5].

Comparison of IV Removal Techniques


Technique	Correct (Best Practice)	Incorrect (High Risk)
Angle of Withdrawal	Low angle, parallel to the skin [1.2.2, 1.2.5]	High angle, pulling up and away from the skin
Speed of Withdrawal	Slow and steady motion [1.2.1, 1.2.2]	Quick, jerking motion
Pressure Application	Applied immediately after the catheter is fully removed [1.2.6]	Applied during catheter withdrawal
Catheter Handling	Never re-insert or re-advance the stylet into the catheter [1.5.6]	Attempting to re-thread the needle into the catheter
Action if Resistance Met	Stop, do not force removal, and notify the physician [1.2.5, 1.8.2]	Applying force to overcome resistance

Managing Potential Complications

While generally safe, PIVC removal can have complications.

Catheter Shearing/Embolism: This is a rare but life-threatening complication where a piece of the catheter breaks off. It can be caused by reinserting the needle into the catheter during insertion or applying excessive force during removal if resistance is met [1.5.3, 1.4.7]. If you suspect the catheter is not intact, notify the provider immediately [1.2.3].
Bleeding or Hematoma: Excessive bleeding or the formation of a hematoma (a collection of blood under the skin) can occur. This risk is higher in patients on anticoagulants. Ensure adequate pressure is applied for the appropriate duration [1.2.2].
Phlebitis and Infection: Redness, swelling, warmth, and pain at the site can indicate phlebitis (vein inflammation) or a local infection. Document these findings and report them as per policy. Catheter-related bloodstream infections are a serious risk associated with PIVCs [1.4.6].
Infiltration/Extravasation: If the site was infiltrated (leaking non-vesicant fluid) or extravasated (leaking vesicant fluid), additional care like elevation and warm or cold compresses may be needed post-removal [1.7.5].

Conclusion

The simple act of removing a peripheral IV catheter is a procedure with significant implications for patient safety. The correct technique—a slow, steady withdrawal parallel to the skin—is essential to prevent pain, vein trauma, and dangerous complications like catheter shearing. By following a standardized, evidence-based protocol that includes thorough preparation, careful execution, and vigilant post-procedure assessment, healthcare professionals uphold their commitment to providing the highest standard of care and ensuring patient well-being from the beginning to the very end of infusion therapy.

For further reading and official standards, consult the Infusion Nurses Society (INS) which provides comprehensive evidence-based recommendations for infusion therapy. https://www.ins1.org/

Frequently Asked Questions

The most critical steps are withdrawing the catheter slowly and parallel to the skin to prevent vein trauma, and immediately inspecting the catheter tip to ensure it is intact and has not fractured [1.2.2, 1.2.3].

A slow, steady motion that is flush or parallel to the skin minimizes trauma to the inner lining of the vein, reduces patient pain, and helps prevent complications like hematomas or post-infusion phlebitis [1.2.5, 1.2.2].

If the catheter breaks, a fragment can travel through the bloodstream, becoming a catheter embolism. This is a medical emergency that can cause serious complications like arrhythmias or thrombosis. If the catheter is not intact upon removal, the physician must be notified immediately [1.4.7, 1.2.3].

You should apply firm pressure for 2-3 minutes for most patients. For patients on anticoagulant medications or with bleeding disorders, pressure should be held for 5-10 minutes or until bleeding has completely stopped [1.2.2].

The basic supplies needed are clean non-sterile gloves, sterile gauze pads (typically 2x2), and tape or an adhesive bandage to dress the site afterward [1.2.2].

If resistance is met, you should not forcibly remove the catheter. Stop the procedure and notify the physician or authorized prescriber. Forcing it could cause the catheter to break [1.8.2, 1.2.5].

The bandage should be kept on for at least one hour after IV removal to ensure the puncture site has closed and to prevent bacteria from entering the site [1.7.2]. Some sources recommend keeping the site clean and dry for several hours [1.7.1].