Removing Intravenous (IV) and Intra-Atrial Lines

An intravenous line (or IV) is used to introduce fluid or medication directly into the bloodstream. Although they are inserted with a needle, all that is left in the body is a plastic cannula. They can have one to three lumens (ports).
Peripheral IV Overview:
  1. A peripheral IV is generally inserted in the hand or forearm. The cannula is up to 1 inch long. It is generally held in place with a piece of tape or, rarely, with a suture.
Midline IV Overview:
  1. A Midline IV is inserted in the elbow and is 3-10 inches long, not going past the armpits. 
  2. The midline IV is held in place by a burr at the end of the cannula as well as with tape.
Peripherally Inserted Central Catheter (PICC) Overview:
  1. A PICC line, like a midline IV, is inserted through a vein in the elbow but goes all the way to the Vena Cava (the vein returning blood to the heart).
  2. The PICC line is usually held in place with a plastic adhesive stabilizer. It may be stitched into the skin at the place of insertion to hold it in place.
  3. PICC lines have one or two ports.
Central Venous Catheter (CVAD) Overview:
  1. Like a PICC line, a CVAD goes directly to the heart — although it is usually inserted directly under the collar bone or jugular vein in the neck.
  2. CVADs have one or two lumens (ports).​
Removal:
  1. Before removing any IV line, first prepare Monsel's solution or another blood coagulating agent, as well as webril/cotton or a fluffed-up Q-Tip to stop bleeding. 
  2. If possible, the limb from which the IV is being removed should be elevated above the rest of the body.
  3. Carefully remove any bandages and medication discoloration (iodine, betadine, etc.) on or around the IV port.
  4.  In the case of a PICC line, it is generally held in place with an adhesive plastic stabilizer. This can be removed with alcohol.
  5. If the IV is stitched in place to the skin, cut the stitch. 
  6. Hold a piece of cotton firmly just behind the location where the cannula enters the skin.
  7. Slowly and smoothly pull the IV out. (In the case of a longer cannula, it is generally held in place by a small burr at the end of the cannula. Removing it may require a little more force.)
  8. PICC lines will take longer to pull out since they are much longer. Don't be concerned with the length; keep pulling until it is completely out of the body.
  9. Continue applying pressure until more Monsel's solution is applied. The Monsel's solution should be applied as far into the hole as possible. This is most effective with a fluffed up Q-tip. If the bleeding persists, pack the hole with Monsel's-soaked cotton.