How to Remove (discontinue) an IV
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Outline
Overview
Proper removal of the IV is based on:
- Completion of therapy
- Comfort of the patient
- Necessary safety precautions
Nursing Points
General
- IV catheters should be removed if
- Therapy is completed (i.e. patient discharge)
- The IV is not patent
- Another safety risk is present (i.e. infection, extravasation, phlebitis, etc.)
- IVs shouldn’t be removed if
- The patient doesn’t want it anymore
- The patient may require further teaching or a modification of therapy
- There is a facility or unit policy that requires a minimal number of lines present for admission
- There is anticipated further therapy or treatment
- The patient doesn’t want it anymore
- Proper IV removal technique
- Verify order
- Collect all supplies
- Bandaid
- Tape and gauze or cotton ball
- Disconnect all IV tubing
- Begin by removing all tape and transparent dressings
- Alcohol wipes may be necessary for excessive adhesive
- Begin by removing all tape and transparent dressings
- Nondominant hand
- With only the catheter indwelling in the vein, place gauze or cotton ball over the insertion site
- Apply light pressure
- Dominant hand
- While applying pressure, grasp the hub of the catheter and remove
- Apply pressure with the nondominant hand
- Inspect the catheter end
- Catheter tip should be intact and have no presence of shearing
- If the catheter tip is missing, notify the provider immediately.
- Apply pressure liberal pressure
- Typically 1-2 minutes is sufficient
- For patients on thrombolytics or anticoagulants, prolonged pressure may be necessary
- Use clinical decision making
- Inspect for continued bleeding (if present, continue to apply pressure until cessation of bleeding)
- Apply bandage
- Reassess to verify placement of bandage and comfort of the patient.
- Typically 1-2 minutes is sufficient
- Pro-Tips
- IV catheters should not be removed simply for discomfort
- Some infusions are irritating (i.e. Potassium)
- Modify fluid rates for discomfort, with an order
- Some infusions are irritating (i.e. Potassium)
- If a patient does refuse the IV, or removes them due to noncompliance, document accordingly
- Apply a bandage to control bleeding
- IV catheters should not be removed simply for discomfort
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Transcript
All right guys. In this lesson we’re going to talk about discontinuing the IV. Now, the first thing you need to know is that is based on three factors. The first one is did your patient received all the therapy that they needed while they were being taken care of? The second one is patient comfort. If the patient’s uncomfortable, we might need to discontinue the IV and the third one is patient safety. Does the patient having the IV cause a safety problem? You should always take out your patient’s IV if they’ve completed the therapy. If the IV’s not Peyton or working or if there’s some sort of safety concern. When should you not take out a patient’s IV? Well, sometimes if your patient is in the unit and there’s a facility policy or a unit policy that says they have to have a minimum number of IVs, that’s a good reason.
For instance, the ICU that I worked at it often, they often said they had to have a minimum of two IVs so we could never just arbitrarily discontinue one. The other reason you shouldn’t think about taking your patient’s IV out is if you think they might receive more therapy. If that’s a possibility, don’t take it out. And the last one, and probably most important is that the patient just doesn’t want it. This requires some due diligence on your part. We’re not taking away a patient’s right to refuse or their autonomy. If they say, Hey, I just don’t want the patient, the IV anymore, what you need to do is educate them. Hey, you need this IV because X, Y and Z, and educate them. If they have, if they refuse, then, by all means, they have every right to take it up. I’ve seen patients who actually wanted to leave the hospital against medical advice and they take that IVA out and there’s nothing I can do about it because they were totally coherent and fully capable of making those decisions for themselves.
But what’s important to remember is that you have to do your due diligence and educating them and documenting when you need to. So what is the proper technique and taking out an IV, you can’t just take it out. There is some thought process. First off, you need to make sure that you have an order to discontinue the IV. I need to make sure it’s appropriate and you need to make sure all the things that we just talked about are in place. Now what you need to do is gather your supplies. Typically that’s like a bandaid or a, my favorite was a piece of tape and gauze that allowed me to make sure that we’re, that I had everything that I needed to. The next thing you want to do is discontinue any lines that are already attached to the patient. There’s nothing more annoying than having an IV that’s still connected while I’m trying to discontinue to IV and everything goes everywhere.
It’s just a big giant mess. Try to clean up your mess and make sure that it’s easy for you to do what you need to do. Now what you’re going to do is you’re going to slowly and carefully remove all of the dressing and now you should just have that IV catheter sitting in the skin with your nondominant hand. What you’re going to do is you’re going to take the cotton ball or the gauze and apply it directly over the IV site and apply pressure, and then with your dominant hand, which I’m right hand dominant, I’m going to pull that IV catheter out. It’s not taped in and connected to anything anymore, so it’s free to float around while I’m applying pressure at the same time I’m withdrawing the IV, I’m inspecting the IV end and the reason I do this is because I want to make sure that entire IV Kanyola is intact.
Sometimes in very rare instances during the insertion of the IV process, the stylette or the needle will actually cut the end of that IV catheter off. If that happens, it actually creates an embolus. I’ve only happened to me one time, it was never a problem for the patient, but it does happen. So just take a quick look, make sure that the IV tip is in place, even if it’s all crazy and crooked looking, that IV tip should still be in place and continue to apply pressure. You can peek every now and then make sure that that thing is not bleeding anymore. Apply your tape or your bandaid and your patient should be good to go. Always reassess, make sure they’re not continuing to bleed. You also need to be mindful of patients that are on blood thinners or um, uh, Antifa robotics or uh, anti plate medications, patients that have the potential to continually bleed.
We need to make sure that those patients have just a little bit of extra pressure applied. Here are a couple of pro tips. IV catheters shouldn’t be just removed for discomfort. What you need to do is educate your patient and also sometimes medications just need to be adjusted. An example of this is potassium. Potassium is can be pretty irritating. If that’s the case, talk to your patient, ask them about it. As long as the IV is still patent, what you need to do is talk to your provider about alternating that rate just a little bit of adjusting it just to make sure that you can get everything that you need to and that way your patient gets all their medication and also make sure that it’s comfortable for them. Every patient that is coherent has the right to refuse. If they can make their own medical decisions that they have a right to not have an IV in, just make sure if they want to take that IV out, that you do it properly and you make sure you educate them on the needs for the IV and as long as they still refuse, take it out and document it accordingly.
I hope that these tips have been helpful. Now go out and be your best selves today and as always, happy nursing.
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