Understanding the Nursing Scope of Practice
The scope of practice for registered nurses (RNs) is defined by state or national regulations, known as the Nurse Practice Act, and further guided by individual facility policies. For routine, short-term peripheral intravenous (IV) catheters, removal is a standard procedure well within an RN's scope of practice. This is distinct from the removal of central lines, such as PICC lines or implanted ports, which typically requires advanced training or may be performed only by a physician or advanced practice nurse.
The Role of State and Facility Protocols
State Nurse Practice Acts provide the legal framework for nursing activities, and they are generally permissive of RNs removing peripheral IVs. However, every healthcare facility—from hospitals to outpatient clinics—maintains its own set of policies and procedures that can be more restrictive. These internal rules dictate the precise steps, required documentation, and situations in which a catheter can or cannot be removed by a nurse. Factors influencing this include:
- Type of catheter: While a peripheral IV is standard, a midline catheter's removal might be regulated differently, even though it is still considered a form of peripheral access.
- Patient condition: The patient's clinical stability, anticoagulant status, and risk of bleeding can alter the procedure and pressure-holding time required.
- Signs of complications: If a complication like phlebitis or infiltration is present, the nurse must assess and document the site meticulously, and possibly notify a physician before removal.
The Step-by-Step Peripheral Catheter Removal Process
Proper technique is paramount to ensure a safe and complication-free procedure. The process involves several key steps:
- Verify the order: Ensure there is a physician's order to discontinue the IV, or that the IV is no longer clinically indicated according to a nurse-driven protocol.
- Gather supplies: Collect necessary materials, which typically include gloves, gauze pads, sterile tape or an adhesive bandage, and a non-toxic adhesive remover wipe if needed.
- Perform hand hygiene: Wash hands thoroughly and don clean gloves to maintain aseptic technique.
- Remove the dressing: Gently peel back the IV dressing and securement device. This can be aided by an adhesive remover to avoid skin trauma.
- Withdraw the catheter: Place a sterile gauze pad over the insertion site. With a smooth, steady motion, pull the catheter out completely while applying gentle pressure with the gauze.
- Apply pressure: Apply firm, direct pressure to the site with the gauze for a minimum of 2–3 minutes to achieve hemostasis. For patients on blood thinners or with clotting disorders, longer pressure may be necessary.
- Inspect the catheter tip: Examine the catheter tip to ensure it is intact. A fragmented or broken catheter requires further medical intervention and notification of the physician.
- Dress the site: Once bleeding has stopped, apply a new, clean dressing or adhesive bandage to the site.
- Document the procedure: Record the date, time, site condition, dressing applied, and patient tolerance in the electronic health record.
Potential Complications and What to Watch For
Although peripheral catheter removal is a routine procedure, nurses must remain vigilant for potential complications. These can include:
- Bleeding: Excessive or prolonged bleeding from the site, especially in patients with coagulopathies or on anticoagulants.
- Hematoma: The formation of a bruise or swelling under the skin at the insertion site, caused by blood leakage.
- Infection: Redness, swelling, warmth, or purulent drainage at the site may indicate a local infection. In rare cases, this could lead to a more serious bloodstream infection.
- Catheter embolism: A piece of the catheter breaks off and travels through the bloodstream. This is extremely rare but inspecting the catheter tip is a crucial safeguard.
- Air embolism: While less likely with a peripheral line than a central line, it is still a potential risk if a large-gauge catheter is removed from a vein above the heart.
Comparison of Catheter Removal Responsibilities
| Aspect | Peripheral IV | PICC Line |
|---|---|---|
| Who Removes | Registered Nurse (RN) with competency | RN with specialized training, Advanced Practice Nurse, or Physician |
| Physician Order | Often required, but may be guided by nurse-driven protocols based on clinical indication | Always required |
| Aseptic Technique | Standard aseptic technique | Strict sterile technique |
| Risk of Complications | Low; primarily local bleeding or bruising | Moderate to high; risk of air embolism, nerve damage, or infection |
| Training Required | Basic nursing education and clinical orientation | Advanced infusion therapy certification or supervised training |
| Inspection | Inspect catheter tip for intactness | Inspect catheter length and tip for intactness, often requires specific documentation |
The Importance of Patient Assessment and Education
Before, during, and after removal, a nurse's assessment skills are critical. Before removal, the nurse assesses the site for signs of infection or infiltration. During the procedure, they monitor for resistance during removal, which could indicate a problem, and apply appropriate pressure. After removal, the patient is educated on site care, including when to remove the bandage and what to watch for, such as signs of bleeding or infection. This patient education is a core part of the nursing process and a key component of preventing post-procedure complications.
Conclusion: The Professional Judgment of Nursing
In summary, yes, a registered nurse is professionally and legally permitted to remove a peripheral catheter under most circumstances. The process is a routine nursing function that highlights the essential combination of technical skill, critical thinking, and patient education. Adherence to state regulations and facility policies is non-negotiable. It is this combination of knowledge, skill, and careful judgment that allows nurses to perform this seemingly simple but clinically important procedure safely and effectively, ensuring the best possible outcome for the patient. For further reading on standard practices, you can review guidelines from organizations such as the Infusion Nurses Society (INS) on infusion therapy standards https://www.ins1.org/.
