Table 4 Summary of evidence for peripheral arterial manometry catheter removal in adult patients
Evidence Topic | No. | Evidence description | Level of evidence | Recommended level |
|---|---|---|---|---|
Assessment of removal timing | 1 | The necessity of indwelling artery catheter is evaluated daily to fully assess the benefits and risks and should be removed as soon as unnecessary [13,14,15, 17,18,19]. | 4c | A |
2 | There are obvious signs of infection, the catheter is not working effectively, and the arterial catheter should be removed immediately when complications occur (blockage, hematoma, circulatory disturbance) or when it is no longer needed [14, 16,17,18, 20]. | 4c | A | |
3 | If the aseptic technique for the insertion of an arterial catheter in an emergency is not strictly followed, the catheter should not be indwelled for more than 48Â h [15, 17]. | 3e | B | |
Preparation before removal | 4 | Check the international normalized ratio, partial thromboplastin time, and platelet count before peripheral arterial catheter removal and confirm the use of drugs that interfere with coagulation and platelet function of the patients [13]. | 5b | B |
5 | When the platelet count is < 50 × 109/L, the activated partial thromboplastin time is > 1.3 times the normal value, and/or the international normalized ratio is > 1.8, correction using blood products are recommended to use [24]. | 5b | B | |
6 | Wear sterile gloves and PPE after washing hands before arterial catheter removal [13]. | 5b | B | |
7 | Clean the catheter site with chlorhexidine after removal of the dressing [13, 14, 19]. | 1b | A | |
8 | Flush artery catheter before removal. Pay attention to avoid blood spatter during removal [13]. | 5c | B | |
Removal procedure | 9 | Place a sterile dressing at the site of arterial puncture and compress both the artery and skin puncture sites. Slowly pull out the catheter [13, 14]. | 4b | B |
10 | Simultaneously press the arterial puncture point and skin puncture point during removal to achieve hemostasis by manual compression [13, 14]. | 5c | B | |
Compression time | 11 | Generally, the radial artery should be continuously pressed for 5Â min after removal, and the femoral artery should be pressed for 10Â min after removal [13]. | 5b | B |
12 | If there is blood seepage after the compression time, check again after compressing for 5Â min [13]. | 5b | B | |
13 | If the international normalized ratio, partial thromboplastin time, and platelet count are abnormal, or the patient received antiplatelet therapy, the compression time should be extended by 50–100% [13]. | 5b | B | |
Points after removal | 14 | Check the catheter after removal to ensure integrity. Compress the distal end of the catheter if the catheter breaks [13, 14, 16]. | 5c | B |
15 | In patients with femoral artery puncture catheterization, the hip should not be moved for 2Â h after catheter removal [13, 20]. | 5c | B | |
16 | Patients were told to avoid holding the puncture-side limb forcefully or performing non-invasive blood pressure measurement within 2Â h after removal. Closely observe whether local blood seepage and subcutaneous hematoma were formed [13, 20]. | 5b | B | |
17 | Assess and record the pulse at the puncture site and its distal end after removal. Notify the physician if there is any abnormality [13, 14, 16]. | 4c | B |