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Haemorrhage following removal of femoral catheters | Signal

Reference number
1293
Issue date29 October 2010
TypeSignal

This Signal is about the risk of haemorrhage following the removal of femoral catheters from adult patients.



An extract from an incident reads:


“Pressure applied for 10min after removing femoral catheter, then dressed and 10min rest . No bleeding so left with husband. In bathroom bled approx 1 pint .”


Femoral catheters are a reliable route of access to the cardiovascular system. They are inserted in aseptic conditions, often in the operating theatre or intensive care unit, by specifically trained individuals. Removing the catheter should be a carefully planned, aseptic procedure associated with minimal blood loss. When the procedure is not performed in a controlled manner with adequate monitoring, excessive bleeding may result.


A trigger incident, where a patient died following elective femoral catheter removal in the evening, prompted a search of the National Reporting and Learning System (NRLS). There were 45 incidents reported related to femoral catheter haemorrhage of which two resulted in death and 15 in moderate harm. A range of themes emerged such as insufficient pressure on the site following catheter removal, catheter removal prior to transfer without informing the receiving team, catheters thought to be venous were in fact arterial and no outward signs of bleeding thus delaying diagnosis (one of these was a death). Other confounding factors were sometimes cited as contributing to the outcome such as heparin infusions, coexisting thrombosis, and catheter removal while on ECMO (Extracorporeal membrane oxygenation) treatment. There were 15 cases of inadvertent removal, often by the patient themselves.


The reports suggest inconsistencies with preparation for catheter removal and aftercare, particularly in relation to recommended duration of pressure, observation and rest. Methods to secure the catheters would also appear to be variable.


Units that use these devices should have access to local guidelines for safe removal and aftercare of femoral catheters (arterial and venous). The procedure should be planned and occur in areas where assistance is readily available and a contingency for excessive bleeding on catheter removal should be in place. 


Please contact us with any information about your initiatives to reduce risks in these areas.


Signals are notifications of key risks emerging from review of serious incidents reported to the NRLS and shared by the NPSA.