This chapter describes the basic principles to be followed when the removal of a medical device is contemplated. The use of medical devices of increasing levels of complexity and with a range of exposure to nonsterile areas or exit sites has risen exponentially in the past several decades. Regardless of site, infection remains the major complicating factor in medical device usage. While scrupulously introduced, totally implanted devices are less prone to infection, when infection occurs, it has much more serious repercussions. The authors correctly advise that the decision to remove a device must be balanced with the effect of its loss on the health of the patient, but the golden rule remains “If in doubt, take it out.”