Intravenous Catheters Reading Assignment: CTVT pages 591-596 & 887-891

Vocabulary Words Patent Lumen Injection port Osmolality OTN / TTN/ CLC Thrombosis Stylet Erythema Flash Chamber Chlorhexidine scrub Aseptic technique Phlebitis

Catheter Placement Sites Peripheral Vein Catheterization Cephalic, Medial Saphenous, Lateral Saphenous Usually OTN Cheap, simple and quick to place Central Vein Catheterization (CLC) Catheter placed into the jugular vein or femoral vein TTN (jugular only) or Wire-guided Multi-lumen options Expensive, more complicated to place, most invasive to patient

Indications for an IV Catheter Fluid therapy Replacement fluids To correct _______________ To correct ___________imbalances Daily maintenance fluids Fluids given during surgery Medication administration Repeated doses over an extended period of time Quick access for critical/unstable patients CRIs (fluids + medication) Pain management and/or anesthesia

Indications for a Central Venous Catheter _______________ drugs can be given simultaneously Repeated blood collection TPN CVP monitoring Note: IA catheters can be placed to directly monitor a patient’s blood pressure

Central Line Catheter Jugular is most common location Animal is generally critically ill or sedated Usually is multi-lumen

CLC Placement Placed using the Placed using the Seldinger technique Placement requires extra supplies: Sterile gloves Sterile drape Suture supplies https://www.youtube.com/watch?v=RGXP-FSjih8

Parts of the OTN Catheter

IV Catheter Gauges Always use the largest gauge catheter the patient can comfortably accommodate!

IV Catheter Supplies For each item, please know what it will be used for. Clippers with a 40 blade Antiseptic scrub (chlorhexidine scrub & alcohol) Appropriately sized catheter Syringe filled with (heparinized) saline flush Injection port or T port White Tape (Zonus porus) Vet Wrap *Sterile gloves, suture supplies, sterile drape

Prior to retrieving patient: Gather your supplies Plug in clippers and test blade Loosen your catheter parts, break the seal on the port ALL PARTS MUST REMAIN STERILE May or may not place with the plug attached Flush your t-port if using one Why? Prepare your tape Two thin, one large with slit, one large no slit

Prep the Site Shave all the way around the leg on the most _________ aspect the vein is accessible. Avoid clipper burn Make edges neat! Find the vein and remember where it is 3. Apply a “dirty” antiseptic scrub This involves one chlorhexidine scrub gauze & one alcohol gauze Purpose of this is to:

Aseptic Technique 4. Begin aseptic technique scrub Alternate chlorhexidine and alcohol soaked gauze x 3 (6 pieces total) The gauze/cotton is placed over the insertion site and then directed away from the insertion point Gauze should not touch hair You do not go over tissue twice with the same gauze What is happening if you do? Once your site is prepared you MAY NOT TOUCH IT AGAIN!

Catheter Placement With the bevel up, place the stylet/catheter into the vein (stay parallel to vein) while watching the flash chamber. The bevel should be visible past the catheter These two pieces move as a single unit until in the vessel Once you have obtained a flash, you then, very steadily, advance the catheter off of the stylet and feed it completely into the vein. This is done with your ____________ finger. The stylet DOES NOT move during this process Purpose of the stylet:

Notes About Placement It is sometimes necessary to advance the stylet and the catheter a little further into the vein (after you have a flash) before advancing. This is only if the catheter needs more stability Must stay parallel to the limb! The step of advancing the catheter takes a lot of practice to make perfect. If redirections are required: must move stylet and catheter TOGETHER as one Facilitative incision may be required When?

Continue Placement Once you have the hub of the catheter up to the skin, ASK THE RESTRAINER TO STOP OCCLUDING Remove the stylet What do you think will happen once you do this? How can you/restrainer prevent that from happening? Never place your thumb/finger over the open hub This can cause bacteria to go directly into the animal’s vein! Place the injection port or T-port onto the catheter Restrainer should release pressure now, but hold the limb

Secure in Place 1. Using one of your ½ inch tape strips, place it STICKY SIDE _____, underneath the hub of the catheter Tape should go all the way up to the skin Make a short side and a long side Flip the short side over the hub and then the long side back over the short side Wrap around the patient’s limb at least ___________. “pinch pinch pinch” 2. Using the 1 inch piece with the slit, sticky side ________, place the slit under the hub, all the way up to the skin and wrap around the limb at least twice.

Checking Patency Now the catheter is secure Flush the catheter to determine patency Sterile saline or ______________ sterile saline Technically this may be done at any point that you feel the catheter is secure But don’t wait too long! What should you do if the fluid forms a SQ bubble?

Continue to Secure 3. Using a ½ inch strip, sticky side _______, secure the port onto the catheter Go under the port leaving a short tab and a long side Wrap the short side around the port Wrap the long side towards the other direction around the port and then around the limb at least twice Pinch pinch pinch 4. The fourth piece of tape (1 inch) is used sticky side _______ and goes around limb once Covers the entire area and used to record information: 5. Lastly place a piece of VetWrap (with a small hole in it for the port) over the whole set up to ensure cleanliness

Maintenance Patients with an indwelling catheter that are not receiving fluids: Must flush catheter every ___________ to check patency All catheters should be constantly monitored for any signs of infection: Erythema Swelling Tenderness upon palpation Site is hot to the touch Purulent discharge Increased body temperature Lethargy, change in vitals

Complications Remove bandaging at least once every 24 hours to check for phlebitis or these other complications: Swelling above site: Swelling below site: Catheter lumen visible: Thrombosis- Bandaging must be removed immediately and replaced if it becomes soiled or wet Regardless of if there are complications or not, all peripheral IV catheters should be changed q __________.

Additional Information For a quick reference to the information presented, please see pages 498-501 in your DRG.