Continue Chapter 3 Diagnostic Sampling and Therapeutic Techniques (pgs Continue Chapter 3 Diagnostic Sampling and Therapeutic Techniques (pgs. 105-110, 574) Read pgs. 91-118 Catheters

Intravenous Catheter Placement When intravenous fluids or drugs must be infused in large volumes, repeatedly, or continuously, a catheter is placed in the cephalic, jugular or saphenous vein. Be familiar with catheter selection, placement, and maintenance.

Four Types of Catheters Utilized Butterfly catheter-temporary catheter Indwelling Catheters: OTN catheter=Over the needle catheter TTN catheter=Through the needle catheter Single-lumen and Multi-lumen guide-wire catheter (Detailed placement instructions come from the manufacturer for these type of catheters)

Butterfly catheters = short term administration of drugs over a few minutes or to obtain blood samples. This type of catheter usually takes less time to place compared to other traditional catheters.

Butterfly Catheters Used to administer small volumes of fluid Used to obtain small volumes of blood from critical care patients, sometimes used as a last resort Not left indwelling for longer than a few minutes

Indwelling Catheters Use aseptic technique to minimize subsequent thrombus formation, phlebitis, and infection. Now you can shave the fur! The skin surface is cleansed a minimum of 3 minutes with an antimicrobial scrub and alcohol. Ideally, the skin should be in contact with the antimicrobial solution for 2 minutes. If it is necessary to palpate the cleansed skin area to identify the vein, the area should be rescrubbed or you must wear gloves. However, you will undoubtedly either touch the area yourself or see someone do it.

OVER THE NEEDLE CATHETERS Come in various lengths and gauge sizes just like needles.

Catheter Flushing Heparinized Saline Solution (1 unit of heparin per milliliter of 0.9% saline solution) Flush the catheter prior to inserting into the animal. After insertion, verified placement by flushing the catheter prior to securing onto the leg. Flushing helps to prevent blood clots within the catheter lumen.

Heparin Sodium Flush Per Your CTVT book: Add 1 unit of Heparin to 1 ml of 0.9% NaCl to make heparin sodium flush Heparin Sodium comes in various quantities and units. Please read the bottle carefully and ask questions if you are in doubt of the amounts involved. 1000ml bag of Saline 0.9% (0.001 x 1000 ml = 1 ml of heparin needed to add to the 1 liter bag.

There are several variations of Heparin.

OVER THE NEEDLE CATHETERS Without the protective covering

CATHETER COMPONENTS (Handout) CATHETER CASING CATHETER CAP OR INJECTION PLUG STYLET

Gather your supplies Appropriate catheter Antimicrobial scrub 3. Alcohol Gauze sponges Heparinized flush Syringes Needles* Injection cap/plug Clippers Bandage tape Bandage scissors* Vet wrap*

Please read in your CTVT book pg. 106

INSERTING THE CATHETER

                                                                                                                                                                                                Puncture the skin and vein in one swift movement. If you are too gentle, the vein moves away from the catheter. Once the vein is punctured, blood will flow through the needle that is inside the catheter and into the hub.

CAP

Injection Plugs (Caps)

This is another technique used to anchor the catheter in place.

Fluid Accumulation This patient’s cephalic catheter was not properly positioned within the vein during intravenous fluid administration. Fluid accumulated in the subcutaneous tissue proximal to the catheter site and resulted in swelling of the left front leg and pectoral region.

Tada! The finished product of all your hard work.

Removing the Catheter Antibiotic ointment treated gauze sponge is applied over the catheter entry site. Remove vetwrap/tape first, then gently pull out the catheter. You may need to apply digital pressure to the site if it begins to bleed with a gauze sponge. Secure the gauze sponge with vet wrap to the leg. If you do not have vet wrap, you may use bandaging tape. This may be left on the animal for an hour or longer if it warrants it, (not days! And in inform the owner of this please). Supplies needed Antibiotic ointment Gauze sponge Vetwrap Bandage scissors Hydrogen peroxide

Jugular Vein Catheterization Catheter size required depends on the size of the animal. Sterile gloves should be worn when placing a TTN catheter. Position: lateral recumbency Word to the wise: when walking dogs with jugular catheters always walk them on a harness or loop the leash behind one or both front legs.

Jugular Vein Catheterization-Indications Large volume of crystalloid or colloid fluid infusion (IV fluid administration) Continuous drug infusion (long term) Repeated blood sample collection Infusion of parental nutrition (TPN) or other hyperosmolar substances Central venous pressure measurement

Venocath-18g The TTN catheter is also utilized for long Saphenous/femoral vein catheterization.

A jugular catheter placed in the medial saphenous vein will have its tip in the posterior vena cava. Such catheters can be used for repetitive blood sampling. Because the tip of the catheter is in a large vein, hypertonic solutions such as hypertonic dextrose and total parenteral nutrition (TPN) solutions can be administered through catheters in this location. Note the bruising around the needle puncture site. This may occur when placing a through-the-needle catheter. The hole in the vein created by the needle is larger than the diameter of the catheter so when the needle is retracted from the vein, blood may leak from the puncture site into surrounding tissues.

When not to use the Jugular vein for catheterization Jugular vein is inaccessible Patient is vomiting Patient has some sort of neck injury/disease

When not to use the Saphenous vein for catheterization Animals that cannot stand to void Animals with severe diarrhea If the catheter should get wet or soiled, it must be rewrapped or possibly replaced.

Intravenous Catheter Maintenance Catheters should be inspected every few hours and not left in place for more than 72 hours. (Exception: Jugular catheter) Check the catheter site for pain, redness, swelling, and discharge. If any of these are present, replace the catheter. Flush venous catheters every 4 to 6 hours with heparinized saline solution. If a patient is on a continuous infusion of fluids the catheter should be flushed every 8 to 12 hours. Catheters should be check for patency before medication is injected and should be flushed with heparinized saline solution after drug administration. Make sure that the drug you are giving does not precipitate with heparin.

Catheter Trouble-shooting If a catheter can not be flushed without resistance or if blood cannot be aspirated back into the syringe, the catheter may be bent, occluded with a blood clot, extra vascular or the catheter cap may be loose. Can you correct these issues

Arterial Catheter Placement Useful in nonambulatory, critically ill, small animal patients. Very commonly utilized in horses as well. Indications: measurement of direct arterial blood pressure (invasive) and to obtain blood samples for blood gas analyses (assessment of ventilation and oxygenation in cases with pulmonary compromise). Contraindications: NEVER to be used for blood sample, drug, or fluid infusion. Common sites: dorsal pedal, femoral, coccygeal, and auricular arteries

Necessary Supplies

Clip and aseptically scrub over the site of proposed arterial catheter placement.

Intraperitoneal Administration Placement of substances in the abdominal cavity. Blood products, noncaustic fluids, or medications Faster than SQ, but slower than IV or IO Lavage the abdomen of animals with peritonitis, pancreatitis, hypothermia or hyperthermia

Nasoesophageal and Nasogastric tubes Do not use in patients that are vomiting or that do not have a gag reflex! Easy to place and cheap for the clients Short term force feeding Radiography evaluates placement Technicians place these, sutures and all!

Thoracocentesis Where is the thorax located? Hint: it contains the heart and lungs. The process of removing accumulated air or fluid from within the pleural space (space between the lungs and the chest wall). When air or fluid fills the pleural space the lungs are unable to fully expand and the animal is unable to breath properly. Visible signs: rapid and difficult breathing.

The End