Page 372 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

362 FLUID THERAPY

and rapid application of a sterile dressing and ban- dry this exposed section with a sterile gauze sponge.
dage provides direct compression and tamponade. Wrap a 2.5- to 5-cm (1 to 2 inches) “butterfly” of
8. Depending on the brand of catheter used, the needle waterproof white tape around the catheter and
is split off the catheter or is covered with a plastic needle guard. This piece of tape should bridge the
needle guard as directed by the manufacturer needle guard and the exposed portion of catheter to
(Figure 15-4, E). where it enters the skin (Figure 15-4, H). Through-
9. Remove the wire stylet (Figure 15-4, F). the-needle cathetersfrequentlyfailbecauseofkinking
10. Attach the “T” piece, injection cap, or needleless con- at the point of exit from the needle guard or the point
nection device to the Luer hub. If using a “T” piece, of entry into the skin. The tape prevents this by
first attach a syringe with heparinized saline solution forming a protective “sandwich” around the
to it, and purge all air from the lumen. If you use an catheter as it exits the needle guard or hub.
injection cap, purge the air from its dead space by 12. Ifthecatheter wastoolong,leaveanappropriatelength
filling it with sterile solution. Attach the device, outside the skin, and incorporate it into a “sandwich”
aspirate any air from the catheter, and confirm catheter of white tape as described previously. If there is suffi-
patency by successful aspiration of blood. Purge the cient length, it may be coiled into a loop that is
catheter with the solution (Figure 15-4, G). completely encased between the two layers of tape.
11. If the catheter was inserted completely, withdraw it 13. Dry the Luer connection at the junction of the nee-
1 to 2 cm (0.5 to 0.75 inch) from the skin, and dle and catheter hubs with a sterile gauze sponge,

A B

C D

Figure 15-4 Procedure for jugular vein catheterization using a 19-gauge, 20-cm (8-inch) Intracath (Becton
Dickenson). A, Proper positioning in sternal recumbency, with the nose and rear legs directed away
from the side to be catheterized. B, Following blockade with a 9:1 mixture of lidocaine/bicarbonate and
sterile prep, a facilitation incision is made in the skin lateral and cranial to the point of entry into the vein.
C, The device is grasped firmly at the hub of the needle, and the skin wound is penetrated with the bevel of
the needle facing away from the neck. The needle is advanced subcutaneously parallel to the vein and with
the bevel oriented away from the neck for at least 0.75 inch (2 cm) before introduction into the vein.
D, Penetration of the vein is often heralded by a distinct pop as the needle punctures the tough wall of the
vessel. A flashback of blood entering the catheter (arrow) is often seen. Note that the needle has been
advanced subcutaneously nearly to the hub before venipuncture.