Page 375 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

Technical Aspects of Fluid Therapy 365

14. Suture the tape “sandwich” to the skin at points on 4. A facilitation incision is created at the skin insertion
both sides of the catheter within 0.5 cm (0.2 inch) of site with a No. 11 blade. The incision should be no
the penetration site (Figure 15-4, K). wider than the diameter of the catheter. As with
15. Cover the point of insertion with the antiseptic- through-the-needle catheters, the skin insertion site
treated gauze sponge. isasfarawayfromtheveinpenetrationsiteaspractical.
16. Anchor thecatheter withastripofporouswhitetape.If 5. The vein is cannulated with either a guide needle or an
a jugular vein iscannulated, firmly applythe tape to the over-the-needle style catheter supplied with the kit.
base of the needle guard, and then wrap it in a manner 6. A flexible guide wire is threaded through the
that pulls the catheter in a dorsal direction on the ipsi- introducer catheter several inches into the vein,
lateral side to help prevent the catheter from slipping taking care to avoid threading it into the heart
ventrally later (Figure 15-4, L). The goal is to secure (Figure 15-5, A).
the catheter to the skin, not to wrap it on tightly. 7. The guide wire is held stationary, and the introducer
17. Apply layers of cast padding, stretch gauze, and catheter is removed over it (Figure 15-5, B).
elastic bandage material, wrapping up (dorsally) on 8. A vein dilator is threaded over the guide wire into the
the ipsilateral side in the case of a jugular vein cathe- vein (Figure 15-5, C). The dilator tears an opening in
ter. While wrapping the catheter bandage, hold the the vein to the same diameter as the central catheter.
limb or neck in a natural position (partially flexed 9. The vein dilator is removed, and the central venous
limb or nose pointed down) to prevent binding catheter is threaded over the guide wire. Be sure that
(Figure 15-4, M-O). the guide wire protrudes from the Luer fitting at the
18. If the catheter is intended to be positioned into the end of the catheter (Figure 15-5, D).
anterior vena cava or the intrathoracic portion of the 10. The catheter is passed along the guide wire to a depth
caudal vena cava, a lateral thoracic radiograph calculated to place the tip near the right atrium in the
should be obtained to confirm ideal location of the anterior vena cava (Figure 15-5, E).
catheter tip. 11. All air is aspirated from the catheter, and then it is
purged with heparinized saline solution
GUIDEWIRE PLACEMENT OF (Figure 15-5, F).
CENTRAL VENOUS CATHETERS 12. If the catheter is not fully seated, a suture collar is
Materials Needed placed around it and anchored to the skin at the
insertion site (Figure 15-5, G).
1. Commercial guide wire-style central venous catheter
13. The catheter is wrapped as previously described.
(e.g., Arrow Two-Lumen Central Venous Catheteri-
14. A lateral thoracic radiograph should be obtained to
zation Set, Arrow International). Most commercial
confirm ideal location of the catheter.
products are sold as a kit with a sterile drape.
2. Sterile surgical gloves VASCULAR ACCESS
3. 00 or 000 monofilament nylon, needle holders,
suture scissors PROCEDURES
4. 22-gauge needle
These techniques aid catheterization when direct
5. One roll each 1-inch (2.54-cm) waterproof white
percutaneous access is difficult. They are especially helpful
tape and porous white tape
in emergencies when cannulation with a large-gauge
6. One roll each of appropriately sized stretch gauze, 14,32
catheter is required.
cast padding, and adhesive (Elastikon, Johnson &
Johnson) or coadhesive (Vetrap. 3M) wrap PERCUTANEOUS FACILITATION
7. One catheter injection cap, catheter “T” piece, or PROCEDURE
needleless connection device
A facilitation incision is a small cut made just through the
8. Syringe with heparinized saline solution, 1 to
skin at the intended point of entry, directly over or just to
2 U/mL
9. Sterile gauze sponges the side of the vein. This incision is easily made with the
10. Single dose of povidone-iodine ointment bevel edge of an 18-gauge needle or with the tip of a
No. 11 Bard-Parker blade. In the conscious patient, inject
Procedure a lidocaine/bicarbonate 9:1 mixture subcutaneously at
the site at least 2 to 3 minutes before performing the
Many animated and graphical instructional resources for
procedure. Hold the needle (or blade) like a pencil, and
the Seldinger guide wire technique are available on the
incise the skin to the subcutis parallel to, but not directly
Internet.
over, the vein, creating a wound just large enough for the
1. Prepare the skin as described previously.
catheter to pass through. This incision reduces the resis-
2. The catheter set is opened, and sterile gloves are worn.
tance encountered as the catheter traverses the skin and
3. The catheterization site is draped with a sterile field
provides greater control of the venipuncture when
drape.