Page 380 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

370 FLUID THERAPY

water-soluble lubricant, clip the coat, and flush
the lubricant and clipped hair away. Fill the wound
with fresh lubricant, and perform a surgical scrub of
the surrounding skin.
b. Compress the venotomy site with sterile 4 4-inch
gauze sponges, and remove the catheter. Hold
gentle pressure over the area for 2 to 5 minutes;
this usually stops any bleeding unless the wound
in the vessel wall was large.
c. Remove the sponges, and carefully continue to irri-
gate the wound. If the venotomy incision continues
to bleed, partial or complete ligation may be neces-
sary. Once you are satisfied that the wound is clean,
M
close the proximal two thirds to three fourths of the
Figure 15-6 cont'd M, The wound margins are pulled together, skin incision with monofilament nylon suture,
and the entire area is wrapped with waterproof white tape. The tape leaving the distal section free to drain. Cover the
should securely anchor a loop of fluid administration set tubing. wound with a light dressing, and change the
dressing at least daily until healing is advanced,
usually 3 to 5 days.
a. Use the No. 11 blade to create a small venotomy INTRAOSSEOUS VASCULAR ACCESS
incision directly over the distal handle. It helps to
hold the blade upside down for this step as well, This route is useful for emergency administration of
poke it through the superficial vessel wall, and lift fluids, blood products, and drugs to animals with difficult
it up away from the vein as it is advanced (ever so venous access because of vascular collapse or small
22,61
slightly) up the vessel (Figure 15-6, H). size. If a commercial intraosseous needle placement
b. Insert the catheter introducer into the wound, and system (EZ-IO, Vidacare, Shavano Park, Tex.) is not
lift it to expose the vessel lumen. If it does not easily available, venous cutdown is preferred in older and larger
advance to its elbow, you have probably not animals. Intraosseous access may be accomplished by
entered the vessel lumen and are dissecting hand with a needle or bone marrow needle in puppies
perivascular fascia instead. or kittens or with the commercial system, using the
c. Use a large-bore, over-the-needle catheter with the intertrochanteric fossa of the femur, the tibial tuberosity,
needle pulled back from the tip of the catheter so the medial surface of the proximal tibia 1 to 2 cm (0.5 to
3 / 4 inch) distal to the tibial tuberosity or the greater
that the needle tip is not visible. Introduce the cath-
eter into the vessel lumen (Figure 15-6, I), and tubercle of the humerus.
advance it to the level of the proximal forceps han-
dle, at which point it will travel no further because Materials Needed
the vessel bends at a 90-degree angle as it courses 1. One to two milliliters of 2% lidocaine/bicarbonate 9:1
down into the wound (Figure 15-6, J). mixture
d. Remove the catheter introducer; pull the forceps 2. No. 11 Bard-Parker scalpel blade
toward the paw to straighten and stretch the vein; 3. Needle:
and advance the catheter off the needle all the way a. 16- to 20-gauge bone marrow needle (dogs, cats)
to the hub (Figure 15-6 K.). b. 18- to 22-gauge spinal needle (cats, young dogs)
8. Set the needle aside, and connect an intravenous fluid c. 18- to 25-gauge hypodermic needle (neonates of
line directly to the catheter (Figure 15-6, L). Draw the any species)
wound edges together over the catheter, and wrap d. EZ-IO device (Figure 15-7, A and B)
the entire area with white tape to close the wound 4. 12-mL syringe
temporarily, protect it from contamination, and 5. Heparinized saline solution in a 3- to 6-mL syringe
secure the catheter and fluid line to the limb 6. Antiseptic ointment on a sterile gauze sponge
(Figure 15-6, M). 7. Limb stocking, bandaging material if desired
9. When the patient has been stabilized, an elective, ster-
ile catheter should be inserted into a different limb and Procedure for Hand Placement of a Bone
the cut down catheter removed. Marrow Needle
a. Remove the tape, and flush the wound liberally 1. When time permits, clip the site, and prepare it asep-
with a sterile irrigating solution. If the hair coat tically.Intheconsciousanimal,anesthetizetheskinand
was not clipped, fill the wound with sterile periosteum with a lidocaine:bicarbonate 9:1 mixture.