Page 386 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

376 FLUID THERAPY

A B

C
Figure 15-9 Catheter-related thrombosis. A, A 19-gauge through-the-needle style central catheter was
placed too deeply into the external jugular vein of this patient and terminates within the right atrium (arrow).
B, Contact damage to the right atrial wall has resulted in cellular proliferation on the endothelial surface
(arrows). C, A large catheter-associated thrombus was stripped off of the catheter during removal and
immediately killed the patient. The thrombus obstructs the main pulmonary artery (arrow).

connection, 16,39,69 and the hands of nursing staff. 57 small (1 to 5 mm) diameter zone of inflammation
In addition, the catheter may be colonized by blood- surrounding the skin puncture site, and inflammation
borne bacteria originating from remote locations. In extending beyond this range is suspect. 32 Systemic signs
humans receiving intravenous fluid therapy, infection including fever and leukocytosis may develop in bacter-
arising from contamination of the catheter hub and fluid emic animals. Some may develop organ infection at
administration set connections is comparatively less likely remote sites (endocarditis, abscessation), and some
if sterile technique is strictly followed. 9 Veterinary develop sepsis syndrome. 6 However, other animals
patients that chew, disconnect, and defecate on their develop catheter-related bacteremia with minimal clinical
administration sets are probably at higher risk for this signs. Catheter infection should always be suspected in
source of contamination. The prevalence of positive bac- animals developing clinical evidence of infection while
teriologic cultures from catheters at the time of removal an indwelling catheter is present. If catheter infection is
ranged from 10.7% to 26% in four small surveys of veteri- suspected, the catheter should be removed immediately.
nary patients. 6,40,47,48 Signs of infection may be identical Bacteriologic culture of the catheter tip assists in the
to those of sterile thrombophlebitis. There is normally a diagnosis of catheter infection. Before removal, the skin