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Jugular Catheter Placement and Management 1123

30 seconds/10 breaths at a time. This may • Remove the lid, and attach MDI to the bronchodilators are indicated in a fractious
animal or in an animal resistant to restraint.
take a few weeks. spacer/chamber with an appropriately sized • Nebulization does not offer superior drug
VetBooks.ir Possible Complications and • Position the animal for gentle restraint to administration compared with a face mask
face mask attached to the other end.
Common Errors to Avoid
prevent side-to-side movement.
and spacer MDI combination but allows
• Some animals initially hold their breath; wait
ensuring a snug fit covering the nose and
istered as an inhalant. Examples include
for 7-10 breaths for treatment • Gently apply the mask to the animal’s face, drugs unavailable as an MDI to be admin-
• Infection associated with inhaled glucocor- corners of the mouth but not covering the antibiotics, lidocaine, and saline.
ticoid use eyes.
○ Oral candidiasis, reported in humans, has • Depress inhaler (actuate the MDI). Pearls
not been reported in pets. • Hold mask in place for 5-10 breaths (20-30 • Use oral glucocorticoids for first 1-2 weeks
○ Facial dermatophytosis in the area of the seconds), watching chest wall movements, concurrently with inhaled glucocorticoids
mask can occur. one-way valve in spacer, or counting con- in acute inflammatory conditions, and then
• Some animals cough after receiving treat- densations of breath in the spacer. taper oral medications.
ment; this is often self-resolving. • If a second dose is needed, wait 30-60 seconds • If an animal is intolerant to the sound of the
• Rarely, a mild contact dermatitis can form in between, and repeat the procedure. actuated MDI, actuate the MDI, and then Procedures and Procedures and Techniques Techniques
where the face mask contacts the face. It is place the mask on the face. This will reduce
minimized by wiping the face mask edge Postprocedure the administered dose by approximately
after each use. • Wipe patient’s face/muzzle with a paper towel one-half.
• Untrained, struggling animals can injure their or washcloth. • The manufacturers of veterinary aerosol
eyes on the edge of the face mask. • Maintain cleanliness of MDI and spacer delivery devices offer excellent client tutorial
• Pet owners can be injured if treating following manufacturer’s recommendations; information, including video clips, on their
untrained pets. clean before first use and weekly. websites (e.g., https://www.trudellmed.com/
• Cats with severe bronchoconstriction can • If the MDI does not have a built-in dose trudell-animal-health).
benefit from aerosolized bronchodilators even countdown feature, record number of doses • Chronic, frequent use of racemic albuterol
if administration requires very brief restraint/ used per canister to know when to refill bronchodilators in asthma can be dangerous
stress. medication. Number of doses per canister and should be avoided (p. 84).
• Many topical treatments for human airway is on the packaging. A myth that a float
disease are not in the format of a self- test to determine medication remaining in SUGGESTED READING
propelled MDI. These medications (e.g., a canister is inaccurate and may damage the Feline Asthma: Inhaled medications (website). http://
dry-powder inhalers) cannot be adapted canister. www.fritzthebrave.com/meds/inhaled.html/.
to use in a pet animal. Be sure the drug
formulation prescribed is in the form of an Alternatives and Their AUTHOR: Christine Savidge, DVM, DACVIM
EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
MDI that can fit the spacer device. Relative Merits Thompson, DVM, DABVP
• Medication administered by another route,
Procedure especially when acute antiinflammatory prop-
• Vigorously shake MDI 3-5 times (approx. erties are needed. Inhaled glucocorticoids can
5 seconds). take 7-10 days to reach full effect. Parenteral

Jugular Catheter Placement and Management Bonus Material
Online

Difficulty level: ♦♦ • Infusion of fluids that have a high osmolality • In animals that would not lie still for the
(e.g., > 7.5% dextrose solutions, parenteral procedure, consider the following sedatives,
Synonym nutrition) depending on the animal’s clinical condition
Central line • Longer use of a single catheter for prolonged and temperament: butorphanol 0.2-0.4 mg/kg
hospitalization. A jugular catheter typically IV/IM, midazolam or diazepam 0.2-0.5 mg/
Overview and Goal eliminates the need to replace multiple kg IV. Both of these drugs may be given
Jugular catheterization provides venous access peripheral catheters. individually or combined for better effect.
for a critically ill patient that allows for needle- Avoid benzodiazepines in animals that are
less sampling and longer use of a single catheter Contraindications agitated or fractious. Dexmedetomidine
for prolonged hospitalization. • Coagulopathy or severe thrombocytopenia 1-5 mcg/kg IV may be used in stable
• Increased intracranial pressures (e.g., trau- clinical patients. Dexmedetomidine may
Indications matic brain injury) make visualization of the vessel difficult due to
• Needleless, simple blood sampling; especially • Pyoderma or inflammation of the skin over vasoconstriction.
useful when frequent sampling required (e.g., the neck and jugular vein • Clippers, surgical scrub with gauze for aseptic
patients with diabetes ketoacidosis) or when • Caution in hypercoagulable states (e.g., hyper- preparation of insertion site
sampling is difficult adrenocorticism, protein-losing nephropathy, • Injectable lidocaine
• Measurement of central venous pressure immune-mediated hemolytic anemia) as • A #11 or #15 scalpel
(CVP) in hypovolemic patients or fluid- thrombosis may occur • Sterile surgical gloves
intolerant patients • Sterile drape
• Infusion of multiple fluids concurrently, Equipment, Anesthesia • Suture material
facilitated by catheters with multiple • Sedation is often not required in critically • 0.9% NaCl flush (may contain heparin)
lumens ill animals. • Bandaging material

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