Page 2258 - Cote clinical veterinary advisor dogs and cats 4th

Intraosseous Catheter Placement 1123.e3

into the distal cortex because this can block • There should be no outward signs of dis- • Gentle, steady, downward pressure is
flow through the needle. comfort; if there are, nerve damage or other maintained on the EZ-IO driver to keep
VetBooks.ir the stylet is withdrawn. The T-port is filled Automated humeral approach: preventing it from slipping off the bone when
the catheter tip seated on the cortical bone,
complications should be suspected, and the
• When the needle is sufficiently advanced,
spinal needle may need to be withdrawn.
with heparinized saline, fitted onto the spinal
the driver is engaged.
needle hub, and flushed with heparinized
recumbency (the following describes lateral
and with continued downward pressure, the
saline. • Patient is placed in sternal or lateral • The power button on the driver is depressed,
• The spinal needle is sutured in place (to recumbency). catheter is drilled through the cortex and
prevent migration outward) using a Chinese • The catheter is placed between the greater into the medullary cavity.
finger-trap suture pattern. This may be tubercle and deltoid tuberosity on the lateral • A loss of resistance is felt as the catheter tip
further solidified by applying tissue glue to surface of the humerus. enters the medullary cavity.
the suture as it courses over the hub of the ○ The greater tubercle and deltoid tuberos- • After the catheter is firmly seated, the hub of
spinal needle and the T-port. ity of the proximal lateral humerus are the catheter is stabilized with the thumb and
• Cast padding, roll gauze, and bandage identified by palpation. forefinger, and the EZ-IO driver removed
material are rolled around and over the • Time permitting, the overlying skin is clipped from the stylet. The stylet is then removed
needle hub and T-port to protect the needle of hair and aseptically prepped. by unscrewing it from the catheter. Procedures and Techniques
from becoming kinked or damaged with • Infiltrate skin with 0.25-0.5 mL 2% lidocaine. • After ensuring appropriate analgesia/anes-
the animal’s movements. Wooden tongue • Using the scalpel blade, make a small stab thesia, correct placement of the catheter is
depressors or other splint materials can be incision through the skin. confirmed by attaching a 12-mL syringe to
useful for protecting the part of the needle • The EZ-IO catheter is loaded onto the EZ-IO the catheter and aspirating bone marrow
that protrudes from the femur. driver (see first Video). through the catheter (doing so is painful
• The T-port can be connected to an IV fluid • The tip of the catheter is pushed through to an unanesthetized/lightly sedated patient).
set, a blood transfusion set, or other device the small skin incision to the level of the • The T-port is filled with heparinized saline
based on the patient’s needs. periosteum. and fitted onto the catheter hub.

D

A C
E

B
INTRAOSSEOUS CATHETER PLACEMENT Equipment for EZ-IO catheter INTRAOSSEOUS CATHETER PLACEMENT After a lidocaine flush, a 0.9% saline
placement. A, Lidocaine flush. B, Saline flush. C, Low-profile EZ-IO port. D, EZ-IO flush (2-5 mL/kg) is administered through the catheter to facilitate administration
driver. E, EZ-IO catheter with stylet in place. of blood products, other fluids, and medications.

INTRAOSSEOUS CATHETER PLACEMENT The EZ-IO driver with catheter
connected is passed through a small skin incision and pressed firmly against the INTRAOSSEOUS CATHETER PLACEMENT Different views of two 20-gauge,
bone to prevent it from slipping. 2 2 -inch spinal needles used for manual intraosseous catheterization.
1
www.ExpertConsult.com