Page 2261 - Cote clinical veterinary advisor dogs and cats 4th

1123.e6 Intravenous Catheter Placement

Preparation: Important in the skin using a 20-gauge needle to • When you are satisfied that the catheter is
Checkpoints ease insertion of the catheter without it placed correctly, tape the catheter and T-port
securely as preferred.
crimping.
VetBooks.ir can be torn lengthwise to create a thin strip ○ For severely dehydrated animals or in ○ Some clinicians apply a dab of antimicro-
• Precut tape to desired lengths; medical tape
an emergency when the vessel cannot be
bial ointment over the catheter insertion
for initial wrap.
• Flush T-port with saline for indwelling
of gauze.
may be necessary.
catheter. located, a cut-down using a scalpel blade site, covering this with a very small piece
• Determine site of catheter placement. • Hold the stylet as still as possible while ○ It is helpful to place a strip of tape under
○ Most common sites are the cephalic advancing the catheter over the needle an the catheter hub and T-port as well as over
vein (dog or cat; often preferred site) or additional 1-3 mm into the vessel. You the hub.
saphenous vein (dogs lateral; cats medial) should see blood filling the catheter. • Cast padding, rolled gauze, and Vetrap may
○ Alternate sites: accessory cephalic vein ○ If blood is not visible in the catheter, you be placed over long-term catheters. Be careful
(distal to the carpus), dorsal common may have gone through to the other side that the wrap is not overly tight so that
digital vein (over the metatarsals), or of the vein. circulation to the lower limb is maintained.
auricular veins ○ Back up slightly, and redirect until blood
○ Jugular veins provide central access, as flow occurs again, demonstrating that the Postprocedure
do femoral veins when long catheters are catheter is in the vein. • Unless the patient can be watched constantly,
used. ○ After confirming continued blood flow, place an Elizabethan collar to prevent it from
• Determine the type and size of the catheter advance catheter to hub. chewing at the catheter.
required. Larger-bore catheters allow more • After the catheter is inserted, release pressure • If not in constant use for administration of
rapid infusion of fluids, but smaller catheters on the vessel (loosen the tourniquet or have IV fluids, flush the catheter with pulses of
cause less trauma/damage to veins. the assistant release pressure on the vessel). 0.9% NaCl every 4-6 hours.
○ Over-the-needle catheters used most often; If there is a lot of blood flow through the • Check for tightness of tape, and monitor
these can stay in place for several days catheter, the assistant can place the thumb the foot/limb for inflammation, pain, heat,
with care. on the skin over the length of the catheter or signs of infection. Replace if any sign of
○ Butterfly catheters are best used for imme- to momentarily slow/stop blood flow while infection or inflammation is identified.
diate, short-term infusion of nonirritating the T-port is attached. • Replace catheter if becomes soiled, loses
medications or fluids, or collection of • Attach the preflushed T-port to the catheter patency, or if patient is uncomfortable
blood samples hub, which stops the flow of blood. when flushing, or approximately every
• Quickly secure the catheter with a skinny 3 days.
Possible Complications and piece of tape. The tape is wrapped around
Common Errors to Avoid the catheter hub first and then wrapped Alternatives and Their
• Phlebitis circumferentially around the extremity to Relative Merits
• Thrombosis loosely anchor it in place. • Jugular catheter or long femoral catheter:
• Embolism • Before further taping/wrapping of the useful for hospitalized patients that require
• Systemic or catheter site sepsis; bandage, catheter, check its placement. Attach a frequent blood sampling, the administration
check site daily, change catheter q 3 days syringe of 0.9% NaCl flush to the T-port. of multiple fluid types, or administration of
○ Avoid saphenous catheter for patient with While palpating the vessel above the catheter, hyperosmolar fluids (e.g., parenteral nutri-
diarrhea. administer small pulses of flush. You should tion). May require sedation for placement
• Bleeding be able to feel the pulsations in the vessel, and costs more. Contraindicated for patients
• Overly tight wrap → edema distal to site. and the saline should flow very easily. with coagulopathies.
• Positional occlusion; avoid having catheter
end near elbow/stifle
• Displacement or misplacement of catheter;
check placement/flow before use, especially
for infusion of irritating drugs
Procedure
• Gather supplies and precut tape in accordance
to limb circumference.
• Clip the fur over placement site.
○ Especially if patient has long hair, clipping
the entire limb circumference helps tape
stick and makes it easier to remove when
ready.
• Perform aseptic scrub over placement site.
• With an assistant or tourniquet occluding the
vessel, hold the limb with your nondominant
hand, and place your thumb parallel to the
vessel.
○ When the assistant is occluding the
cephalic vein, gentle pressure with a twist
of the thumb is adequate.
• Insert the catheter with needle bevel facing
up into the vessel, and advance until a flash
is seen in the hub.
○ For tomcats or other animals with tough INTRAVENOUS CATHETER PLACEMENT. Supplies used for placement of a typical over-the-needle peripheral
skin, it may be helpful to create a nick catheter, including precut strips of tape of varying widths to anchor catheter in place.

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