Page 2265 - Cote clinical veterinary advisor dogs and cats 4th

1124 Jugular Catheter Placement and Management

• Electrocardiogram (ECG) machine for • OPTIONAL: infuse lidocaine aseptically into on attached syringe to ensure blood flows
monitoring subcutaneous region around insertion site though catheter easily, flush catheter, and
VetBooks.ir and Arrow) using the Seldinger technique. dogs). Do not exceed 4 mg/kg in dogs. It • Cover insertion site with an adhesive or
secure jugular catheter using sutures.
• Central line kit (MILA International; Cook
(0.1-0.5 mL should be sufficient for most
is best to avoid lidocaine in cats due to risk
nonadhesive dressing, and then apply loose
The kit usually includes an introducer cath-
of toxicity.
bandage.
eter (or needle), guide wire, dilator, and the
central catheter. Some kits may also include • Using sterile technique and a tape measure, • Obtain thoracic radiographs to evaluate for
scrub solution, scalpel, suture, and injectable have assistant measure from the insertion correct positioning of catheter. The tip of
lidocaine. site to the 2nd-3rd intercostal space. the jugular catheter should be in the cranial
○ A through-the-needle central line kit • Aseptically flush all lumens of the jugular vena cava, just before the right atrium. If the
may be used instead of the Seldinger catheter, and clamp off tubing after flushing. catheter is in the heart, it should be backed
technique kit. This chapter presents only • While assistant is holding off jugular vein out to the ideal position.
the Seldinger technique. around the thoracic inlet, place large-bore
over-the-needle catheter (or needle, depend- Postprocedure
Anticipated Time ing on what comes in the kit) into jugular • Monitor catheter insertion site daily for
30-60 minutes vein with tip pointing toward the heart. phlebitis, infection, or catheter backing out.
Feed catheter over the stylet into the vein. • Avoid neck leashes while jugular catheter is
Preparation: Important In thick-skinned animals, you may need to in place to prevent inadvertent removal.
Checkpoints insert catheter in skin first before inserting it • Flush unused lumens with 0.9% NaCl or
• Assess platelet count, and if concern exists, into the vein. Note that introducer catheter heparinized 0.9% NaCl every 4-6 hours.
coagulation profile before catheterization may also be inserted after a mini or surgical • Use three-syringe technique for blood draws.
• Ensure all equipment needed is available, and cut-down procedure. ○ Use a first syringe to evacuate a small
have one or (ideally) two assistants available. • Insert the J end of the guide wire into the volume of blood; this is discarded.
• Assess the patient’s requirement for sedation catheter. To accomplish this, the guide wire ○ Attach a second syringe to collect blood
and have sedatives on hand if needed. is retracted into the plastic end of the sheath. for sampling.
The plastic end is then inserted into the end ○ Use a third syringe filled with 0.9% saline
Possible Complications and of the catheter, and the guide wire advanced or heparinized saline solution to flush all
Common Errors to Avoid through the catheter into the vein for about blood from the catheter lumen.
• Correct hypovolemia before placing catheter. 4-15 cm, depending on the size of the dog. • Remove jugular catheter as soon as it is no
• Ventricular arrhythmias may develop during Watch ECG for ventricular arrhythmias longer needed.
placement but are usually self-limiting. during guide wire placement, and gently • Monitor patient for development of throm-
• Although rare, hemorrhage or pneumome- retract guide wire a few centimeters if bosis associated with the jugular catheter
diastinum may develop, especially if catheter arrhythmias are seen. (e.g., edema of the head).
perforates through jugular vein. • Remove the over-the-needle catheter, and • Ideally, patient should be monitored 24
• Infection and thrombosis are possible delayed ensure that the guide wire does not back hours/day to avoid bleeding if catheter is
complications. out or touch a nonsterile field. Ensure that accidentally removed.
the guide wire is always held on to during
Procedure placement so that it does not inadvertently Alternatives and Their
• Administer sedation if needed; often not migrate completely into the jugular vein. Relative Merits
required in critically ill animals. • Insert plastic dilator into the vessel by placing • A central line can be placed in the lateral
• Place animal in lateral recumbency (or dorsal the guide wire through it and guiding it or medial saphenous vein extending to the
recumbency in heavily sedated animals). into the vessel. Passage of the dilator may caudal vena cava.
• Shave wide area centered on jugular furrow, be facilitated by tenting the skin and gently • A peripherally inserted central line (PICC)
extending up to the ventral midline of the rotating the dilator into the vessel. A cut may be easier to place in animals that do not
neck ventrally and dorsally. Shave cranially into the skin with a #11 scalpel blade next tolerate placement of a jugular catheter and
to the mandible and caudally to just before to the wire may ease insertion. may be safer if thrombocytopenia is present.
the thoracic inlet. • Insert approximately one-half of the length
• Wearing exam gloves, perform surgical scrub of the dilator into the vessel, hold for a few SUGGESTED READING
and preparation of shaved area, focusing seconds, and remove dilator from the guide Campbell M, et al: Catheterization off the venous
around the jugular vein. wire. Expect bleeding from the insertion site, compartment. In Creedon JM, et al, editors:
• Perform hand hygiene, and don sterile and use sterile gauze to apply pressure if Advanced monitoring and procedures for small
gloves needed. animal emergency and critical care, ed 1, West
• Have assistant stand behind the animal, • Insert the jugular catheter over the guide wire Sussex, UK, 2012, Wiley.
with the spine facing the assistant. Have and guide it into the vessel to predetermined AUTHOR: Adesola Odunayo, DVM, MS, DACVECC
assistant hold the head of the animal, keeping length (see above). Ensure the end of the EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
it straight with one hand, while the other wire is projecting out of the distal end of the Thompson, DVM, DABVP
hand occludes the jugular vein outside the catheter before advancement of the catheter
sterile field. into the vein. The wire should be held as
• Drape the area around the insertion site, the catheter is advanced into the vessel.
which is usually around the proximal one- • Remove guide wire after catheter is at
third of the jugular vein. desired length in the jugular vein. Pull back

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