Page 2288 - Cote clinical veterinary advisor dogs and cats 4th

Nasal Infusion of Clotrimazole 1134.e7

Nasal hydropulsion (front to back only):
• Patient is anesthetized and intubated, and
VetBooks.ir • Tip of 20-mL (cats or small dog) to 60-mL
the oropharynx is packed with lap pad (as
above).
syringe of saline for irrigation is placed just
inside the nares.
• Both nares are occluded, and the syringe is
forcefully and quickly emptied to aggressively
flush (hydropulse) the nasal passage.
• Procedure can be repeated 1-3 times on same
or opposite side.
• Drain nasal passages, and suction orophar-
ynx before allowing recovery as previously
described. Procedures and
Postprocedure Techniques
Allow patient to recover quietly and be alert
for excessive bleeding (rare). If bleeding occurs,
NASAL FLUSH Nasal hydropulsion is a simple method of flushing from front to back to dislodge mucus,
tumor cells, or foreign bodies. an ice pack on the muzzle is helpful.
Alternatives and Their
Relative Merits
• Attach a 60-mL syringe of ice-cold saline Flush direction can be reversed by simply
to the catheter end of one of the red attaching the syringe to the other red rubber • See nasal discharge (p. 678) and sneezing
rubber tubes. The author’s preference is tube. (p. 925) for diagnostic test options.
to begin flushing from back to front and • For animals with bilateral disease, cut the • Nasal FBs can sometimes be removed with
attach a syringe to the catheter in the suture just behind the knot, and pull the alligator forceps or during rhinoscopy.
mouth. tubes out. Repeat entire process on the other • Tumors can be biopsied by a blind or rhino-
• Apply firm pressure to the syringe plunger side. By having originally tied a loose knot scopically directed method or by rhinotomy.
to flush as an assistant pulls the other tube with a loop, for the second side, you can Pearls
(flushing while the tube moves through the skip having to place the needle in the tube,
nasal passages). If the syringe is attached to and simply tie the suture to the loop. • The long, loose suture end often catches
the mouth tube, pull the nasal tube until • When finished, cut the suture, and remove plant material and drags it through the
the tip of the mouth tube and the excess both tubes. nostril while the tube is being flushed. The
suture material are out of the nostril (you • Remove lap sponge from the oropharynx loose knot should be pulled all the way out
should be squirting saline out of the dog’s while carefully examining it for dislodged of the nostril.
nose). The loose suture end often catches tissue or FB; remove tape from forehead after • Bleeding tends to be minimal compared to
on plant material FBs and pulls them out lap sponge is out. traditional biopsy methods.
of the nose. • Allow patient to drain fluid from the nose AUTHOR: Matthew Haight, CVT
• Back the tube up, and repeat process as for a few minutes, and suction the oral cavity EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
needed (i.e., FB or tissue is dislodged, or until before recovery. Extubate with the cuff at Thompson, DVM, DABVP
thick mucus has been completely evacuated). least partially inflated.

Nasal Infusion of Clotrimazole

Difficulty level: ♦♦ findings suggesting fungal rhinitis (e.g., (sinusotomy) removal of bulky disease,
turbinate loss, fungal granulomas). followed by topical clotrimazole, should be
Overview and Goal considered.
Intranasal infusion of clotrimazole is a minimally Contraindications
invasive technique for treating confirmed nasal • Cribriform plate erosion/damage secondary Equipment, Anesthesia
aspergillosis in dogs. Treatment is performed for to fungal rhinitis. If CT scanning of the • General anesthesia is required.
1 hour. Resolution of clinical signs is achieved cribriform plate is not available, owners • A cuffed endotracheal tube (mandatory)
in one-half to two-thirds of dogs with fungal should be warned that cribriform integrity • Two 12-Fr Foley catheters, one 24-Fr Foley
rhinitis after a single treatment. has not been assessed. Topical therapy in catheter, and two 10-Fr polypropylene or
animals with known cribriform damage may red rubber catheters
Indications increase risk of adverse reaction. • Laparotomy sponges
• Dogs with confirmed nasal aspergillosis • Bulky fungal granulomas within the frontal • Two 60-mL syringes, one 12-mL syringe
• Confirmation requires histopathologic confir- sinus: massive fungal disease within the • One pack of 3-0 nylon suture
mation of fungal hyphae in nasal tissues or at frontal sinuses often recurs after topical • Suction canister and tubing
least two of the following: positive Aspergillus therapy. It is assumed that the treatment • Three hemostats
fumigatus serum titer, positive Aspergillus does not adequately penetrate the center of • One pair operating scissors
culture, radiographic/CT or rhinoscopy these granulomas. Rhinoscopic or surgical • One long-handled needle holder

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