Page 2314 - Cote clinical veterinary advisor dogs and cats 4th

Postpartum Management of the Bitch/Queen 1151

tissue or a coronary artery. A wide site together another 2-4 mm before threading Alternatives and Their
covering approximately the 2nd to 8th the catheter off the stylet and removing the Relative Merits
• Surgical pericardectomy or less commonly
VetBooks.ir • The site of entry is chosen by ultrasound • A 20-35 mL syringe is attached to the end percutaneous balloon pericardiotomy may
intercostal spaces is clipped and aseptically
stylet from the thorax.
prepared.
be indicated, depending on the cause of the
of the catheter to aspirate PE. Once full,
guidance or by approximating the location
will recur and/or that chronic or recurrent
of the right-sided cardiac notch. this syringe can be exchanged for another. effusion. This reduces the risk that effusion
Optionally, extension tubing and a 3-way
○ Notch is at the 4th or 5th intercostal space stopcock can be used to expel fluid into a PE will cause constrictive pericarditis.
ventral to the costochondral junction (the collecting bowl without the need for syringe • Diuretics are indicated only in the rare
point of contact between the flexed elbow exchange. instances where PE occurs as a manifestation
and the thoracic wall). • An assistant must evaluate the removed of congestive heart failure (cats). Otherwise,
• Local block: a 3-mL syringe and 22-gauge fluid for clotting, which indicates chamber diuretics are not effective in evacuating PE
needle are used to infuse lidocaine (0.5-3 mL, puncture or an acute/active hemorrhage. and can adversely reduce preload, exacerbat-
based on patient size) through the intercostal • ECG is monitored for ventricular arrhyth- ing clinical signs of poor cardiac output.
musculature down to the pleura. The author mias, which may arise from disease or if
prefers to advance the needle to the pleura the catheter tip contacts the myocardium. Pearls Procedures and Techniques
first, aspirate to avoid pleural effusion, This often simultaneously produces palpable • Although most PEs appear red, blood can
and then infuse lidocaine as the needle is friction, in which case the catheter should be distinguished from PE by the fact that
withdrawn to the level of the skin, ensuring be slightly withdrawn/repositioned. When blood will clot and PE will not clot, unless
all layers of tissue are blocked. The needle is this friction becomes unavoidable and/or PE is due to a very recent bleeding event.
redirected, and the procedure is continued when effusion is no longer aspirated into Packed cell volume of the PE is usually less
until a 2-cm perimeter around the site of the syringe, the catheter is withdrawn from than that of peripheral blood.
entry is infused. the thorax. • Samples saved in the red- and lavender-top
• The clinician is sterilely gloved before tubes should be taken first from the fluid
handling the blade or catheter. Postprocedure removed to preserve sterility.
• A #11 scalpel blade is used to make a • Aliquots of fluid should be assayed for type • After the pericardium is penetrated with a
0.5-1 cm deep stab incision at the site of and examined microscopically (p. 1343). If catheter, the tautness of that tissue is reduced,
entry to ease catheter advancement. there is any suspicion that PE is infectious which makes repeated puncture very difficult.
• The same #11 blade can optionally be used in origin, fluid should also be submitted for If a catheter penetrated the pericardium,
to create a side hole in the large 14-18 bacterial ± fungal culture and susceptibility the fluid can escape through the catheter
gauge catheter to promote flow. The side testing. entry site into the thorax, making multiple
hole should not exceed 30% of the catheter • Although rarely necessary, skin glue, a staple, attempts unnecessary.
circumference, and it should be at least or nonabsorbable suture can be used to close
0.5 cm away from the point of tapering in the skin over the catheter entry site. SUGGESTED READING
order to maintain catheter integrity. • Diagnostic echocardiogram and a re- Gidlewski J, et al: Therapeutic pericardiocentesis
• A 6-mL syringe is attached to the stylet inside evaluation are recommended in the 12-24 in the dog and cat. Clin Tech Small Anim Pract
the large catheter. The needle and catheter, hours after pericardiocentesis because rapid 20:151, 2005.
held perpendicular to the body wall and just re-effusion is possible. ECG monitoring is AUTHOR: Erin L. Anderson, VMD, MSc, DACVIM
off the cranial edge of the rib, are advanced recommended throughout this period. EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
together through the stab incision while • Abdominal effusion associated with cardiac Thompson, DVM, DABVP
negative pressure is applied to the 6-mL tamponade often resorbs within 48 hours
syringe. after pericardiocentesis. Therapeutic abdomi-
• Fluid (most commonly hemorrhagic in nocentesis is performed only if necessary to
appearance) is visible in the syringe as rapidly improve patient comfort.
soon as the metal stylet (but not the plastic • IV fluid therapy is indicated for patients
catheter) has penetrated the pericardium. that are clinically dehydrated or have been
Slowly advance the stylet and catheter hyporexic.

Postpartum Management of the Bitch/Queen Client Education
Sheet

Indications
Difficulty Level: ♦ • Dry towels: For vigorous rubbing of neonates
• Owner requests information on postpartum and to keep the dam clean
Synonyms management • Suction: a suction bulb or an Argyle DeLee
• Postparturient care • Natural birth suction catheter for cleaning neonate
• Postwhelping/queening management • Cesarean section at hospital airways
• Postnatal care • Indirect mechanisms for temperature regula-
Equipment, Anesthesia tion (Bair Hugger, warm water bottles, and/
Overview and Goals • Whelping box/nesting area or heating pad/lamp)
• Care of the dam and offspring after • Thermometer: to aid in regulating the tem- ○ Ambient temperature in the pup/kitten
parturition perature of the environment. Thermometer area should be maintained at 29.5°C-35°C
• To wean as many healthy pups/kittens as should be placed at the level of the puppies (85°F-95°F) with space away from the
possible or kittens pups/kittens available for the bitch/queen.

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