Page 2317 - Cote clinical veterinary advisor dogs and cats 4th

PET/CT Scan 1151.e3

○ Apply a sterile gauze and adhesive dressing when using a 1.25% dextrose solution • The dialysate should be monitored daily for
(e.g., OpSite) over the catheter exit site. and exceed infusion volume when using a signs of cloudiness suggesting peritonitis.
VetBooks.ir ○ Make a paramedian incision at the level • Repeat the entire exchange process every 1-2 Alternatives and Their
2.5% or 4.5% dextrose solution to correct
• Percutaneous catheter placement
Perform cytology, Gram stain, and culture
and sensitivity on cloudy dialysate.
overhydration.
of the umbilicus small enough to form a
tight seal around the chosen catheter.
○ Tunnel the trocar subcutaneously for hours until the patient improves clinically Relative Merits
and the uremia stabilizes and then every 4-6
several centimeters before penetrating hours. • Pleural dialysis is technically less demanding,
the abdominal muscles and into the but it is the least effective and has greater
abdomen. Postprocedure complication risks.
○ Advance the PD catheter off the trocar, Patient care: • Intermittent hemodialysis (IHD) and con-
directing it caudally into the pelvic inlet. • Analgesia and nursing care to minimize stress tinuous renal replacement therapy (CRRT)
○ Secure to the skin with a purse-string and discomfort are reliable alternatives for the treatment
suture or with fixation provided in the • Adequate nutritional support (parenteral, of uremia but are limited to specialized
PD kit (if available). enteral, or combination) to reduce the risk centers equipped and trained to offer this
○ Apply a sterile adhesive dressing over exit of hypoalbuminemia and peritonitis service. CRRT is proposed to result in fewer Procedures and Techniques
site. • Monitor hydration status (frequent body complications.
• Dialysate exchange weights, packed cell volume/total solids
○ Inflow: start with small volumes [PCV/TP], central venous pressure [CVP], SUGGESTED READINGS
(10-20 mL/kg) to reduce the risk of dialysate inflow/outflow volume) to avoid Bersenas AM: A clinical review of peritoneal dialysis.
leakage. Increase to 30-40 mL/kg if volume overload. J Vet Emerg Crit Care 21:605-617, 2011.
tolerated after first 24 hours. Warm to • Assess PCV/TP, electrolytes, venous blood
body temperature, and infuse over 10 gas, blood glucose, blood urea nitrogen ADDITIONAL SUGGESTED
minutes by gravity flow or IV infusion (BUN), creatinine, and serum albumin every READING
pump. Reduce infusion volumes if signs 8-12 hours initially. Adjust dialysate and IV Beckel NF, et al: Peritoneal dialysis in the management
of nausea, discomfort, or respiratory fluid composition pending serum chemistry of acute renal failure in 5 dogs with leptospirosis. J
compromise are noted. values. Vet Emerg Crit Care 15:201-205, 2005.
○ Dwell time: initial dwell times should be Catheter care: Dorval P, et al: Management of acute renal failure
short (30-40 minutes) until the patient • Strict aseptic technique (washing hands, in cats using peritoneal dialysis: a retrospective
improves and uremia stabilizes, and then wearing sterile gloves) during handling and study of six cases (2003-2007). J Feline Med Surg
extend to 4-6 hours. delivery of dialysate to minimize risk of 11:107-115, 2009.
○ Outflow: dialysate removal can be done peritonitis. All line connections should be AUTHOR: Michael Ethier, DVM, DVSc, DACVECC
by gravity over 15 minutes by placing covered with chlorhexidine- or povidone- EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
the collection system below the patient. iodine–soaked gauzes. Thompson, DVM, DABVP
Alternatively, a negative suction drain can • The PD catheter insertion site should be
be attached for active removal. Effusate examined daily for any signs of discharge,
volume should equal infused volume swelling, redness, or discomfort.

Video
PET/CT Scan Available

Difficulty level: ♦♦♦ The radiopharmaceutical is sensitive ○ Lymphoma (pp. 607 and 609)
for many types of cancer but not specific ○ Mast cell tumors (pp. 632 and 634)
Synonyms because inflammatory, infectious, and some ○ Melanoma (p. 644)
Positron-emission tomography (PET) scan, degenerative conditions can also accumulate ○ Osteosarcoma (p. 726)
computed tomography (CT) scan glucose. Moreover, certain tissues in the ○ Most carcinomas in dogs
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body, particularly the brain, use glucose as a • F-FDG PET/CT scans are less sensitive
Overview and Goal primary source of energy and will always be for soft-tissue sarcomas (p. 927)
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The purpose of PET/CT scanning is to gener- 18 F-FDG avid. Other tissues such as salivary • F-FDG PET/CT is not sufficient for diag-
ate multidimensional anatomic images of the gland, active muscle, gastrointestinal tract, and nosis of cancer, which requires cytologic or
patient with functional imaging information the neck of the gallbladder also accumulate histologic diagnosis.
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co-registered to highlight anatomic regions that signal. The kidneys and bladder are the route • F-FDG PET/CT is used for assessing
have accumulation of the radiopharmaceuti- of excretion and will have high signal values. patients for inflammatory lesions as a
cal. For cancer patients, the most common Relative intensity of the signal is measured by late-stage test in the evaluation of fever of
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radiopharmaceutical is F-flurodeoxyglucose the standard uptake value (SUV). Higher SUV unknown origin.
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( F-FDG). This form of glucose often accumu- measurements often correlate with more likely • F-FDG PET/CT has been used to evaluate
lates in cancer cells through glucose transporters neoplastic cell infiltration. causes of lameness in dogs.
expressed on the cell surface. The location of the
fluorine atom prevents further metabolism after Indications Contraindications
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initial phosphorylation, trapping the glucose • F-FDG PET/CT scans are indicated for Although there are no absolute contraindica-
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molecule in the cell and creating a signal for staging and restaging patients with cancers tions to F-FDG PET/CT scanning, the
cancer localization. and are sensitive for presence of hyperglycemia can interfere with
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