Page 330 - Small Animal Internal Medicine, 6th Edition

302 PART II Respiratory System Disorders

Poor or no return
VetBooks.ir Length of catheter within airway: Measure distance along path of trachea
-Too far within airway can result in
from cricothyroid ligament (transtracheal
catheterization of a bronchus and
loss of horizontal surface required technique) or proximal end of endo-
to recover fluid. tracheal tube to fourth intercostal
-Not far enough within trachea leaves space for approximate distance to carina
catheter tip in extrathoracic trachea, and ensure catheter reaches just proximal
where surface is not horizontal. to this position.

Position of tip when using stiff Physically straighten catheter before use.
polypropylene urinary catheters: tip Once catheter is in position, rotate it along
may be bent or curved such that it axis in several different positions until
cannot rest on ventral surface of airway. yield improves.

Time delay between instillation and Suction vigorously immediately after
suction is too long. instillation of saline.

Use a 12-mL syringe and suction with
Suction is not sufficiently vigorous.
enthusiasm.
Recovery of only saline

Catheter is not placed far enough
within trachea to exit endotracheal tube See first remedy (above).
using endotracheal tube technique.

Suction many, many times. Mucus that
Too few suction attempts are
performed to pull mucus through has only moved partway through catheter
entire length of catheter. will be pushed back into airways with
subsequent saline infusion.
Negative pressure

Catheter is kinked at neck (trans-
tracheal technique). Holder adjusts position to prevent kinking.

Continue vigorous suction to retrieve this
Thick mucus is obstructing lumen of valuable material. If necessary, flush with
catheter. more saline. If still unsuccessful, consider
using a larger catheter.

Move catheter slightly forward or backward,
Catheter tip is flush against airway wall.
or rotate catheter.

Oropharyngeal contamination
Insertion of a transtracheal catheter
proximal to the cricothyroid ligament. Be sure of anatomy prior to procedure.
Excessive salivation, especially in cats. Premedication with atropine.

Prolonged extension of the head and
neck during catheter or endotracheal Minimize amount of time head and neck
tube placement. are extended.

FIG 20.14
Overcoming problems with tracheal wash fluid collection. Green boxes indicate problems,
blue boxes indicate possible causes, and orange boxes indicate remedies.