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Central Intravenous Line Placement

Central Intravenous Line Placement Wendy Blount, DVM Why Place a Central Line? When serial blood values are needed. Avoids pain, trauma and bruising Can get blood from a fractious cat without actually touching it Makes repeated blood draws from difficult animals possible

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Central Intravenous Line Placement

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  1. CentralIntravenous LinePlacement Wendy Blount, DVM

  2. Why Place a Central Line? • When serial blood values are needed. • Avoids pain, trauma and bruising • Can get blood from a fractious cat without actually touching it • Makes repeated blood draws from difficult animals possible • Maintains integrity of the veins for easy placement of the next IV catheter

  3. Why Place a Central Line? • When do we need serial values? • Diabetic ketoacidosis • Renal failure requiring diuresis • Liver failure • hypoproteinemia • “mean as a snake” diabetics who need a glucose curve • Hemolytic anemia

  4. Why Place a Central Line? • When you need central venous access • Drugs that are caustic • Doxycycline IV • Total Parenteral Nutrition (TPN) • Partial Parenteral Nutriiton (PPN) • Monitoring Central Venous Pressure (CVP) • CVP = pressure in the RA • When giving IV fluids to dogs with right congestive heart failure

  5. Why Place a Central Line? • Central Venous Pressure • Normal • 5-8 cm H20 in dogs • 2-3 cm H20 in cats • Increased CVP can result in signs of right heart failure • >10 cm in dogs • >8 cm in cats • Trends are probably more important than absolute values

  6. Peel Away Introducer • video

  7. Guidewire Technique • video

  8. Around the Needle Catheter • Standard teflon large bore IV catheter – 14-18 gauge x 3-4 inches • Smaller for kittens, puppies, toy breeds • Place the pet in dorsal recumbency and prep the jugular furrows • If you wish, make a stab incision through skin, just medial or lateral to one of the jugular veins

  9. Around the Needle Catheter

  10. Around the Needle Catheter • This helps if dehydrated or hypovolemic • Pass the stylet with catheter into the jugular vein • Attach syringe to minimize blood spillage

  11. Around the Needle Catheter • Advance catheter into the jugular vein

  12. Around the Needle Catheter

  13. Around the Needle Catheter • Attach extension set, so you can disconnect from IV fluids without disturbing the bandage.

  14. Around the Needle Catheter • Tape or suture catheter to the skin • Recover from sedation • Bandage • Antibiotic dressing • Cast padding • Roll gauze • vetrap

  15. Through the Needle Catheter • Angiocath – 16G or 18G • Intracath – 16G or 18G • Venocath – 17G or 19G

  16. Through the Needle Catheter • Three layers: • Guide wire stylet (inner most) • Polypropylene catheter • Needle stylet (outer most) • Needle Guard • Clamps around the needle like a clamshell, to keep the needle from cutting the catheter in half

  17. Through the Needle Catheter • Occlude jugular vein at thoracic inlet • Insert the needle stylet into the vein • With the catheter and bag attached (below) • Or with the catheter and bag detached

  18. Through the Needle Catheter • When you are in the vein: • See “flash” up the catheter if it is attached • Blood out the needle stylet if not attached

  19. Through the Needle Catheter • Stop occluding the jugular vein • Decreases flow of blood out the hub if bag not attached • Thread the catheter by “milking it” through the sterile bag, or threading it into the open needle hub • Thread in at least 3-4 inches in a small dog or cat • All the way in if dog is big enough • To the right atrium, or least well into the thoracic inlet

  20. Through the Needle Catheter • Place a 4x4 gauze at the venipuncture site an apply gentle pressure • Withdraw the needle, leaving the catheter in place. • Remove the protective bag • Seat the catheter hub firmly into the needle stylet hub • I like to use a drop of tissue glue to secure them together • If there is movement here, the catheter can be sheared off the hub

  21. Through the Needle Catheter • Apply the needle guard • Secure closed with white tape • Remove the wire stylet • MAKE SURE the cath & needle hubs are attached (b attached to c) to each other before the stylet (a) is removed • If not, you can remove the catheter (b) with the stylet (a) by mistake

  22. Through the Needle Catheter • attach a 10-12cc syringe filled with saline or LRS • Flush to make sure the catheter is patent • Aspirate to make sure catheter is patent • flush and aspirate about every minute, to make sure catheter is still patent and not kinked, while wrapping

  23. Securing the Catheter • The external part of the catheter should be placed just behind the ear

  24. Securing the Catheter • Place a white tape butterfly on the needle guard • Secures the needle guard closed • Used to suture the guard to the skin • I don’t use the suture holes in the needle guard • Vetafil 2-0 or other Non- absorbable suture

  25. Securing the Catheter

  26. Securing the Catheter • Place a small square of gauze with antibiotic ointment over the venipuncture site • Change this every 2-3 days

  27. Securing the Catheter • Place ¼-1/2 inch padding between the needle guard and the skin • Cotton, gauze or cast padding - prevents sores • Be careful not to kink the catheter here

  28. Securing the Catheter free flow kink

  29. Securing the Catheter • REMEMBER, you are flushing and aspirating every minute or so as you go, with syringe full of saline attached to the catheter hub • Secure catheter to the neck with full circle white tape • Clip a “bridal path” in the fur if needed

  30. Securing the Catheter • Attach the catheter hub to the outer layer of roll gauze with “split” white tape

  31. Securing the Catheter • Outer layer of vetrap • Cut hole over catheter • Can completely cover catheter with another loop of vetrap when not in use.

  32. Securing the Catheter • Attach the catheter hub to the outer layer of vetrap with “split” white tape

  33. Securing the Catheter • These photos show bandaging while anesthetized. • If sedation is required, I prefer to tape while sedated, then finish the bandage after awake and sitting sternal • This prevents a bandage that is too tight

  34. Taking Blood Samples • Disconnect IV fluid line and cap • Flush the catheter with heparinized 3-5 cc saline • Gently withdraw 5-6 cc of blood • Gently withdraw needed sample • All values except platelets will be accurate • Gently replace 5-6cc of blood in “dump syringe” • Flush the catheter with 3-5cc saline

  35. CVP Measurement • Equipment Needed • Bag of fluids • Fluid administration set • IV extension set • Three-way stopcock • Manometer • If you don’t have a manometer, you cant tape IV tubing to a ruler with cm marks on it • Flush patient’s IV catheter • Fill the IV extension set with fluid • Connect the IV extension set • To patient jugular catheter at one end • To 3-way stopcock at the other end (side) • Stopcock off to patient

  36. CVP Measurement

  37. CVP Measurement • Connect manometer to 3-way stop-cock (top) • This connection is the weakest point • Support the manometer when turning the stopcock • Connect the IV set and fill the line with fluids • One end to the fluid bag (one side) • The other end to the stopcock (other side)

  38. CVP Measurement • Turn the stopcock off to manometer, and make sure fluid flows freely into the patient • Turn stopcock off to patient, and fill manometer with fluid • to at least 15-20 cm • Make sure no air bubbles, which could cause vapor lock

  39. CVP Measurement • Patient should be in sternal or lateral recumbency • Place the -0- on the manometer at the level of the right atrium • Midway between dorsal and ventral If in lateral recumbency

  40. CVP Measurement • Turn stopcock off to fluids, and allow fluid to fall until it rests at the patient’s CVP • The meniscus will oscillate up and down as the heart beats and the patient breathes

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