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Central Intravenous Line Placement

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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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why place a central line
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
why place a central line3
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
why place a central line4
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
why place a central line5
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
around the needle catheter
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
around the needle catheter10
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
around the needle catheter11
Around the Needle Catheter
  • Advance catheter into the jugular vein
around the needle catheter13
Around the Needle Catheter
  • Attach extension set, so you can disconnect from IV fluids without disturbing the bandage.
around the needle catheter14
Around the Needle Catheter
  • Tape or suture catheter to the skin
  • Recover from sedation
  • Bandage
    • Antibiotic dressing
    • Cast padding
    • Roll gauze
    • vetrap
through the needle catheter
Through the Needle Catheter
  • Angiocath – 16G or 18G
  • Intracath – 16G or 18G
  • Venocath – 17G or 19G
through the needle catheter16
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

through the needle catheter17
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
through the needle catheter18
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
through the needle catheter19
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
through the needle catheter20
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
through the needle catheter21
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

through the needle catheter22
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
securing the catheter
Securing the Catheter
  • The external part of the catheter should be placed just behind the ear
securing the catheter24
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

securing the catheter26
Securing the Catheter
  • Place a small square of gauze with antibiotic ointment over the venipuncture site
    • Change this every 2-3 days
securing the catheter27
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
securing the catheter28
Securing the Catheter

free flow kink

securing the catheter29
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
securing the catheter30
Securing the Catheter
  • Attach the catheter hub to the outer layer of roll gauze with “split” white tape
securing the catheter31
Securing the Catheter
  • Outer layer of vetrap
    • Cut hole over catheter
    • Can completely cover catheter with another loop of vetrap when not in use.
securing the catheter32
Securing the Catheter
  • Attach the catheter hub to the outer layer of vetrap with “split” white tape
securing the catheter33
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
taking blood samples
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
cvp measurement
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
cvp measurement37
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)
cvp measurement38
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
cvp measurement39
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

cvp measurement40
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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