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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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Central intravenous line placement l.jpg

CentralIntravenous LinePlacement

Wendy Blount, DVM


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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


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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


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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


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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




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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



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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


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    Around the Needle Catheter

    • Advance catheter into the jugular vein



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    Around the Needle Catheter

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


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    Around the Needle Catheter

    • Tape or suture catheter to the skin

    • Recover from sedation

    • Bandage

      • Antibiotic dressing

      • Cast padding

      • Roll gauze

      • vetrap


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    Through the Needle Catheter

    • Angiocath – 16G or 18G

    • Intracath – 16G or 18G

    • Venocath – 17G or 19G


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    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


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    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


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    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


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    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


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    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


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    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


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    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


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    Securing the Catheter

    • The external part of the catheter should be placed just behind the ear


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    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



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    Securing the Catheter

    • Place a small square of gauze with antibiotic ointment over the venipuncture site

      • Change this every 2-3 days


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    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


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    Securing the Catheter

    free flow kink


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    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


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    Securing the Catheter

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


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    Securing the Catheter

    • Outer layer of vetrap

      • Cut hole over catheter

      • Can completely cover catheter with another loop of vetrap when not in use.


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    Securing the Catheter

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


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    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


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    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


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    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



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    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)


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    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


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    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


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    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