Transcript Chap 3 Catheters

Continue Chapter 3
Diagnostic Sampling and Therapeutic
Techniques (pgs. 105-110, 574)
Read pgs. 91-118
Catheters
Intravenous Catheter Placement
 When intravenous fluids or drugs must
be infused in large volumes, repeatedly,
or continuously, a catheter is placed in
the cephalic, jugular or saphenous vein.
 Be familiar with catheter selection,
placement, and maintenance.
Four Types of Catheters Utilized
1) Butterfly catheter-temporary catheter
Indwelling Catheters:
2) OTN catheter=Over the needle catheter
3) TTN catheter=Through the needle catheter
4) Single-lumen and Multi-lumen guide-wire
catheter (Detailed placement instructions come from the
manufacturer for these type of catheters)
Butterfly catheters = short term administration of drugs over a
few minutes or to obtain blood samples. This type of catheter
usually takes less time to place compared to other traditional
catheters.
Butterfly Catheters
• Used to administer small volumes of fluid
• Used to obtain small volumes of blood from
critical care patients, sometimes used as a last
resort
• Not left indwelling for longer than a few minutes
Indwelling Catheters
• Use aseptic technique to minimize
subsequent thrombus formation, phlebitis,
and infection.
• Now you can shave the fur!
• The skin surface is cleansed a minimum of 3
minutes with an antimicrobial scrub and
alcohol. Ideally, the skin should be in contact
with the antimicrobial solution for 2 minutes.
• If it is necessary to palpate the cleansed skin
area to identify the vein, the area should be
rescrubbed or you must wear gloves.
However, you will undoubtedly either touch
the area yourself or see someone do it.
OVER THE NEEDLE CATHETERS
Come in various lengths and gauge sizes
just like needles.
Catheter Flushing
• Heparinized Saline Solution (1
unit of heparin per milliliter of
0.9% saline solution)
• Flush the catheter prior to inserting
into the animal.
• After insertion, verified placement
by flushing the catheter prior to
securing onto the leg.
• Flushing helps to prevent blood
clots within the catheter lumen.
Heparin Sodium Flush
• Per Your CTVT book: Add 1 unit of Heparin
to 1 ml of 0.9% NaCl to make heparin
sodium flush
• Heparin Sodium comes in various quantities
and units. Please read the bottle carefully
and ask questions if you are in doubt of the
amounts involved.
There are several variations of Heparin.
OVER THE NEEDLE CATHETERS
Without the protective covering
CATHETER COMPONENTS
(Handout)
CATHETER CASING
CATHETER
STYLET
CAP OR
INJECTION PLUG
Gather your supplies
1.
2.
3.
4.
5.
6.
7.
Appropriate catheter
Antimicrobial scrub
Alcohol
Gauze sponges
Heparinized flush
Syringes
Needles*
8. Injection cap/plug
9. Clippers
10. Bandage tape
11. Bandage scissors*
12. Vet wrap*
Please read
in your
CTVT
book pg.
106
INSERTING THE CATHETER
Puncture the skin and vein in one swift movement. If you
are too gentle, the vein moves away from the catheter. Once
the vein is punctured, blood will flow through the needle
that is inside the catheter and into the hub.
CAP
Injection Plugs (Caps)
This is another technique
used to anchor the
catheter in place.
Fluid Accumulation
This patient’s
cephalic catheter
was not properly
positioned within
the vein during
intravenous fluid
administration. Fluid
accumulated in the
subcutaneous tissue
proximal to the
catheter site and
resulted in swelling
of the left front leg
and pectoral region.
Tada! The finished product of all your
hard work.
Removing the Catheter
• Antibiotic ointment treated gauze sponge is
applied over the catheter entry site.
• Remove vetwrap/tape first, then gently pull
out the catheter. You may need to apply
digital pressure to the site if it begins to bleed
with a gauze sponge.
Supplies needed
• Secure the gauze sponge with vet wrap to the
leg. If you do not have vet wrap, you may use
Antibiotic ointment
bandaging tape.
Gauze sponge
• This may be left on the animal for an hour or
Vetwrap
longer if it warrants it, (not days! And in
Bandage scissors
inform the owner of this please).
Hydrogen peroxide
• Catheter size required
depends on the size of the
animal.
• Sterile gloves should be worn
when placing a TTN
catheter.
• Position: lateral recumbency
• Word to the wise: when
walking dogs with jugular
catheters always walk them
on a harness or loop the
leash behind one or both
front legs.
Jugular Vein Catheterization-Indications
• Large volume of
crystalloid or colloid
fluid infusion (IV fluid
administration)
• Continuous drug
infusion (long term)
• Repeated blood
sample collection
• Infusion of parental
nutrition (TPN) or
other hyperosmolar
substances
• Central venous
pressure measurement
Venocath-18g
The TTN catheter is also utilized for long
Saphenous/femoral vein catheterization.
A jugular catheter placed in the medial
saphenous vein will have its tip in the
posterior vena cava. Such catheters can be
used for repetitive blood sampling. Because
the tip of the catheter is in a large vein,
hypertonic solutions such as hypertonic
dextrose and total parenteral nutrition
(TPN) solutions can be administered
through catheters in this location. Note the
bruising around the needle puncture site.
This may occur when placing a throughthe-needle catheter. The hole in the vein
created by the needle is larger than the
diameter of the catheter so when the needle
is retracted from the vein, blood may leak
from the puncture site into surrounding
tissues.
When not to use the Jugular vein for
catheterization
• Jugular vein is
inaccessible
• Patient is vomiting
• Patient has some sort of
neck injury/disease
When not to use the Saphenous vein
for catheterization
• Animals that cannot
stand to void
• Animals with severe
diarrhea
• If the catheter should get
wet or soiled, it must be
rewrapped or possibly
replaced.
Intravenous Catheter Maintenance
• Catheters should be inspected every few hours and not left
in place for more than 72 hours. (Exception: Jugular
catheter)
• Check the catheter site for pain, redness, swelling, and
discharge. If any of these are present, replace the catheter.
• Flush venous catheters every 4 to 6 hours with heparinized
saline solution.
• If a patient is on a continuous infusion of fluids the
catheter should be flushed every 8 to 12 hours.
• Catheters should be check for patency before medication
is injected and should be flushed with heparinized saline
solution after drug administration. Make sure that the drug
you are giving does not precipitate with heparin.
Catheter Troubleshooting
• If a catheter can not be flushed
without resistance or if blood
cannot be aspirated back into
the syringe, the catheter may be
bent, occluded with a blood clot,
extra vascular or the catheter
cap may be loose.
• Can you correct these issues
• Useful in nonambulatory, critically ill,
small animal patients. Very commonly
utilized in horses as well.
Common sites: • Indications: measurement of direct
arterial blood pressure (invasive) and to
dorsal pedal,
obtain blood samples for blood gas
femoral,
analyses (assessment of ventilation and
coccygeal,
oxygenation in cases with pulmonary
and auricular
compromise).
arteries
• Contraindications: NEVER to be used for
blood sample, drug, or fluid infusion.
Necessary Supplies
Clip and aseptically scrub over the site of proposed
arterial catheter placement.
• Placement of substances in the abdominal
cavity.
• Blood products, noncaustic fluids, or
medications
• Faster than SQ, but slower than IV or IO
• Lavage the abdomen of animals with
peritonitis, pancreatitis, hypothermia or
hyperthermia
• Do not use in patients that are vomiting or
that do not have a gag reflex!
• Easy to place and cheap for the clients
• Short term force feeding
• Radiography evaluates placement
• Technicians place these, sutures
and all!
• Where is the thorax located?
Hint: it contains the heart and lungs.
• The process of removing accumulated air or
fluid from within the pleural space (space
between the lungs and the chest wall).
• When air or fluid fills the pleural space the
lungs are unable to fully expand and the animal
is unable to breath properly.
• Visible signs: rapid and difficult breathing.