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Jugular Catheter Placement and Management



OVERVIEW AND GOALS


Jugular venous access is essential in small-animal critical care and general medicine for a variety of therapeutic and diagnostic reasons.



• The duration of catheter patency and function tends to be longer with jugular catheters compared to peripheral catheters.

• Higher osmolar solutions (parenteral nutritional solutions, glucose solutions) may be administered more safely through these catheters compared to peripheral venous catheters.

• Jugular venous catheters allow for easier through-the-catheter blood sampling and are necessary for measuring central venous pressure.

• Jugular catheter sites are less likely to be contaminated from vomit and diarrhea in animals with those problems.


INDICATIONS



• When multiple/serial blood samples are required (e.g., diabetic ketoacidotic animals)

• Measuring central venous pressure (CVP)

• Constant rate infusions of hyperosmolar solutions (e.g., dextrose solutions > 5%)

• Total/partial parenteral nutrition (T/PPN) administration

• In animals with severe vomiting and diarrhea that require IV access


CONTRAINDICATIONS



• Hypercoagulable states (e.g., protein-losing nephropathy)

• Increased intracranial pressure (holding off jugular vein may increase intracranial pressure)

• Hypocoagulable states (e.g., liver failure, rodenticide anticoagulant intoxication)

• Thrombocytopenia

• Thrombocytopathia

• Skin infection over site of jugular catheter placement


EQUIPMENT, ANESTHESIA



• Sedation generally not necessary in critically ill animals but may be needed in fractious animals

• Clippers

• Sterile surgical gloves

• Surgical scrub soap

• Gauze squares for surgical prep of site

• Heparinized saline flushes

• Suture material

• White cloth-type tape

• Bandaging material (e.g., roll gauze, cast padding, and Elastikon/Elastoplast-type adhesive roll bandage)

• Injection cap

• Triple-antibiotic ointment

• Guide-wire technique: the following four items are available in kits manufactured by Cook, Mila, and Arrow:
○ Hypodermic needle

○ Guide wire

○ Dilator

○ Polyurethane IV catheter

• Other materials:
○ A #11 scalpel blade

○ Suture material (e.g., 2-0 to 4-0 nylon)


ANTICIPATED TIME


About 20 minutes



PREPARATION: IMPORTANT CHECKPOINTS


Check coagulation profile (prothrombin time [PT], partial thromboplastin time [PTT], platelet count, platelet function)

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Jul 24, 2016 | Posted by in SMALL ANIMAL | Comments Off on J

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