Placement and Management of Intravascular Catheters

I. Placement [1,2]

1. Venous

1. Sites include jugular, cephalic, saphenous and lateral thoracic veins. Jugular veins are the easiest to access therefore is the most commonly used peripheral veins in equine neonate.
2. Catheter selection

1. Teflon catheters are not recommended and should be avoided for intravenous or intraarterial use unless no other type of catheter is available. They carry high risk for thrombosis and catheter induced sepsis.
2. Polyurethane IV catheters with single, double or triple lumen (Mila®, Arrow®, Cook®, Jorvet®) with a guidewire or peel away introducers can be used in a size of 4-7FR X 5-10” (12-25cm).
3. Clip or shave site.
4. Surgical scrub and prep with alcohol and povidone iodine.
5. Inject lidocaine over jugular and sterile part of field.
6. Use sterile technique including sterile single or double gloves.
7. Perforate skin with large gauge needle or Size 11 scalpel blade first.
8. If vein is collapsed or not visible and venous preparation is necessary, use sterile technique and blunt dissection.
9. Place introducer needle in jugular vein.
10. A J-wire is placed in the vein through the needle and the needle is removed.
11. The actual catheter is threaded over the J-wire and down into jugular vein and wire removed.
12. Suture or superglue catheter to skin in 4-5 points.

i. Sutures: Attach T-port® if it is not included to the catheter set. If T-ports® are not available, attach an I.V. extension set to the catheter. Cap the open end of the extension set with an infusion plug. Making injections or drawing samples through the T-port® or extension set rather than directly from the catheter will prolong the life of the catheter. Place two simple interrupted sutures through the skin and around the T-port®. One suture should be on each side of the extension arm of the T-port®. The catheter and T-port® should lie in a straight line parallel to the vein.

ii. Glue: Attach T-Port® and PRN® infusion plug or I.V. set to catheter. Tighten with hemostat. Apply tincture of benzoin to skin. Apply cyanoacrylate (Superglue®) and press catheter to skin.

iii. Tape: Catheters in the cephalic or saphenous veins may be secured by placing a strip of adhesive tape, Vetwrap®, or Elasticon® sticky side up under the catheter and infusion plug then folding the tape over the catheter (back on itself) and continuing around the leg. The skin should be dried before applying tape.

13. Catheter can be used for up to 2-3 weeks.
14. Silicone elastomer catheters (Mila®, Braun®, Arrow®, Cook®) with single or double lumen (60 cmX5-7Fr) have minimal thrombogenicity and can be left in a central vein for up to 30+ days.

2. Arterial

1. Sites include metatarsal, facial and femoral arteries.

1. Catheter selection: 20 or 22 ga, 1.25" to 2.5" Mila®, Arrow® or Jorvet® polyurethane over-the-needle catheters. 18 or 20 ga. catheters may also be used in the femoral artery.
2. Although placement of the over the wire catheters into the arteries requires lots of practice they are usually not indicated unless long-term direct blood-pressure measurements are performed.

2. Preparation, placement and securing as for venous catheters.

II. Management [1,2]

1. Dressings

1. Apply povidone iodine ointment at insertion site.
2. Cover dry 4" X 4" gauze sponges with povidone ointment and wrap entire neck or limb with gauze and elastic tape.

2. Manipulation of Catheter

1. Should be minimized. Avoid disconnecting the system once it has been established, e.g. when moving patient or taking blood samples.
2. Use sterile technique. Swab injection ports with alcohol before using.
3. Change all infusion sets and fluid containers every 24-48 hours. Flush catheters QID with 2-3 ml of sterile isotonic fluid containing 10U/ml of heparin.

3. Changing Intervals

1. Change catheter sites depending on the catheter type, or sooner if there is evidence of inflammation or loss of catheter integrity. Remove all intravascular catheters as soon as therapeutically possible. These steps should help minimize catheter-related infections.