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Intravenous catheter techniques 

Objectives:  To familiarize the veterinary technology student with the basic techniques of placement of intravenous catheters.  The student should be able to accurately place a secure catheter using aseptic technique in a peripheral vein. 

Keywords: peripheral veins, sterile scrub technique, heparin, flashback, stylet, hub, over the wire, double-bore 

Required reading:
Pages 607-610, 651-655 Clinical Textbook for Veterinary Technicians McCurnin, 7th ed.

Other reading:
Equine catheterization:  Hanie, Large Animal Clinical Procedures for Veterinary Technicians pgs 87-94.
Ruminant catheterization:  Hanie, Large Animal Clinical Procedures for Veterinary Technicians pg 355.

I) Intravenous catheter placement in peripheral veins: Please read the unit in the text.
Most veterinarians develop their own technique for intravenous catheter placement; often technicians working in multiple doctor practices learn more than one technique of securing catheters. Obviously the most important things are using aseptic technique, and accurate and secure catheter placement.

Below is a step by step diagram and brief explanation of one of the techniques used at the Veterinary Technology Program NVCC.

A) Aseptic patient preparation
1) The area is neatly clipped and scrubbed three times with chlorhexidine (similar to surgery).



Figure 1:  The sterile IV catheter set up used at NVCC

2) A heparinized saline flush is prepared, intravenous fluids are ready, an over the needle catheter of proper size (20 G) for mid-sized canine is flushed with a heparin/saline mixture, and 3 strips of adhesive tape readied. A long one inch strip is split in half lengthwise and a shorter 1 inch strip is prepared.

A) Vein held off by an assistant

B) Catheter inserted with bevel of stylet facing away from the vein.  Flashback of blood in the catheter indicates entry into the vein.

How might you know you’ve  inserted  the catheter into the carotid artery vs the jugular vein in a horse?

 C) Securing catheter:

1) The first piece of tape (1/2 wide and long enough to form a "butterfly" on the catheter hub) is placed below the hub of the catheter sticky side up. Three inches of tape should extend beyond the hub on the left side of the hub.

2) A butterfly tab with two wings extensions is formed

a) Bring 2 inches of the shorter length of the tape (on the left side of the hub) back over the hub of the catheter and press it down, a 1 inch wing is formed on the left side. Extend the tape over the hub to about 1 inch on the right and press it down. A double layer butterfly with 1 inch wings has now been formed.

b) The long length of the tape on the right side of the hub is brought over the wings of the butterfly and pressed down. There is now a three layer butterfly formed around the hub of the catheter. The rest of the tape is placed around the leg and the catheter is secured around the leg with butterfly tabs on each side to stabilize.

c) The 1 inch piece of tape is secured over the tip of the catheter (under the skin) and around the leg. Antibiotic is often placed below this piece at the point of skin insertion.

 

d) The third ½ inch tape is placed below the injection port and around the leg to create a clean easily visualized area below the hub.

 

e) Short tabs are placed on the ends of tape by folding over the edges. This enables easily grasping tape edges when the catheter is removed.
A tension loop and carpal splint are placed to decrease the chance that the patient will remove the IV set up; an Elizabethan collar can also be placed to prevent chewing, licking, or otherwise mistreatment of the catheter by its owner.

 

Sometimes if "your legs are short and your ears are long" the catheter can be placed in non-traditional sites! Note the well secured catheter, padded collar, infusion port and coiled infusion line.

Special thanks to Lynn Chipkin and the ICU unit at the College of Veterinary Medicine, Virginia Tech, for this photo.

Specialized catheters:

This website is a good description of how to place a catheter provided from another perspective http://www.vin.com/VINDBPub/SearchPB/Proceedings/PR05000/PR00447.htm

Go to this website to explore one company that makes long-term over the wire catheters…  http://www.milaint.com/GWPicc.php

Long term catheters can be placed.  These are designed to be minimally reactive, and stay in the animal for weeks at a time with little irritation at the catheter site.  Often these are designed to be placed in a large central vein – such as the jugular – and are longer than traditional short-term catheters.  They are placed in a similar manner, with special attention to sterility.  Many have “over the wire” placement, which can be challenging to learn initially. 

Double and triple bore catheters are designed to deliver multiple drugs, fluids, and partial parenteral nutrition through one catheter without mixing of the compounds within the catheter.  One should always pay attention to the appropriate port with these types of catheters, as often mixing of the drugs will cause precipitation, leading to clogging of the catheter and the need to replace it, which is EXPENSIVE!!!

What is meant by Parenteral Nutrition?________________________________________________________________________

Questions: E- Mail answers to Dr. Bidwell:  abidwell@nvcc.edu

Don’t forget to answer the question posed within this lesson – there are two this time!

1) What are the 4 types of catheters used for peripheral IV veins?

2) What type(s) is used for longer term indwelling?

3) What are 3 common complications if aseptic technique is not used when placing a catheter?

4) Why and how is heparin used in IV catheterization?

5) At about what angle should the catheter enter the patient?

6) What size and length is preferred for cats? Dog? Horses?

7) Describe the technique that you have been taught at your clinic. Also, please answer these questions: Where is the catheter inserted into the vein (lateral or over the vein)? Is the stylet moved or the catheter when "seating" the catheter? How is the catheter taped to the leg?

8)  What should you monitor at least twice a day in any animal that has a catheter in place?