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There are several types of
jugular catheters available. Most catheters are threaded through a needle, therefore, the
hole made in the vessel wall by the needle is larger than the diameter of the catheter so
for a short time after placement, blood tends to leak back around the catheter. Catheters
demonstrated in the slide are Intrafusor (a) which has its own extension set and a
separate needle guard, the Venocath (b) that has an attached needle guard and the
Intracath (c) that has a detached needle guard. |
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The venipuncture models located in the
psychomotor skills lab on the second floor of McCoy are available to you, any time that
you want to practice. See Lynn Duncan to obtain a code to access the room. |
A jugular catheter can be placed with the patient in
sternal recumbency, with the neck extended upwards.
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..or in lateral
recumbency. The catheter insertion site should be widely shaved of hair and aseptically
prepared using an antiseptic solution such as BetadineTM or Chlorhexadine. Digital pressure is
applied at the thoracic inlet to cause the jugular vein to distend with blood. This is
usually done by the person placing the catheter if the dog is in sternal recumbancy, but
is done by the holder if the dog is in lateral recumbancy. The jugular vein is clearly
visable in this dog. |
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The following series of
slides will show placement of a jugular catheter using an IntracathTM by
Deseret. |
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Insert the catheter through the skin and
through the wall of the vein in one motion, if possible. Make the puncture through skin
and vein wall rapidly and forcefully. If you are too delicate and slow when inserting the
needle, you will push the vein away from the needle instead of puncturing it. When the
vein is punctured, blood will "flash" up the catheter along the blue marker
line. |
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Once it is clear that the vein has been
punctured, the catheter is threaded (pushed) through the needle by pinching through the
plastic behind the catheter which pushes the catheter forward. The green plastic end of
the catheter (a) is securely forced into the metal hub of the needle (b). The white
plastic cap that still covers the needle hub in this slide will be removed. |
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The Intrafusor is packaged with a rigid
plastic cylinder (a) covering the catheter. The white y-shaped part of the catheter (b) is
pushed forward until it locks into the yellow hub of the needle (c). This results in the
catheter being pushed through the needle. The catheter is the gray "stripe"
between c and b. The white plastic cylinder (a) is pulled off and discarded. Other parts
of this catheter are the extension tubing (d) and the needle guard (e). |
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When using an Intrafusor style
catheter, wait for blood to "flash" back into the extension set (a), to assure a
good venipuncture, before pushing the catheter through the needle into the vein. |
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The needle guard is folded
over the needle like a clamshell. Make sure that the needle is in the groove of the guard
so that the catheter is not pinched by the needle guard when it is closed. Make sure that
the tip of the needle (a) is within the needle guard so the needle does not lacerate the
catheter. |
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The wire stylet (a) is removed. Make sure
that the hub of the catheter (b) is firmly locked into the hub of the needle (c) when the
stylet is removed or you may remove the entire catheter along with the
stylet. |
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An injection cap (a) is attached to the
catheter and the catheter is flushed with heparinized saline to assure the catheter is
properly placed before it is bandaged. If the catheter is properly placed, you should be
able to aspirate blood from the catheter and solutions can be injected without resistance. |
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The external portion of the catheter
should be positioned just behind the ear. Notice the small amount of blood leaking around
the catheter at the puncture site (arrow). Bleeding around the catheter occurs as the
catheter is slightly smaller than the hole made in the vein wall by the catheter needle. |
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Although the needle guard has two holes
for suturing (the second hole is under the tape), a butterfly of tape offers better
stability in securing the catheter in place. |
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The butterfly wings of tape
are sutured to the skin using a 20 gauge hypodermic needle and nonabsorbable suture such
as medium weight vetafil. |
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Antiseptic or antibiotic ointment is
applied on a gauze square to the site that the catheter penetrates the skin. BetadineTM
ointment is being applied in this picture. |
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A 1/3 to 1/2 inch thick pad of gauze is
placed behind the catheter to elevate it away from the neck. This change in position of
the external portion of the catheter "pushes" the catheter under the skin at the
level of the skin puncture. If a segment of the flexible part of the catheter is visable
at the puncture site, that segment of catheter may be bent and thus occluded. |
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One inch tape is placed completely around
the neck of the animal on either side of the catheter, catching the butterfly wings and
the gauze pad with the antiseptic ointment. |
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This is followed by a layer of stretchy
wrap such as cast padding or cling gauze. The wrap is placed around the neck both in front
of, and behind, the external segment of catheter, two to three times on each side. The
weave of the gauze can be loosened and placed over the top of the catheter, allowing the
catheter to protrude through the gauze. |
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A piece of 1 inch tape split
lengthwise can be wrapped around the catheter for added security. |
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This is followed by an outer layer of Vet
Wrap. This wrap is placed in front of, and behind the catheter. The wrap encircles the
neck twice on each side of the catheter. A small hole is cut in the wrap and it is passed
over the catheter. The tip of the catheter and injection cap protrude through the hole in
the wrap. |
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Another piece of 1 inch tape (~4 inches
long) split lengthwise, is wrapped around the top of the catheter to make it more secure. |
Jugular catheters can be
used for obtaining blood samples. They are especially useful for repetitive sampling such
as occurs when monitoring a diabetic animal. When using an Intrafusor, which has an
attached extension set, an extra piece of tape should be applied to the extension set. If
the animal pulls on the catheter the chances of it being dislodged are reduced if the
catheter is securely taped in place.
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