Comprehensive Guide to IV, Jugular, and Endotracheal Intubation Techniques in Veterinary Medicine

What does IV catheter site selection depend on?

Available vessels, vessel condition, patient temperament & health status, & urgency of situation.

What are the four general categories of IV catheters?

Winged needle (aka butterfly), over-the-needle (OTN), through-the-needle (TTN), & multi-lumen catheter.

Over-the-needle (OTN) catheter

Fitted outside over a steel needle with the needle point extending just beyond the catheter tip for entry into the vein.

Through-the-needle (TTN) catheter

Usually longer than OTN catheters & used primarily in the jugular vein. Requires a needle guard to be placed to protect the needle from sticking the animal & shearing the catheter.

Multi-lumen catheter

Has 2 to 3 separate lumina in one catheter, provides simultaneous infusions at a singular catheter site

What type of catheter is primarily used for peripheral vein catheterization?

Over-the-needle (OTN); also the most common.

What is the purpose of a needle guard in IV catheter placement?

To protect the needle from sticking the animal and shearing the catheter.

What materials are needed for IV catheter placement?

Catheter type, flush (3mL syringe with heparinized saline), injection cap or T-connector, tape or non-absorbable suture, bandage material, clippers, & antiseptic scrub (chlorhexidine & alcohol)

IV catheter placement steps

1. Tear 3 strips of tape (2 skinny, 1 fat) long enough to go completely around the limb

2. Clip & aseptic prep over the vessel, generally shave all the way around the limb

3. Restrain limb & occlude vein

4. Tech extends leg & flexes paw to tense & immobilize vein; may also align thumb aside the vein to stabilize

5. Break the seal of the catheter & flush it

6. Insert catheter, generally at very slight angle

7. Advance catheter & watch for flash in the flash chamber (hub)

8. Slide catheter off the needle & into the vessel lumen

9. Cap catheter with injection cap or T-connector

10. Place an initial piece of tape (skinny) sticky side up to secure catheter

11. Flush catheter

12. Finish taping. 2nd skinny tape sticky side down, then fat piece on top of catheter

13. Cover taped area with a simple bandage

How should the vein be prepared before catheter insertion?

Occluded upstream of the insertion site by an assistant or a tourniquet.

What indicates successful entry into the vessel during catheter placement?

The appearance of blood in the flash chamber (hub) of the catheter.

What should be done after blood appears in the flash chamber?

Advance the needle and the catheter together as a unit for 1 to 4 mm.

What is the purpose of flushing the catheter before insertion?

To ensure it is clear and ready for use.

Why is it important to have everything ready before starting the IV catheter placement?

To ensure a smooth and efficient procedure.

What should be done to the insertion site before placing the catheter?

Aseptic preparation, generally shaving all the way around the leg.

What should be remembered when taping an IV catheter in place?

Don't cover the area where the catheter meets the injection cap.

What is the primary use of butterfly catheters?

For short-term use in fairly quiet animals.

What should be done to prevent accidental catheter removal during flushing?

Be cautious, as it is easy to pull out the catheter if the patient jerks its leg.

Jugular catheter

Placed antegrade with the tip of the catheter always directed to the heart.

In what position should the patient be placed for jugular vein catheterization?

In lateral recumbency with the head extended and forelimbs positioned caudally.

What is the purpose of aspirating the catheter after placement?

To confirm proper placement and remove any air.

How often should a catheter be observed for maintenance?

Multiple times a day.

What should be done if a catheter bandage is wet?

Investigate the cause, fix the issue, and replace with a dry bandage.

What does swelling distal to the bandage indicate?

It usually indicates that the bandage is too tight.

How often should a catheter be flushed if not in continuous use?

Every 4 hours.

How frequently should the catheter dressing be removed and inspected?

Every 48 hours or as needed, no longer than 72 hours.

What are the signs of phlebitis?

Erythema, swelling, tenderness, and increased skin temperature.

What are the signs of thrombosis?

A vein standing on its own or a cord-like feeling in veins.

What are the signs of infection at the catheter site?

Erythema, swelling, tenderness, increased skin temperature, and purulent discharge.

What is the acronym ALE used for in emergency drug administration?

Atropine, Lidocaine, & Epinephrine.

What is the difference between giving ALE drugs through tracheal injection versus IV?

Can be given twice the IV dosage.

What is the purpose of injecting drugs into the trachea of an unconscious animal?

To achieve extremely rapid absorption of the drugs during emergencies.

What is the procedure for intratracheal administration of drugs?

Insert a polypropylene urinary catheter or rubber feeding tube into the trachea and inject the drug, followed by air or saline to disperse the drug.

What is intraosseous (IO) administration used for?

To deliver fluids, drugs, and blood products when IV access is not possible.

What sites can be used for intraosseous needle insertion?

Tibia, femur, humerus, and occasionally the iliac wing or ischium.

What gauge needles are typically used for intraosseous administration?

15 to 18 gauge bone marrow needles; 18 to 22 gauge for neonates.

What is the intraperitoneal (IP) route used for?

To place substances directly into the abdominal cavity for administering noncaustic fluids, blood products, or medications.

What is the benefit of using warm or cool fluid IP lavage?

To treat patients with severe hypothermia or hyperthermia.

How should the abdominal area be prepared for IP administration?

Shaved and aseptically prepared.

What position should the patient be in when measuring for ET tube size and placement?

Sternal recumbency.

How should the assistant position the patient when preparing for intubation?

Grasp the maxilla behind the canine teeth, extend the neck, and raise the head.

How should the mouth be opened for intubation?

Grasp the tongue with a gauze sponge and pull it out and down.

What technique is used to visualize the glottis during intubation?

Gently displace the epiglottis ventrally or the soft palate dorsally with the tip of the ET tube.

What should you do after inserting the ET tube past the vocal folds?

Gently transfer the patient to lateral recumbency.

What materials can be used to secure the ET tube?

Roll gauze or used IV tubing.

What should you do after securing the ET tube?

Turn on the oxygen & connect the tube connector to the breathing circuit.

How can you check for proper placement of the ET tube?

Revisualize the larynx

Expansion & contraction of the reservoir bag as the patient breathes

Feel for air movement from the tube connector

Palpate the neck, only 1 firm structure should be palpable, 2 structures mean the ET tube is in the esophagus

Vocalization indicates incorrect placement

A cough reflex indicates proper reflex

And normal waveform on an end-tidal CO2 monitor.

What is laryngospasm?

A complication where the glottis forcibly closes during intubation, making tube placement difficult; can be given lidocaine to relax glottis

What should you never do when intubating a patient?

Never force the tube.

What is the recommended pressure for cuff inflation to prevent leakage of anesthetic gases?

Inflate the cuff until leaking ceases at a pressure of 20 cm H2O.

What can result from overinflation of the cuff?

Serious complications, including damage to the trachea.