Jugular catheterization in Cats (Felis) | Vetlexicon
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Jugular catheterization

ISSN 2398-2950

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Introduction

  • Good sample collection technique is vital to successful biochemical and hematological analysis of blood.
  • Jugular vein gives rapid, unobstructed flow of blood.
  • Peripheral veins, eg cephalic and saphenous, often detrimental   →   slow blood flow   →   sample artifacts (hemolysis and microclots).

Uses

Advantages

  • Easily accessible, large vein.
  • Simple technique.
  • Can be performed in conscious animal with simple restraint.

Disadvantages

  • Difficult to apply sustained pressure to venipuncture site if required.

Technical problems

  • Poor technique or attempts to place in an animal with coagulopathy may result in significant bruising/hemorrhage.

Alternative techniques

Requirements

Personnel

Nursing expertise

  • Success depends on good holding and raising of vein.

Materials required

Minimum equipment

  • Tourniquet (if skilled assistant unavailable).

Minimum consumables

  • Intravenous catheter of choice - available in a wide range of materials; with/without provision for stitching in place; various sizes dependent upon use and size of patient. 3-way taps or capping mechanisms.

Ideal consumables

  • 3-way tap.
  • 5 ml syringe containing heparinized saline.

Preparation

Site preparation

  • Clip and prepare lateral cervical region from ramus of the mandible caudally to the thoracic inlet and dorsally and ventrally to midline Jugular catheterization 01 .

Restraint

  • Restrain cat in lateral recumbency.

Technique

Approach

Step 1 - Preparation

  • Aseptically scrub clipped area Jugular catheterization 02 .

Core procedure

Step 1 - Locate vein

  • Wearing gloves, occlude jugular vein at thoracic inlet.
  • Palpate for jugular vein Jugular catheterization 03 .

Step 2 - Insert catheter

  • Tent skin over site of insertion Jugular catheterization 04 .
  • Direct needle under skin at a 30-45° angle until needle is just under skin Jugular catheterization 05 .
  • Position needle so it runs parallel with jugular vein.
  • Bring needle over jugular vein.
  • If jugular vein cannot be easily visualized, strum vein with needle, watching for a "jumping" movement of vein under skin and subcutaneous tissues.
  • Once vein is isolated, insert needle using a 30-34° angle into vein, watching for a flash in the catheter Jugular catheterization 06 .
  • Insert catheter and its stylette.
  • Remove needle from vein and out from skin.
  • Secure catheter into hub.

Step 3 - Secure catheter

  • Place manual pressure with gauze 4x4s over site of insertion into vein to prevent hemorrhage.
  • Remove small portion of catheter from vein and make loop.
  • Tape catheter in place.
  • Bandage around catheter to prevent slipping from vein Jugular catheterization 07  Jugular catheterization 08 .

Exit

Step 1 - Remove catheter

  • Withdraw catheter and apply pressure to venipuncture site for 1-2 mins.

Aftercare

Immediate Aftercare

Wound Protection

  • Withdraw catheter and apply pressure to venipuncture site for 1-2 mins.

Special precautions

  • Before use flush catheter with normal saline to ensure that the lumen is not blocked, or draw back on syringe - should fill with blood.
  • A patent catheter is a potential route for the hematogenous spread of infection - always use aseptic technique when using and swab injection port before use.
  • To limit introduction of infection in long-term placement cover insertion site with antiseptic dressing.

Potential complications

  • Catheter may become blocked with blood clot when not in use - flushing with heparinized saline after use can reduce this risk.
  • Catheter can migrate if not firmly fixed in position.
  • A catheter positioned too close to the joint can become occluded by limb flexion interfering with fluid flow.
  • Blood leakage around catheter can occur particularly in long-term placements   →   hematoma formation - should resolve once catheter removed.
  • Infusion of irritant substances can    →   inflammation of blood vessel wall and surrounding tissues   →    discomfort, swelling and/or pain.
  • Hematogenous spread of infection can occur via catheter - if suspected, catheter should be removed immediately and bacteriology performed from catheter tip swab. Treat with antibiotic of choice.

Outcomes

Complications

  • Inadvertent puncture of opposite vessel wall on introducing needle into vein   →   hematoma formation.

Reasons for treatment failure

  • Low blood pressure, eg in terminally ill patient for euthanasia, may make location of vein difficult - an alternative route may have to be used.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Lainesse C, Boysen S R & Doucet M Y (2007) One-step method for catheterising the jugular vein of cats to enable repeated blood sampling. Vet Rec 161 (7), 221-5 PubMed.