Intraperitoneal catheterization in Cats (Felis) | Vetlexicon
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Intraperitoneal catheterization

ISSN 2398-2950


Synonym(s): Diagnostic peritoneal lavage

Introduction

  • To introduce a catheter into the abdomen for administration or drainage of fluids.

Uses

  • Peritoneal lavage, eg uroperitoneum.
  • Collection of fluid samples for diagnostic techniques. 
  • Fluid dialysis, eg acute renal failure Kidney: acute renal failure
  • Drainage of large volumes of abdominal fluid where rapid reduction of pressure is required, eg dyspnea due to ascites.

Advantages

  • Simple technique requiring minimal equipment and expertise.

Disadvantages

  • May not be possible to drain viscous fluid through needle.
  • Not recommended for fluid administration (venous route is far preferable).

Alternative techniques

  • Rigid needle placement for sampling rather than catheter.

Time required

Preparation

  • 5 min.

Procedure

  • 15 min.

Requirements

Materials required

Minimum equipment

  • Seldinger needle or catheter or standard needle.

Minimum consumables

  • Local anesthetic - 2% lignocaine Lidocaine.
  • Scalpel.
  • Swabs.
  • Syringe and needle.
  • Sample collection pots (EDTA and plain).

For lavage

  • Warmed IV fluid, eg Hartmann's or saline.
  • Infusion set.

Preparation

Site preparation

Site

  • Midline 2-3 cm cranial to umbilicus.
  • Alternatively needle can be placed in any of 4 quadrants (left cranial, right caudal, etc) if midline approach fails.

Preparation

  • Standard aseptic (clip, swab and drape).

Restraint

  • Restrain animal in left lateral recumbency.
  • Fluid aspiration can also be perfomed in standing animal.

Technique

Approach

Step 1 - Local anesthetic

  • Inject 2% lignocaine into skin and linea alba at a site in the midline 2-3 cm cranial to umbilicus.

Step 2 - Skin incision

  • Make a small skin incision with a scalpel over the denervated area.

Core procedure

Step 1 - Introduction of catheter

  • Connect infusion set to fluid bag and prime.
  • Insert catheter through skin incision.
  • If using peritoneal lavage catheter insert guide wire then thread catheter onto guide wire.
  • Push through abdominal wall into the abdominal cavity.
  • Withdraw guide wire or stylet.

Step 2 - Peritoneal lavage

  • Attach fluid line.
  • Advance catheter some more.
  • Fluid therapy - run in fluid as required.

Step 3 - Diagnostic peritoneal lavage

  • Run in 20 ml fluid/kg and gently massage abdomen.
  • Turn off fluid.
  • Disconnect fluid line.
  • Collect back flow into sterile container for analysis Peritoneal fluid: analysis.

Exit

Step 1 - Catheter removal

  • Withdraw catheter applying pressure on abdominal wall around point of entry.
  • Apply pressure to skin wound for a few minutes.
  • Wipe away any escaped fluid.
  • Skin incision does not require suturing or dressing.

Aftercare

Immediate Aftercare

Potential complications

  • Complications are rare and usually minor.
  • Potential complications include:
    • Organ laceration.
      Care if suspect hemangiosarcoma that trauma does not precipitate bleeding.

Outcomes

Reasons for treatment failure

  • Failure to obtain sample from simple aspiration:
    • No fluid present.
    • Fluid too viscous to aspirate through catheter size selected.
    • Catheter clogged by omentum or exudate.
  • Incorrect needle placement:
    • Blood contamination.
    • Placement outside peritoneal cavity:
      • Bowel contents.
      • Blood from splenic puncture.
      • Urine from bladder puncture.

Further Reading

Publications

Refereed papers