Jugular thrombophlebitis resulting from an anaesthetic induction technique in the horse

Use of saline contrast ultrasonography in the diagnosis of complete jugular vein occlusion in a horse

Background

Thrombophlebitis and thrombosis are the most common causes of jugular vein occlusion in horses. Medical and surgical treatments aim to recanalize the occluded vessel and reduce proximal venous congestion and edema.

Case Description

The present report describes a clinical case of equine jugular vein thrombosis (JVT) with complete vein occlusion diagnosed by saline contrast ultrasonography (SCU) and confirmed by contrast venography.

Conclusion

Our results demonstrated that the SCU test can be easily performed and objectively interpreted using standard ultrasound equipment; it is not expensive and it does not require x-ray exposure. The SCU test is a valid tool to assess vessel patency and presence of collateral circulation in JVT. The test could therefore be used to monitor the progression of the disease and the effectiveness of therapy against JVT in horses.

Outcome and complications in horses administered sterile or non-sterile fluids intravenously

Background

Obtaining commercial fluids for intravenous administration (IVF) was challenging during a recent shortage. This necessitated use of custom‐made non‐sterile fluids for intravenous administration (JUGs) in some hospitals. There are no studies comparing outcome of horses treated with JUG versus IVF and limited information is available about adverse effects of JUGs.

Hypothesis/Objectives

To evaluate death, complications, blood pH, and plasma electrolyte concentrations of horses that received JUG versus IVFs.

Animals

One hundred eighty‐six horses that received IVFs and 37 that received JUGs.

Methods

A retrospective review of medical records was performed to identify horses that received IVFs or JUGs during hospitalization. Information including survival to discharge, complications (fever [>38.5°C], jugular vein phlebitis/thrombosis, arrhythmia, or laminitis), blood pH, and plasma electrolyte concentrations were obtained.

Results

There was no difference (P = .67) in survival to discharge for horses that received JUGs (78%) compared to horses that received IVFs (87%). Horses that received JUGs were more likely to develop a jugular vein complication (3 of 37 versus 1 of 186, odds ratio 17.2 [95% CI 1.9‐389.8], P = .04). Horses that received JUGs were more likely to have electrolyte abnormalities consistent with hyperchloremic metabolic acidosis.

Conclusion and Clinical Importance

Veterinarians using JUGs should obtain informed client consent because of a potential increased risk of jugular vein complications. Chloride content of JUGs should be considered to limit development of hyperchloremic metabolic acidosis.

[Catheter-associated complications in the horse - diagnosis and treatment in practice]

Venous diseases due to venous catheters have variable symptoms and clinical progress. They comprise perivenous hematoma, periphlebitis, endophlebitis, phlebothrombosis or septic thrombophlebitis. To diagnose venous disease, a clinical examination (possibillity to distend the vein, swelling, pain, increased skin temperature, and any exudation around the injection site) and an ultrasonographic examination (perivenous tissue, venous wall, venous content) of the vein are performed. Treatment of venous diseases depends on the etiology and pathogenesis and combines the use of anticoagulants (heparin, phenprocoumon), anti-inflammatory and analgesic substances (non-steroidal inflammatory drugs) as well as the application of antibiotics depending on the case. For prevention of venous diseases a careful catheter management is important. This includes in particular the adequate selection of the catheter system (long-term catheter made of polyurethane), catheter care and intensive monitoring. This article reviews the different venous diseases, diagnosis and therapeutic measures in a practical manner.

Surgical treatment of septic jugular thrombophlebitis in nine horses

OBJECTIVE

To report a technique for surgical treatment of septic jugular thrombophlebitis unresponsive to medical treatment.

STUDY DESIGN

Case series.

ANIMALS

Horses (n=9) with septic jugular thrombophlebitis unresponsive to medical treatment.

METHODS

Jugular vein thrombectomy was performed under standing sedation and local anesthesia. The contents of the affected portion of vein were removed by multiple incisions in the vein, with the incisions left open to drain and heal by second intention.

RESULTS

The technique was curative in all instances, although 2 horses required a 2nd procedure. One horse required ligation of the linguofacial vein to control postsurgical hemorrhage.

CONCLUSIONS

The technique is an effective surgical treatment for septic jugular thrombophlebitis unresponsive to medical treatment.

CLINICAL RELEVANCE

Jugular vein thrombectomy is a straightforward technique, and has minimal postoperative complications. It allows expedient and cost-effective resolution of medically recalcitrant cases of septic jugular thrombophlebitis.

Jugular thrombophlebitis developed from buccal ulcer in a thoroughbred horse

A 22-year-old Thoroughbred stallion had severe left jugular thrombophlebitis. Macroscopic and microscopic examinations revealed extension of the lesions from a penetrating ulcer on the left buccal mucosa to the underlying muscle and local vein, and sequentially to the left jugular vein. This was a rare case of equine jugular thrombophlebitis caused by direct extension of infection from a traumatic oral lesion.

A study of seven different types of grafts for jugular vein transplantation in the horse

The aim of this study was to investigate the biological behaviour of vascular grafts replacing a section of the jugular vein in order to improve the results of the surgical treatment of complete thrombosis of the jugular vein in the horse. Seven graft types: fresh allograft, home frozen allograft, glutaraldehyde-fixed allograft, cryo-preserved allograft, PTFE-graft (Gore), small intestinal submucosa preparation (Cook) and fresh autograft, were randomly implanted in ponies. The grafts were removed after one month and examined histologically for: preservation of the graft structures, acceptance by the host, intima proliferation, presence of endothelium and patency. The glutaraldehyde- and cryopreserved grafts show reasonable results and the PTFE and autograft had the best results especially with respect to host acceptance, endothelium presence and patency. Further research is necessary to improve graft behaviour, especially to the aspect of endothelisation. Obstruction of the jugular vein in horses can be treated surgically.

Clinical observations during induction and recovery of xylazine-midazolam- propofol anesthesia in horses

To evaluate clinical usefulness of xylazine (1.0 mg/kg)-midazolam (20 microg/kg)-propofol (3.0 mg/kg) anesthesia in horses, 6 adult Thoroughbred horses were examined. The quality of induction varied from poor to excellent and 5 out of 6 horses presented myotonus in the front half of the body. However, paddling immediately after induction observed in other reports of equine propofol anesthesia was not observed. Recovery time was 35.3 +/- 9.3 min and the quality of recovery was calm and smooth in all horses. Respiration rate decreased after induction and hypoxemia was observed during lateral recumbency. Heart rate also decreased after induction, however mean arterial blood pressure was maintained above approximately 100 mmHg.

Equine surgical colic: risk factors for postoperative complications

The reason for undertaking this study was that postoperative complications of colic surgery lead to patient discomfort, prolonged hospitalisation and increased cost. Potential risk factors for the 6 most common postoperative complications (jugular thrombosis, ileus, re-laparotomy, wound suppuration, incisional herniation and colic) were evaluated using multivariable models. Jugular thrombosis was associated significantly with heart rate greater than 60 beats/min and with increased packed cell volume (PCV) at admission. The risk of postoperative ileus also increased with increasing PCV at admission and was higher in horses recovering from pedunculated lipoma obstruction. Incisional herniation was strongly associated with wound suppuration and with increasing heart rate at admission. The emergence of cardiovascular parameters as risk factors for several postoperative complications is consistent with the hypothesis that endotoxaemia is important in the development of these complications. Early referral of colic cases, prior to the development of severe endotoxaemic shock, may minimise the risk of some postoperative complications. Horses that have suffered epiploic foramen entrapment, are more than 4 times as likely to undergo re-laparotomy than other horses. Horses that have suffered postoperative ileus have a similarly increased risk of undergoing re-laparotomy. The risk of postoperative colic is significantly associated with horses recovering from large colon torsion (>360 degrees) and with having undergone re-laparotomy. Hazard ratios (with 95% confidence intervals) for these last two effects are 3.1 (1.7, 5.7) and 3.4 (1.9, 6.2), respectively. Knowledge of the risk factors for postoperative complications allows more accurate prognostication postoperatively and suggests ways in which the risk of postoperative complications can be minimised.

Factors influencing the occurrence of thrombophlebitis after post-surgical long-term intravenous catheterization of colic horses: a study of 38 cases

Thrombophlebitis is a well-known complication of the use of long-term in-dwelling catheters. In humans, catheter material has been shown to strongly influence the occurrence of thrombophlebitis. In the horse, the influence of catheter material has been studied in healthy experimental animals, but information on the relative importance of this factor is lacking. To investigate which factors have most impact on the frequency of jugular vein thrombosis in post-surgical colic horses, a clinical study was performed on 38 animals. Horses were randomly divided into two groups. In one group a polytetrafluoroethylene catheter was used, in the other a polyurethane catheter. Both groups were clinically monitored and screened for signs of thrombophlebitis. Seven out of 38 horses developed thrombophlebitis. The type of catheter material used had no influence on thrombophlebitis development. Dwell time was significantly longer in horses that developed thrombophlebitis compared with those that did not. There was no relationship between the occurrence of thrombophlebitis and underlying disease or surgical treatment, suggesting that the general state of debilitation these horses experienced was the most important determinant for the development of thrombophlebiris. This was further stressed by the fact that seven horses developed thrombophlebitis of the contralateral vein that had been used for the induction of anaesthesia (this incidence is much higher than in horses anaesthetized for elective surgery). It is concluded that the state of debilitation is the most important determining factor for the occurrence of thrombophlebitis after the use of long-term in-dwelling intravenous catheters. This makes a substantial reduction of the incidence of thrombophlebitis difficult, but some progress can be made by consequently restricting dwell time.

A retrospective study of vein thrombosis in horses treated with intravenous fluids in a veterinary teaching hospital

The medical records of 68 horses treated with IV fluids for 24 hours or more were reviewed to determine the risk of vein thrombosis and to determine which factors were associated with the occurrence of vein thrombosis in these horses. Three factors were positively associated with vein thrombosis including use of locally produced fluids and presence of fever and diarrhea. Two factors, having general anesthesia or having surgery, were negatively associated with vein thrombosis. One continuous variable, duration of treatment, was positively associated with vein thrombosis. Factors not associated with vein thrombosis included breed, age, sex, type of catheter, outcome (lived or died), laminitis, colic, other drugs via the catheter, and type of surgery. One type of catheter was used in the majority of horses (57) making it difficult to detect effect of catheter type. Preparation of the catheter site, the person placing the catheter, and technique of catheter maintenance were not evaluated. Like all retrospective studies, this study has limitations to the conclusions that can be made; however, the strong association between source of fluids, fever, diarrhea, anesthesia/surgery, and the occurrence of vein thrombosis merits consideration in the clinician's therapeutic plan.

Jugular vein wall repair after intravenous injection in equids

The evolution of the healing process of venous puncture wounds was studied macroscopically and light-microscopically in order to determine the time of venipuncture. Seven small equids of various ages, all in normal healthy condition, were experimentally injected in the external jugular vein with a physiological Hartmann solution at different times before euthanasia. Two types of needle diameters i.e. 16.5 G and 19 G, were used. A fairly good uniformity in the healing process was seen in the 7 animals. In most cases the lesions induced within 5 weeks before death were macroscopically visible, whereas older perforation sites became indistinct. Light-microscopic study enabled determination of the time lapse after intravenous injection. The needle diameter seemed hereby relatively unimportant. Points of reference were endothelium repair, presence of a fibrin plug containing red and white blood cells, neovascularization and healing of the connective tissue fibers.

Effects of 5% and 10% guaifenesin infusion on equine vascular endothelium

Twelve horses of various breeds and either sex were anesthetized with xylazine and ketamine injected into a median or lateral thoracic vein. During anesthesia, with the horse in sternal recumbency, a 14-gauge, 8.9 cm catheter was inserted into each jugular vein by using aseptic technique. Guaifenesin in water (100 mg/kg or a maximum dose of 50 grams) was infused into one jugular vein and an equal volume of 0.9% saline solution was infused into the other jugular vein. Seven horses received 10% guaifenesin, and five horses received 5% guaifenesin. The catheters were removed before the horses recovered from anesthesia. The horses were euthanatized approximately 48 hours later, and the jugular veins were removed for histologic examination. Adherent thrombus material was observed in all veins exposed to 10% guaifenesin and in one vein exposed to 5% guaifenesin. No evidence of thrombus was observed in four veins infused with 5% guaifenesin or in those infused with saline solution. These findings are of particular significance with horses at increased risk for thrombosis or thrombophlebitis.