Comparison of time to obtain intraosseous versus jugular venous catheterization on canine cadavers

Comparison of placement characteristics using two intraosseous devices in canine and feline cadavers by novice users

Introduction

Intraosseous (IO) catheterization enables rapid access to systemic circulation in critical patients. A battery-powered IO device (BPIO) utilized in veterinary practice is reliable in facilitating IO catheter placement. A new spring-powered IO device (SPIO) has been developed for people but has not been tested in veterinary patients. The goal of our study was to compare placement characteristics and flow rates achieved with the BPIO compared to the SPIO in animals when operated by novice users.

Methods

Six veterinary students performed 72 catheterizations in the humeri and tibias of 12 dog and 6 cat cadavers. The user, cadaver, device, and site of placement were randomized. Flow rates were determined by three-minute infusions.

Results

In dogs, overall success rates (50% BPIO, 46% SPIO; p = 0.775) and flow rates based on location were similar between devices. Successful placement was faster on average with the BPIO (34.4 s for BPIO and 55.0 s for SPIO, p = 0.0392). However, time to successful placement between devices was not statistically significant based on location (humerus: 34.7 s for BPIO and 43.1 s for SPIO, p = 0.3329; tibia: 33.3 s for BPIO and 132.6 s for SPIO, p = 0.1153). In cats, success rates were similar between devices (16.7% for BPIO and 16.7% for SPIO, p = 1.000), but limited successful placements prevented further analysis.

Discussion

This is the first study to examine the use of the SPIO in animals, providing preliminary data for future IO studies and potential applications for training in the clinical setting.

Comparison of success rate and time to obtain venous cannulation by cutdown technique at 3 locations using canine cadavers

OBJECTIVE

To compare the success rates and time taken to cannulate the jugular, cephalic, and lateral saphenous veins using a cutdown technique by personnel with 4 different levels of experience.

DESIGN

Prospective ex vivo study.

SETTING

Veterinary university teaching hospital.

ANIMALS

Eighteen canine cadavers.

INTERVENTIONS

Recently euthanized canine patients that were donated to the hospital for research purposes between October 2019 and March 2020 were enrolled. Four groups of personnel participated in the study to give 4 varying levels of experience: 8 final year veterinary students, 2 registered veterinary nurses, 1 emergency and critical care intern and 1 ACVECC diplomate. Each cannula placer had 5 minutes to attempt cannulation by venous cutdown at each site. Time to venous cannulation (VC) was compared for each site and group and complications encountered during each attempt recorded.

MEASUREMENTS AND MAIN RESULTS

The overall success rate for cannulation of the jugular, cephalic, and lateral saphenous veins were 81%, 84%, and 87%, respectively. The median times for venous cutdown for all personnel were as follows: jugular vein 119 s (range 51-280 s), cephalic vein 82 s (range 39-291 s), and lateral saphenous vein 110 s (range 41-294 s). There was no difference in time to VC between veins. When comparing personnel at the 3 cannulation sites, the ACVECC diplomate was faster than the registered veterinary nurses and students (P = 0.042 and P = 0.048, respectively). No differences were found between any other groups. Complications encountered often related to cadaver factors such as hematoma from antemortem venipuncture.

CONCLUSIONS

All groups were able to perform venous cutdown at each site with good overall success even without prior experience of the technique. VC by cutdown technique of the jugular, cephalic, or lateral saphenous veins may be considered in an emergency setting by personnel of various skill levels.

Advanced Vascular Access in Small Animal Emergency and Critical Care

In canine and feline patients presenting in a state of hemodynamic collapse, obtaining vascular access can be challenging. Delays in achieving vascular access interfere with delivery of patient care. In human medicine, definitions of difficult vascular access are variable and include the need for multiple placement attempts or involvement of specialized teams and equipment. Incidence and risk factors for difficult vascular access have not been well studied in veterinary patients, which limits understanding of how best to address this issue. Alternatives to percutaneous peripheral or central intravenous catheterization in dogs and cats include venous cutdowns, umbilical access in newborns, corpus cavernosum access in males, ultrasound-guided catheterization, and intraosseous catheterization. In recent years, advances in ultrasonography and intraosseous access techniques have made these more accessible to veterinary practitioners. These vascular access techniques are reviewed here, along with advantages, limitations, and areas for future study of each technique.

Update on Canine Parvoviral Enteritis

Canine parvoviral enteritis is one of the most common causes of morbidity and mortality in dogs worldwide. Tests can detect viral antigen in feces, and characteristic decreases in total leukocyte, neutrophil, and lymphocyte counts can increase the index of suspicion in affected cases and can be used to prognosticate morbidity and mortality. The standard of care for infected animals includes IV crystalloid and sometimes colloid fluids, antiemetics, broad-spectrum antibiotics, and early enteral nutrition. Vaccination induces protective immunity in most dogs. Vaccination, along with limiting exposure in young puppies, is the most effective means of preventing parvoviral enteritis in dogs.

Intraosseous Catheter Flow Rates and Ease of Placement at Various Sites in Canine Cadavers

Objective: To compare intraosseous catheter placement difficulty, success rates, and flow rates at four different locations in canine cadavers.

Design: Prospective study.

Setting: Private referral center.

Animals: Eleven fresh canine cadavers.

Interventions: With owner consent, animals presenting for euthanasia were recruited. Animals received heparin (1,000 IU/kg IV) at least 5 min prior to euthanasia. After euthanasia, EZIO intraosseous catheters were placed into the ilial wing, proximal medial tibia, proximal lateral humerus, and distal lateral femur on one side of the animal. Time to catheter placement and catheter difficulty were scored for each placement site. Sterile saline was infused into each location simultaneously over 5 min, first via gravity then using 300 mmHg pressure. Animals were repositioned onto the contra-lateral side and the experiment repeated.

Measurements and Main Results: Placement was successful in 16/22 ilial, 18/22 tibial, and 22/22 femoral and humoral attempts. A post-hoc analysis revealed the ileum had a significantly greater difficulty score when compared to the femur and humerus (p ≤ 0.0001). The femur had a statistically significant faster placement time when compared to the ileum (p ≤ 0.05). Gravity infusion rates were statistically lower in the tibia when compared to humerus (p ≤ 0.01) and between the tibia when compared to the femur (p ≤0.001). Additionally, pressurized infusion rates were statistically lower in the tibia compared to the humerus (p ≤ 0.0001), the femur (p ≤ 0.0001), and the ileum (p ≤ 0.01).

Conclusions: The femur and humerus had high success rate for IO catheter placement and low placement time and difficulty scores. Pressurized intraosseous flow rates were highest in the humerus and femur. Contrary to human literature, success rates for catheter placement in the humerus and femur were higher than at other sites, suggesting the humerus and femur may be preferred sites for intraosseous catheter placement in the dog. Further investigation through a larger sample size is required to confirm these findings.