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Bergstrom TC, Kilcoyne I, Magdesian KG, Nieto JE. Increasing tourniquet number has no effect on amikacin concentration within the radiocarpal joint in horses undergoing intravenous regional limb perfusion. Am J Vet Res 2022; 83:364-370. [PMID: 35113796 DOI: 10.2460/ajvr.21.08.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether IV regional limb perfusion (IVRLP) performed in the cephalic vein with a wide rubber tourniquet (WRT) applied proximal and distal to the carpus results in a higher peak concentration (Cmax) of amikacin in the radiocarpal joint (RCJ), compared with the Cmax for IVRLP using a single WRT proximal to the carpus. Animals 7 healthy adult horses. Procedures Horses underwent IVRLP using standing sedation with 2 g of amikacin sulfate diluted to 60 mL by use of saline (0.9% NaCl) solution in the cephalic vein with 2 different tourniquet techniques; proximal WRT (P) and proximal and distal WRT (PD). Synovial fluid was collected from the RCJ at 5, 10, 15, 20, 25, and 30 minutes after IVRLP. Tourniquets were removed after the 30-minute sample was collected. Blood samples from the jugular vein were collected at 5, 10, 15, 20, 25, 29, and 31 minutes after IVRLP. Amikacin concentration was quantified by a fluorescence polarization immunoassay. Median peak concentration (Cmax) of amikacin and time to maximum drug concentration (Tmax) within the RCJ were determined. Results Median peak concentration in the RCJ was 1331.4 μg/mL with technique P and 683.1 μg/mL with technique PD. Median Tmax occurred at 30 minutes with technique P and 25 minutes with technique PD. No significant (Cmax, P = 0.18; Tmax, P = 0.6) difference in amikacin Cmax or Tmax between techniques was detected. Clinical Relevance Placement of 2 WRTs offers no advantage to a single proximal WRT when performing IVRLP to deliver maximal amikacin concentrations to the RCJ using IVRLP.
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Affiliation(s)
- Thomas C Bergstrom
- William R. Prichard Veterinary Medical Teaching Hospital, University of California-Davis, Davis, CA
| | - Isabelle Kilcoyne
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - K Gary Magdesian
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - Jorge E Nieto
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA
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de Souza Garcia AF, Ribeiro G, de Assis Arantes J, Reginato GM, Xavier NV, Carregaro AB, Silva TJF, Grigoletto R, de Freitas SH, Dória RGS. Evaluation of totally implantable catheters in healthy horses. BMC Vet Res 2021; 17:339. [PMID: 34702265 PMCID: PMC8549289 DOI: 10.1186/s12917-021-03052-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For horses requiring prolonged daily cephalic intravenous regional limb perfusion (IVRLP), the use of a totally implantable catheter (TIC) could be indicated to reduce complications associated with frequent venipuncture or external catheterization. This study aims to evaluate the implantation technique of the TIC in the cephalic vein of horses for IVRLP, describe the complications associated with the device's placement and use, and assess its viability up to 60 days after implantation. Totally implantable catheters, cut to 15 cm (n = 5) and 46 cm (n = 5) in length, were implanted into one cephalic vein in ten adult horses (n = 10). Twenty-four hours following placement, IVRLP with contrast was performed via the TIC and evaluated with radiography. Physical examinations, lameness evaluation, hematologic assessment, and the catheter patency tests were performed at scheduled intervals for the duration of catheterization (7-60 days). RESULTS Catheters were implanted without difficulty and allowed for IVRLP 24 h post implantation. Complications resulted in removal of the catheters, with four maintained for 7 days, three in place for 15 days, and three catheters maintained for 60 days. Complications included lameness, limb swelling, catheter kinking, and venous thrombosis. CONCLUSIONS The implantation technique of the TIC in the cephalic vein of horses is feasible and requires minimal technical effort. Although TIC allows venous access without the need for repeated venipuncture, its long-term use presents complications. For horses requiring prolonged daily cephalic IVRLP, the use of a TIC could be indicated. However, the high incidence of venous thrombosis may limit clinical application.
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Affiliation(s)
| | - Gesiane Ribeiro
- United Metropolitan Colleges, Rua Ministro Nelson Hungria, 541, Vila Tramontano, São Paulo, São Paulo, 05690-050, Brazil
| | - Julia de Assis Arantes
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil
| | - Gustavo Morandini Reginato
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil
| | - Nathalia Villaca Xavier
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil
| | - Adriano Bonfim Carregaro
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil
| | - Thiago Jhonatha Fernandes Silva
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil
| | - Renan Grigoletto
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil
| | - Silvio Henrique de Freitas
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil
| | - Renata Gebara Sampaio Dória
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil.
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Kelmer G, Tatz AJ, Famini S, Bdolah-Abram T, Soback S, Britzi M. Evaluation of regional limb perfusion with chloramphenicol using the saphenous or cephalic vein in standing horses. J Vet Pharmacol Ther 2014; 38:35-40. [PMID: 25073920 DOI: 10.1111/jvp.12140] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 05/14/2014] [Indexed: 11/28/2022]
Abstract
Regional limb perfusion (RLP) significantly decreases morbidity and mortality associated with distal limb injuries in horses. There is an urgent need for finding additional effective antimicrobial drugs for use in RLP. In this study, we tested the pharmacokinetics (PK) of chloramphenicol in RLP. Eight horses participated in the study, which was approved by the University Animal Care and Use Committee. The cephalic and the saphenous veins were used to perfuse the limbs. Synovial samples were collected from the metacarpo/metatarsophalangeal (MCP/MTP) joint. The Friedman Test was applied for assessing change in PK concentration over time, for all time points. The Wilcoxon Signed Ranks Test was used to test the difference between PK concentration in joint & serum as well as concentration in joint vs. MIC. The comparison of measurements between measurements taken on hind vs. front legs was carried out using the Mann-Whitney Test. A P-value of 5% or less was considered statistically significant. After RLP, the concentration of chloramphenicol in the synovial fluid of the MCP/MTP joint using either the cephalic or the saphenous vein was initially far above the minimal inhibitory concentration (MIC) of most susceptible pathogens and remained above the MIC for approximately 6 h. The results indicate that performing RLP using the cephalic and saphenous veins enables reaching concentrations of chloramphenicol in the MCP/MTP joint that are well above the MIC of most susceptible pathogens. The chloramphenicol concentrations achieved in the synovial fluid of the MCP/MTP joint in the current study were between 1.5 (MTP) and 7 (MCP) times the MIC of MRSA in horses. These results are encouraging since MRSA infections are becoming far more common, causing considerable morbidity. To the best of our knowledge, this is the first study to evaluate the pharmacokinetics of chloramphenicol following RLP in the horse and the results are positive.
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Affiliation(s)
- G Kelmer
- Department of Large Animal Medicine and Surgery, Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
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Rubio-Martínez LM, Elmas CR, Black B, Monteith G. Clinical use of antimicrobial regional limb perfusion in horses: 174 cases (1999-2009). J Am Vet Med Assoc 2013; 241:1650-8. [PMID: 23216042 DOI: 10.2460/javma.241.12.1650] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the clinical use of regional limb perfusion with antimicrobials (A-RLP), complications, and outcome in a large series of patients. DESIGN Retrospective case series. ANIMALS 174 horses. PROCEDURES Medical records of horses treated with A-RLP between 1999 and 2009 were reviewed. Signalment, primary complaint, horse use, etiology, duration of clinical signs, previous treatment, structures involved, concurrent conditions, A-RLP characteristics, additional treatments, complications, and outcome were recorded. At long-term follow-up, 2 outcomes were investigated: survival rate and return to previous use at the same or higher level. Univariate and multivariate logistic regression analyses were conducted. RESULTS Group 1 (96 horses) included septic synovitis. Group 2 (50 horses) included extrasynovial lacerations (23 horses) and fresh, minimally contaminated intrasynovial lacerations without evidence of established synovial infection (27 horses). Group 3 (28 horses) included miscellaneous other conditions. Only minor complications were reported in 12.26% of horses that received IV (n = 155) and 33% of horses that received intraosseous (27) A-RLP. Horses with septic synovitis had a lower survival rate (53.43%) than did horses with lacerations (91.89%). Within group 2, no significant differences in short- or long-term outcomes were found between horses with extrasynovial and fresh, minimally contaminated intrasynovial lacerations. For the horses returning to previous use, 80% of horses with septic synovitis and 72.72% of horses with lacerations were performing at the same or higher level at the time of follow-up. CONCLUSIONS AND CLINICAL RELEVANCE The results of the present study indicated that A-RLP is a safe technique with minimal adverse effects. The IV route presented fewer complications than intraosseous injection. Horses with infection of synovial structures had a lower survival rate than did those with acute, minimally contaminated intrasynovial lacerations. The latter had a similar prognosis for horses with extrasynovial lacerations treated with A-RLP.
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Affiliation(s)
- Luis M Rubio-Martínez
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Canada.
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Kelmer G, Martin-Jimenez T, Saxton AM, Catasus C, Elliot SB, Lakritz J. Evaluation of regional limb perfusion with erythromycin using the saphenous, cephalic, or palmar digital veins in standing horses. J Vet Pharmacol Ther 2012; 36:434-40. [DOI: 10.1111/jvp.12028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 11/02/2012] [Indexed: 11/26/2022]
Affiliation(s)
- G. Kelmer
- Large Animal Clinical Sciences; College of Veterinary Medicine; University of Tennessee; Knoxville TN USA
| | - T. Martin-Jimenez
- Comparative Medicine; College of Veterinary Medicine; University of Tennessee; Knoxville TN USA
| | - A. M. Saxton
- Department of Animal Science; College of Agricultural Sciences and Natural Resources; University of Tennessee; Knoxville TN USA
| | - C. Catasus
- Large Animal Clinical Sciences; College of Veterinary Medicine; University of Tennessee; Knoxville TN USA
| | - S. B. Elliot
- Large Animal Clinical Sciences; College of Veterinary Medicine; University of Tennessee; Knoxville TN USA
| | - J. Lakritz
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; The Ohio State University; Columbus OH USA
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Kelmer G, Tatz A, Bdolah-Abram T. Indwelling cephalic or saphenous vein catheter use for regional limb perfusion in 44 horses with synovial injury involving the distal aspect of the limb. Vet Surg 2012; 41:938-43. [PMID: 22809228 DOI: 10.1111/j.1532-950x.2012.01006.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe indwelling cephalic or saphenous vein catheter use for intravenous regional limb perfusion (ID-IV-RLP) to treat horses with synovial injury (contamination/infection) of the distal aspect of the limb. STUDY DESIGN Retrospective case series. ANIMALS Horses (n = 44; 45 limbs) treated with proximal ID-IV-RLP. METHODS Horses had ID-IV-RLP using a cephalic (21 limbs) or saphenous (24 limbs) vein. Amikacin was the most frequently used antibiotic. Number of perfusions ranged from 3 to 21 (median 7). A cast was applied to 14 injured limbs (1 tube cast, 1 full-limb cast, 2 foot casts, and 10 half-limb casts). RESULTS Synovial sepsis of the distal portion of 87% of limbs (39) resolved, and 61% of horses returned to soundness. Catheter-related complications occurred in 27% of the limbs but were not significantly associated with outcome. Presence of osteomyelitis was significantly associated with a poor outcome. CONCLUSIONS ID-IV-RLP using the cephalic or saphenous vein is an alternative to traditional RLP. An indwelling catheter provided prolonged venous access and facilitated successive perfusions.
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Affiliation(s)
- Gal Kelmer
- Department of Large Animal Medicine and Surgery, Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, the Hebrew University of Jerusalem, Israel.
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