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Veterinarian Technician July 2010 (Vol 31, No 7)

Final View: A One-in-a-Million Catheter Placement

by Jacklyn V. Fischer, CVT, Elisa M. Mazzaferro, MS, DVM, PhD, DACVECC, Stacy Meola, DVM, MS

    Pesky, a 16-year-old, domestic medium-haired cat, was transferred to our emergency department for diagnostics and continued specialty care after a history of elevated renal values, hypertension, and inappetence (for 1 week). Abdominal ultrasonography showed severe pyelectasia and hydronephrosis of the left kidney with dilation of the left ureter and no evidence of a urethral calculus.

    Our critical care specialist instructed our technician to place a jugular central venous catheter. Pesky was restrained in left lateral recumbency, and the right jugular area was routinely clipped and aseptically scrubbed. A 16-gauge, over-the-wire catheter was placed using the Seldinger technique. The catheter placement was fairly uncomplicated except for mild resistance when the catheter was fed over the guidewire. The catheter was successfully placed and sutured in place according to the manufacturer’s recommendations. The catheter was flushed with heparinized saline, and patency was confirmed. Sterile, 4 × 4–inch gauze squares were placed over the catheter site, and Pesky was placed in right lateral recumbency for placement of an esophagostomy tube (e-tube) by the attending veterinarian.

    Sedation was induced with propofol (4 to 6 mg/kg IV to effect) through the jugular IV catheter for e-tube placement. A right lateral radiograph showed proper placement of the e-tube and the looped jugular catheter (FIGURE 1).

    The jugular catheter entered the lateral neck, coursed distally to the thoracic inlet, coursed medially, and ascended cranially and rostrally, with final positioning of the catheter tip medial to the catheter entrance (FIGURE 2). Because of the abnormal placement of this catheter, attempts were made to place a new central line; however, these were unsuccessful because of the patient’s dehydration and previous venipuncture sites. It was decided to keep the original long catheter in place for blood draws. A peripheral IV catheter was placed for administering IV fluids.

    The patient’s disease progressed rapidly, and the owner elected euthanasia 72 hours after admission.

    Presumably, the jugular catheter had entered the external jugular vein and crossed into the internal jugular vein—a one-in-a-million catheter placement.

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