IV Canulars

Re: IV Canulars

Evelyn Barbour-Hill — Sat, 21 Mar 2015 14:25:19 GMT

[quote user="Linda Filshie"]To diverge slightly, I'd be interested in how aseptically others place IV catheters/cannulae. I clip the fur, wash my hands, quick scrub of the skin with hibi on cotton wool, swipe with alcohol and place the catheter. Have never had a problem with catheters left in 3-4 days. Contemplating this I am not sure how much point there is in the hibi stage as obviously contact time is a key determinant of decreasing skin surface bacteria levels. So how do the rest of you do it?

[/quote]

Much the same, but without the hibiscrub unless the skin is visibly excessively greasy or dirty. Wipe firmly several times with spirit. I don't believe that does much to the microbial population, but it removes what we scientists call the superficial crud.

If it's a longhaired animal, scissor the hair short right round the leg.

Re: IV Canulars

Linda Filshie — Sat, 21 Mar 2015 09:41:27 GMT

To diverge slightly, I'd be interested in how aseptically others place IV catheters/cannulae. I clip the fur, wash my hands, quick scrub of the skin with hibi on cotton wool, swipe with alcohol and place the catheter. Have never had a problem with catheters left in 3-4 days. Contemplating this I am not sure how much point there is in the hibi stage as obviously contact time is a key determinant of decreasing skin surface bacteria levels. So how do the rest of you do it?

Re: IV Canulars

Hannah Wynne Richards — Sat, 21 Mar 2015 08:53:04 GMT

Well said. The risks of leaving a cannula > 48 hrs have to be balanced against the risks of repeated venupuncture. Speaking as a dinovet (and fully aware I shall arouse the wrath of the "Thou shalt not give antibiotics " brigade ) what would be the % increase in antibiotic resistance if every animal who had an indwelling cannula for > 48 hours was given covering antibiotic? Not much, because there aren't many of them.

Wynne

Re: IV Canulars

Virginia Campbell — Fri, 20 Mar 2015 20:48:16 GMT

[quote user="Carolyn"]We have a new member of the practice who insists IV canulars should be replaced every 48hours regardless. [/quote]

Well, make her put the fresh IVs in all the dachshunds till she changes her mind ;-)

Re: IV Canulars

Wren — Fri, 20 Mar 2015 12:11:10 GMT

[quote user="Carolyn"]Thank you for the responses which have aimed to be helpful. I apologise for the apparent distress caused by my spelling.

[/quote]

And I apologise for my pointing it out! I did also wonder if it meant you weren't going to find much when searching for papers etc, so I didn't do it purely for selfish reasons.

Re: IV Canulars

Carolyn — Fri, 20 Mar 2015 11:01:15 GMT

Thank you for the responses which have aimed to be helpful. I apologise for the apparent distress caused by my spelling.

Re: IV Canulars

Hannah Wynne Richards — Fri, 20 Mar 2015 09:00:32 GMT

Agree with David

Wynne

Re: IV Canulars

Wren — Fri, 20 Mar 2015 08:47:41 GMT

Regardless of which we are talking about it's CANNULA (plural cannulae, as Robin and Michael said). There is no 'R'. You don't even say it with an 'R' on the end, and you aren't going to find many papers on recommended length of use by searching 'canular'.

Sorry, but it's been making my eyes hurt.

(Still, it doesn't even begin to compare with a post I saw somewhere from a US vet which asked 'what's with you Brits putting an 'O' on the beginning of Esophagus?'. Where do you even start?)

Re: IV Canulars

Martin Atkinson — Thu, 19 Mar 2015 19:23:45 GMT

How come this has suddenly changed to urinary catheters the OP was about IV cannulae?!

On the last CPD meeting I went to involving this subject it was suggested that IV cannulars should be safe for several days and the main reason to remove them is if the animal is irritated by them and interfering with them. There is little evidence that they were a focus for infection. Also I have a habit of flushing through with heparin and was told this is unnecessary, fluid out the bag you're using is fine, so there's a saving.

Re: IV Canulars

David Mills — Thu, 19 Mar 2015 19:07:13 GMT

[quote user="Carolyn"]

This article is quite interesting. I don't have access to the Journal of the American Animal Hospital Association to assess the original study that it references:

http://bluepearlvet.com/newyork/wp-content/blogs.dir/3/files/downloads/2011/03/Kibble-NYC-sp11-web-LINKS1.pdf

http://jaaha.org/doi/abs/10.5326/0430013

[/quote]

The study is interesting but how relevant it is to 1ry practice is questionable.

1. The animals were in intensive care, so, one would assume, already quite severely compromised;

2. positive culture did not affect outcome

3. positive culture of catheter tips are surrogate markers which are not associated with infection, necessarily, as most are localised biofilms. This is why the culture of urinary catheter tips following blocked bladders is no longer recommended as they have very poor correlation with any residual bladder infection.

Putting rigid times on these types of things is, to my mind, rather arbitrary and dogmatic. Any phlebitis associated with cannula presence is normally obvious and should, to my mind, be the only determinant of when to change catheters. Equally extrapolation from human medicine is likely to be invalid due to the difference and tolerance in commensal bacteria between us and animals.

Re: IV Canulars

Robin Grimmer — Thu, 19 Mar 2015 18:11:23 GMT

[quote user="Michael Woodhouse"]

Should this read IV Canulae?

[/quote]

It should be cannulae actually ;)

Re: IV Canulars

Carolyn — Thu, 19 Mar 2015 17:42:56 GMT

This article is quite interesting. I don't have access to the Journal of the American Animal Hospital Association to assess the original study that it references:

http://bluepearlvet.com/newyork/wp-content/blogs.dir/3/files/downloads/2011/03/Kibble-NYC-sp11-web-LINKS1.pdf

http://jaaha.org/doi/abs/10.5326/0430013

Re: IV Canulars

James Laidlaw — Thu, 19 Mar 2015 17:23:06 GMT

I would think it depends a LOT on how they are placed, and the quality of the aseptic technique for placement as well.

Re: IV Canulars

Michael Woodhouse — Thu, 19 Mar 2015 17:12:43 GMT

If they want to change current practice it is up to them to present you with the evidence!

Hospitals stick to a 48 hour official rule, but I'm not aware of great evidence of death and sepsis at 49 hours......

Should this read IV Canulae?