IV catheters

RE: IV catheters

Hannah Wynne Richards — Wed, 09 Dec 2015 08:40:14 GMT

Exactly. If I was on a desert island, didn't have a cannula, no hope of a delivery for a week, and an animal needing fluids - then I'd use a needle.

A very different matter to using 1 because too mean to buy a cannula

Wynne

RE: IV catheters

Evelyn Barbour-Hill — Wed, 09 Dec 2015 00:32:59 GMT

[quote user="Iain Richards"]As did I. Then I learned a better way.[/quote]

So did I.

Still wouldn't hesitate to give a fluid infusion with a needle if for some reason no cannula were available.

RE: IV catheters

Virginia Campbell — Tue, 08 Dec 2015 23:21:34 GMT

[quote user="John Flynn"]Obviously a needle taped in the vein is an alternative to "secure" iv access, but I personally find an iv cannula more secure.[/quote]

Ah, God be with the days of bitch spays done with a syringeful of thio strapped to the leg and the second half of the dose given halfway through. There was an anaesthetic gas machine in the corner of the room, but it appeared to be there for decoration or perhaps special occasions (I didn't actually work there at the time, but saw practice as a student. They had started using the gas machine by the time I locumed there a few years later).

RE: IV catheters

Iain Richards — Tue, 08 Dec 2015 21:18:51 GMT

.[quote user="Evelyn Barbour-Hill"]

[quote user="Iain Richards"]We wouldn't give fluids without one,[/quote]

Did so many times, starting in vet school, before cannulae became regularly available.

As did I. Then I learned a better way.

[/quote]

RE: IV catheters

Anthony Todd — Tue, 08 Dec 2015 19:24:49 GMT

[quote user="Hannah Wynne Richards"]

Micheal. I wonder whether the 4x increase in fatalaties when using fluids is because the animals were that much sicker to begin with? Also whether the increased rate of fatalities in hospital practicies is because they often employ Specialists/certificate holders and have animals referred to them for difficult surgery which most of us would be terrified to try

Wynne[/quote]

Yes, just thinking of the death rates in blocked bladders in a university, [previous citation] obviously referrals and much more toxic [and probably a much longer time before the unblock].

We gave fluid off the needle or via the needle intra op and after op for yonks and, provided the needle was placed low enough on the radius it was fine, no probs at all for sometimes a day or two.

During a GA, with the animal unconscious, the needle or the leg doesn't move so I really don't see the advantage of a can/theter and back in the day, and indeed in the noughties a can/theter seemed to be a difficult thing to place and I still think an ordinary needle seemed to remain in place and patent. Perhaps C/Ss need fluids more these days; they take long enough.....?

RE: IV catheters

Hannah Wynne Richards — Tue, 08 Dec 2015 18:34:45 GMT

Happens to us all

Wynne

RE: IV catheters

Kate Richardson — Tue, 08 Dec 2015 18:29:59 GMT

[quote user="Hannah Wynne Richards"]

Kate Surely you mean injudicious,or excessive, not over judicious!

Wynne

[/quote]

Oops yes, brain tired. I meant over enthusiastic use of fluids

RE: IV catheters

Hannah Wynne Richards — Tue, 08 Dec 2015 17:32:06 GMT

Kate Surely you mean injudicious,or excessive, not over judicious!

Wynne

RE: IV catheters

Sarah Wheadon — Tue, 08 Dec 2015 17:31:10 GMT

Replying to John and Kate, if I/V access is not available, in an emergency, drugs such as atropine and adrenaline are well absorbed if given via an endotracheal tube. Fastest absorption would be via a central venous line, which I suspect very few of us would have in place.

RE: IV catheters

Michael Woodhouse — Tue, 08 Dec 2015 17:25:28 GMT

[quote user="Evelyn Barbour-Hill"]I hope nobody is sticking the same needle in the dog that they have stuck in the drug bottle.[/quote]

Of course I do. Never seen any need to swap needles. Injection technique is far more important (skin tight).

I had a course of vaccines at the doctors and the nurse used the same needle to draw up and inject and I didn't feel a thing.

RE: IV catheters

Anthony Todd — Tue, 08 Dec 2015 16:48:50 GMT

[quote user="Thomas Johnson"]Then why does it say "I/V Catheter" on the Jelco packet? [/quote]

Probably 'cos the writer hasn't started here etc then gone here.......etc

RE: IV catheters

Anthony Todd — Tue, 08 Dec 2015 16:47:21 GMT

[quote user="Thomas Johnson"]Then why does it say "I/V Catheter" on the Jelco packet? [/quote]

I was waiting for this.... so start here!

https://en.wikipedia.org/wiki/Catheter

then go here:

https://en.wikipedia.org/wiki/Cannula

but does it really matter?

RE: IV catheters

Thomas Johnson — Tue, 08 Dec 2015 16:37:52 GMT

[quote user="Michael Woodhouse"]

BTW a cannula makes a new hole, a catheter goes in an existing one!

[/quote]

Then why does it say "I/V Catheter" on the Jelco packet?

RE: IV catheters

Kate Richardson — Tue, 08 Dec 2015 16:34:58 GMT

[quote user="John Flynn"]I find the argument of having intravenous access in the event of a problem less convincing overall for genuine risk mitigation (with adequate monitoring, most drugs can be given IM or off the needle), but still reason enough in its own right[/quote]

They may be able to be given IM, but if circulation is collapsing, will they be absorbed and affective?

[quote user="Hannah Wynne Richards"] I wonder whether the 4x increase in fatalaties when using fluids is because the animals were that much sicker to begin with? [/quote]

Hannah Wynne Richards I think the risk was associated with over enthusiastic use of fluids and rates being too high, at least that was my memory wrt cats. A case of putting an animal on fluids because it was thought to be beneficial when undergoing a GA but not monitoring carefully or making a risk-benefit assessment beforehand, poss related to sub clinical cardiac disease. But don't quote me on that

RE: IV catheters

Hannah Wynne Richards — Tue, 08 Dec 2015 12:29:25 GMT

Wynne

RE: IV catheters

Evelyn Barbour-Hill — Tue, 08 Dec 2015 11:37:35 GMT

Clip and wipe with spirit. Hold vein up. Thumbnail size bit of cotton wool on the vein, squirt Ethycalm on that, wait a second or two. If using jugular, squirt on little bit of cotton wool and wipe vein lightly. Works much better than squirting direct on skin.

RE: IV catheters

John Flynn — Tue, 08 Dec 2015 11:30:25 GMT

[quote user="Evelyn Barbour-Hill"]Ethycalm is great.[/quote]

Never used it - thanks for the tip. Any practical points to make best use of it I should know? If effective instantly then that would be a very useful tool to try out.

RE: IV catheters

Evelyn Barbour-Hill — Tue, 08 Dec 2015 10:39:45 GMT

When did this phrase "off the needle" become commonplace? I've never heard it before.

It seems an odd one. The patient is, if anything, on a needle rather than off it while the injection is being made, and the drug of course comes through, not off, the needle. Then, why "the needle" rather than "a needle"? How many needles do you possess? I hope nobody is sticking the same needle in the dog that they have stuck in the drug bottle.

[quote user="John Flynn"]How many use EMLA cream or alternative[/quote]

Ethycalm is great.

RE: IV catheters

John Flynn — Tue, 08 Dec 2015 08:24:15 GMT

If there is a reduction in anesthetic risk from the use of cannulae, I would think the most likely reason would be reducing the speed of induction agent administration in fidgety patients and therefore reducing the risk of overdose in a patient with poor circulation and an unexpectedly reduced requirement.

I find the argument of having intravenous access in the event of a problem less convincing overall for genuine risk mitigation (with adequate monitoring, most drugs can be given IM or off the needle), but still reason enough in its own right. And it is easier to place an iv cannulae in a euvolemic patient and hypovolemia (or anesthetic-induced hypotension) are best corrected with iv access.

If we consider patient awareness (rather than just death...) as an adverse outcome, then I think it's pretty obvious that established iv access lets that be corrected faster as nothing really sorts that as quick as a bolus of induction agent kept to hand.

Obviously a needle taped in the vein is an alternative to "secure" iv access, but I personally find an iv cannula more secure.

How many use EMLA cream or alternative routinely before either placing iv cannnula or adminsitering off the needle fora routine planned GA?

RE: IV catheters

Evelyn Barbour-Hill — Tue, 08 Dec 2015 00:14:01 GMT

[quote user="Iain Richards"]We wouldn't give fluids without one,[/quote]

Did so many times, starting in vet school, before cannulae became regularly available.

RE: IV catheters

Nicola Cole — Mon, 07 Dec 2015 23:41:29 GMT

I'm not sure the argument of ' we wouldn't give fluids without one, so why not apply to all I/v substances' holds-surely the main reason for giving fluids through a cannula is that no one is going to want to sit there holding the patient's leg all day and night with a needle in to stop the needle from moving!

RE: IV catheters

Iain Richards — Sun, 06 Dec 2015 20:38:48 GMT

A cannula won't reduce anaesthetic risk. Not having one, in the event of a problem, is different. I can think of many occasions where an animal has twitched during induction with off the needle induction. Not an issue with a cannula in place (and why I use them for PTS). We wouldn't give fluids without one, so why not apply that to all i/v substances?I agree that a good VN is the best option for reducing risk.

RE: IV catheters

Kerry Peak — Sun, 06 Dec 2015 12:20:44 GMT

Thank you for everyones input, it is really interesting to hear what other practices do. The main objection seemed to be the cost, but I agree I'm not really sure it's a justifiable one.

RE: IV catheters

Anthony Todd — Sun, 06 Dec 2015 00:16:38 GMT

[quote user="Michael Woodhouse"]Do we have any evidence that iv access reduces our patients anaesthetic risk?[/quote]

It sounds like the initial terminology is wrong. You have an "anaesthetic risk" with a 12yo fat lab with a heart murmur and a pyo.

Even the dinovets would have a drip up, lots of fluids and O2, as little anaesthetic as possible and get the pyo done quick.

I think here we're talking about "anaesthetic emergencies" ie apnoea plus or minus cardiac arrest, a totally different scenario.

My impression is that animals with "anaesthetic risk" do very well indeed and fatalities are rarely related to the anaesthetic and usually related to the length of surgery, fluid balance etc.etc.

"Anaesthetic emergencies" again, in my experience, occur suddenly without apparent reason, and usually on inductions in young "normal" animals.

I think this is what we're discussing.

I would like to know what drugs are available for use via the now mandatory cannula in situ, ie I/V, which will do anything to start a heart.....

RE: IV catheters

Michael Woodhouse — Sat, 05 Dec 2015 23:34:17 GMT

From David Broadbelts anaesthetic risk dissertation:

Intravenous catheters were not routinely placed by most
centres, and though similar to previous work (Wagner and Hellyer 2000), this was cause
for concern as perioperative venous access was not immediately available in most
centres.

The use of perioperative fluids was associated with nearly 4 times increased odds of
death.

IV cannulae are mentioned and seemingly don't seem to alter the risk of anaesthetic death.......

Dogs were 3X more likely to die in a hospital than a general small animal practice...

https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCEQFjAAahUKEwirgZK64OrIAhUFiRoKHcPDCxg&url=http%3A%2F%2Fwww.rvc.ac.uk%2FMedia%2FDefault%2Fstaff%2Ffiles%2Fdbrodbelt-thesis.pdf&usg=AFQjCNESDgO_0MMuPKHOamKaLjoKu6Y1Qg&sig2=FjT9zIMF2OXIcyH49Uj6Ow&cad=rja