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IV Catheter Placement

Views: 48998 - Comments: 33

Megan Brashear, CVT, VTS (ECC), walks you through how to place a cephalic intravenous catheter in a dog.

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Megan Brashear's picture
Megan Brashear


Enrolled: 07/2011

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Andrea Howard's picture

I have had very good success using the accessory vein on larger dogs with long forelegs. I have not had problems with clotting or issues with the IV pumps but you do need to realize that it will end up more towards the lateral aspect of the leg. If you choose the entry point carefully it will not interfere with the area of the carpus. I like using it when feasible to allow for use of the cephalic vein if and when the catheter needs replaced because of extended IV treatments. At the hospitals where I have worked we replace any IV after it has been in place for 36 hours. We should all understand though that each practice may have their own protocol for such procedures. Great demo though and awesome web site!

Traci Wade's picture

Where are the tehnicians gloves? Does she overwrap with vetwrap or coflex? And I am pretty sure she meant "lateral" not "medial"....

Megan Brashear's picture

Just curious... how many of you wear gloves when placing IV catheters? What other methods are you using to help prevent insertion site infections? We'll have a forthcoming article about IV catheter care and preventing problems. We don't commonly wear gloves but with proper hand washing, scrub/alcohol/gauze care, clean tape, and regular checking of insertion sites and changing tape out PRN we don't have problems with infections. How about you?

Beth Armstrong's picture

I think that it is recommended to wear gloves by OSHA and AAHA however I am not sure how much everyone follows this. I do know some people that after they finish scrubbing the leg they swipe their thumb or finger that touches the site. I thought that was a good idea. At our clinic we wrap with cling and vet wrap and break down the wrapping at least every 2 hours to inspect the site. We do change IV catheters out after 72 hours. I love the video! Great demo dog as well! :)

Beth Armstrong's picture

I meant every 24 hours we break down the wrapping! Not every 2 hours! haha

Dana May's picture

Hi Megan, Are you not using the little "anchor" piece of tape anymore? The little half an inch piece placed under the t-port and then criss crossed over the top? Commonly placed after the 2nd piece of tape. There is a photo of this taped method in the Decreasing IV Catheter Problems article. I've been taught this anchor piece is an integral part of making sure the IVC remain stable.

Megan Brashear's picture

Dana, you've hit on the most controversial topic at Dove, the anchor tape... It's personal preference, I don't like it because I think it adds a false sense of security - I see leaking around the t-port just as much with the anchor piece as without. But there are others who swear by it. I also think the anchor loop makes removing the catheter more messy (the t-port pulls out too early!). As long as the catheters are taped the same (the other 4 pieces of tape!) and half the staff isn't using 1/2" tape as the first layer etc. then you're in good shape. But it makes for great debate in technician meetings!

Kari Walker's picture

At the hospital I work in, it is common practice for the end of the t-set to be let loose in case of a difficult patient so that we can access the fluid port easily. This isn't the way I was taught, in fact, I was taught very similarly to how the t-set is taped in in this video. What are your thoughts on leaving the fluid port of the t-set loose??

Megan Brashear's picture

Kari - my fear with leaving the t-port dangling is that it's then that much easier for the patient to get it caught on something, disconnect it from the catheter and leave the poor staff with no IV access and a crabby patient. In the case of a potentially explosive patient we will tape everything down and add an extension set to give us distance. Yes, it's not ideal to have to chase sedatives or anesthetics with 4ml of saline but I feel better knowing the catheter will stay put. You can still dose "to effect" through an extension set as long as you're paying close attention to volumes.

Megan Brashear's picture

A couple of you have brought up the 'lateral vs. medial' issue - when I'm pointing to and discussing the little accessory branch on the carpus my mouth was working faster than my brain and I said lateral aspect when it is the medial aspect. Thanks everyone for catching that! Moral of the story - we don't like IV catheters to be hidden in the medial aspect of the leg, front and center wins every time!

Theresa Pellicano's picture

Megan, I see that the IV is not then bandaged. the practice I am at, routinely does a kind of robert jones type bandage. We were told to wrap the bandage snuggly Is this an old practice now? When I go on other vet tech sites, I see that alot of people do not bandage. The teaching hospital at Davis, CA, does not bandage. So many ways to do one thing. Does this office believe in applying AB ointment? I heard there are pro/cons to this also.

Megan Brashear's picture

Theresa, great questions. We don't bandage IV catheter legs because it makes it more difficult to monitor for problems. The idea behind bandaging is to help prevent the swelling that often happens distal to the catheter (mega-paw) but a bandage hides any insertion point infections, swelling proximal to the catheter that indicates loss of patency, fluids leaking at or around the catheter, and any bleeding that soils the tape. We monitor our catheters often and if there is any swelling we will re-tape rather than place a large bandage. I think bandaging the leg is fine as long as you are removing the bandage to check the site at least every 24 hours and monitoring for moisture. We also do not use triple AB ointment, the oil-based ointment can work as a magnet attracting dirt and trapping it to the insertion point. I have seen some practices that place a real (human, if you will!) Band-aid over the site with triple AB, that will keep out the dirt better than just tape but again is adding risk to infection. At Dove, our best prevention is clean hands, fresh scrub/alcohol gauze, checking the catheters often and changing out tape as needed if it becomes bloody or soiled. There are many different ways out there to do it, discuss it with your DVMs and tech staff and as long as you are having success and no infections then that's the best way!

Andrea Howard's picture

Megan, I was reviewing the video and just noticed you stated to loosen the seal of the stylet and catheter. Can you explain why you suggest this? I have seen many Tech do this. I spoke to a human phlebotomist and asked about the seal and she stated in her opinion it is best not to break that seal as the seal is designed to help facilitate the ease of the catheter going through the skin. If you look very closely at the end of the catheter you will see that it tapers every so slightly where the seal is. Breaking that seal may increase the chance that it will "roll" (wrinkle up) as you try to insert it through the skin. I am not saying you can't place it after breaking the seal I was just wondering your reason behind it.

Megan Brashear's picture

Andrea, as far as the loosening the catheter off of the stylet; it's one of those things that everyone seems to do because that's how we were taught! I do it because if the catheter sticks a bit when you try to feed it off the stylet then you may change your hand position to help and that may mean bumping the catheter out of or through the vein. It also may add enough time and movement that your patient moves and dislodges the catheter from the vein. I never really thought about the catheter being manufactured to stay together until it's in the vein, I'm going to try it without loosening it and see how it goes! Thanks for the comment!

Avi Solomon's picture

Andrea, DoveLewis currently uses BD Insyte IV catheters and according to the package inset : Prior to venipuncture hold catheter hub and rotate barrel 360 degrees, then make sure catheter is seated back in the notch; this is to break the seal between the catheter and stylet. I would refer to your manufacturers packaged instructions.

Imani Preyor's picture

I would anchor the T-port as well. But overall clean placement. Good job! :)

Leslie Wereszczak's picture

Would love to see the use of gloves for prep and placement. Also, shaving all the way around the leg is especially helpful in dogs with more hair and with cats.

Megan Brashear's picture

Leslie, totally agree with the shaving all the way around, better to not have long feathers in the way and causing unneeded pain when removing the tape. The gloves issue has come up a couple of times. At DoveLewis we have very low, almost non-existent IV catheter site infections. We take care with our scrub bottles keeping them clean and changing them out weekly, and keep our gauze and cotton balls in drawers away from major contaminants which has allowed us to keep the placement clean without wearing gloves. We are also careful about blood on the tape and make sure to clean any blood from the area before taping. I agree if infections are increasing then gloves are first on the list and should be worn to protect the patient. Thanks for your input!

Reanna Pearson's picture

I have always seen and be taught to shave all the way around the leg instead of just a rectangle to ensure tape adherence and minimize discomfort when removing the tape. What are the advantages of shaving just the rectangle? Do you shave more for a dog with a longer coat or a cat?

Megan Brashear's picture

Reanna, there are definitely two schools of thought on the shaving all the way around. It does prevent contaminants from hair getting into the way of taping and may make removal more comfortable. Here is why I do not shave all the way around: shaving, especially with a #40 blade provides opportunity for skin irritation which can lead to contamination, discomfort and infection. If the animal has a reaction to the glue on the tape it makes removal much mire difficult and painful, and in my experience I tend to see worse mega-paw issues since there is no buffer for the tape as it adheres tightly to the skin. If I have a patient with long hair I will trim the feathers and cut the hair short above the placement site so that no hair is wrapped into the insertion site, but I personally do not prefer to shave all the way around. That being said, it isn't wrong to do that, just use caution with clipping and check the site often!

Brianna Diaz's picture

If you're dealing with a wiggly patient, wouldn't letting go of the elbow to put your finger over the insertion point cause the patient to move? Is there another way of blocking the blood from coming out?

Carolyn Tran's picture

Good point Brianna- it’s always important to consider the needs of each individual patient. If you have concerns about a wiggly patient (which I think almost every patient is) prior to placing the IVC, then having your assistant remove their hold from the elbow is probably not recommended. I would recommend trying this instead: one- have the assistant keep a hold of the patients elbow, two- the technician placing the IVC will slip their thumb over the end of the IVC in the vein to prevent blood flow after you remove the stylet. I know this can be difficult because you have to let go of the patient's paw, and getting blood everywhere might be inevitable. You can also put dry gauze squares right under your IVC, so when you pull the stylet out (and neither the tech nor assistant can put pressure on the end of the IVC in the vein) blood will flow onto the gauze square and hopefully keep your shaved area clean.

Let us know if it works for you!

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Felicity Edwards's picture

I was taught to place the T-port so that the end is on the lateral side of the leg, not medially as shown in this video. Is there a reason you guys tape it medially?

Carolyn Tran's picture

Great question Felicity. We actually will tape the t-port medially and laterally. I apologize the video only shows medial placement of the t-port. Honestly, no real reason we choose one or the other but some considerations would be patient dependent (reactive patients you may put laterally so you are not reaching in front of them but to the side of them when capping patient off fluids), or how the IVC will sit on patient's leg. It comes down to technician preference.

Let me know if you have anymore questions.

Milimar Rivera's picture

When we have a cat or a dog with mega-paw we cut through the tape, medial or lateral to the IVC, inspect the area then re-taped and bandage on top of the old tape. I was wondering what were your thought about this method. There have been time when we tried to undo all the tape to inspect the IVC insertion area but the IVC end up coming out by accident.

Jessica Waters-Miller's picture

Hi Milimar,

Thanks for the comment! This is a good question and is difficult to answer because you bring up a very valid possibility when taking the tape down. So I will answer with our protocol, and even then we can make adjustments when necessary and every hospital should do what works best for them and is still a clean process. Our protocol is to take the tape down and inspect the insertion site whenever we have a patient with a mega-paw, a transfer from another clinic (with an IVC in place), and every 24 hours or when we find another reason to inspect. We also all tape the same way and tab every piece of tape, which helps with taking down the tape. However, sometimes you have to tape differently for different reasons or you can't take the tape down. I think of fractious or scared pets, when the limb is painful, there are so many reasons. So first we try to take the tape down first and if we are unable to then we might carefully cut the tape and secure it with new tape.

It's always good to be able to visualize the insertion site which can be hard to do with the tape still being in the way. And I have pulled out a catheter or two taking the tape all the way down, so sometimes I can see well enough by leaving that first piece of tape and then retaping. Sometimes I have had trouble with it being secure enough after putting more tape over the old tape but if that isn't a problem and the tape is clean, dry and that's what you can do then sometimes you just have to do what you can do as long as it is clean, secure and comfortable for the patient.

We don't often apply a bandage over our tape because it is easier to visualize the IVC and tape, but sometimes a bandage is necessary to help keep it clean. I think this is a hospital preference.

I hope that helps!