In today’s VETgirl online veterinary continuing education blog, Amy Newfield, CVT, VTS (ECC) reviews how to place a peripheral intravenous (IV) catheter. Placement of an intravenous catheter is one of the most common procedure performed by a veterinary technician or assistant. Intravenous catheters are often needed to administer both fluids and drugs. These steps below will help guide you for a successful IV catheter placement in your veterinary patient.
Before you start the catheter placement itself, it is important to gather the needed supplies:
- Clean clippers, #40 blade
- Exam gloves
- Clean gauze squares
- Antiseptic scrub / Isopropyl alcohol
- Small clean individual containers
- Porous Medical Tape and any other catheter wrap material
- Intravenous Catheter
- Extension set/T-Set/Injection cap (optional)
It’s important to ensure the patient is safely restrained using proper restraint techniques for intravenous catheter (IVC) placement. The restrainer has as equal important job as the person placing the IV catheter. It is imperative that the restrainer acts as a tourniquet so that the vessel fills with blood and dilates. This will make placing the catheter easier. The restrainer is also responsible for helping restrain the leg of the pet. Almost all pets will try to pull their leg back once they feel the insertion of the catheter. It is a normal reaction for a pet to withdraw their leg away from pain. The restrainer is also responsible for the safety of the team. Remember to use restraint devices when needed (muzzles, towels, gloves, Elizabethan collars).
When I worked in a general practice I only shaved the front part of the leg over the cephalic. All emergency practices I have worked in have the team shave all the way around the leg. There’s no data to support whether shaving a little versus a lot reducing infection. Regardless of what your hospital decides, shave the fur/hair wide enough to be able to visual the vein. Shaving around the entire circumference helps to ensure that hair/fur isn’t dragged in to the insertion site when taping the catheter.
I wash my hands and don non sterile medical gloves. Wearing gloves previous to this step will result in the gloves touching the hair/fur that you have shaved. The site should be prepared in a manner similar to a surgical prep. An antibacterial solution should be placed on sterile gauze will alternate with a rubbing alcohol gauze. The aseptic used should maintain contact with the skin for the appropriate amount of time as recommended by the manufacturer. After the scrub has been performed palpation of the insertion site should be avoided.
When opening up the catheter packaging it is imperative you do not touch the catheter itself. If the catheter falls on the floor or touches anything other than the prepared skin it must be discarded and another catheter should be obtained. Also, remember that one poke per catheter. So, if you are successful on the first attempt you need to get a new catheter. Do not reinsert a catheter that was already used in the skin.
With your dominant hand you should grasp firmly on to the hub of the catheter with a minimum of 2 fingers (up to 3 can be placed to help secure the catheter in your hand). I’m right handed so I hold on the catheter with my right hand. Be careful not to touch the catheter itself. The other hand should grab the patient’s leg below where the catheter is to be placed. The grip on the leg should be firm to help restrain the leg from movement during placement.
The area chosen to insert the catheter should occur as low as possible towards the foot. This will allow for subsequent attempts to be made using the same vein. Remember the vein should not be palpated and no finger should be allowed to touch insertion site of the prepared skin.
The bevel (the opening of the catheter) of the stylet needle should be pointed up so that you can see the opening. The catheter must be inserted at a 10-30° angle to breach the skin. Once a flash of blood is seen in the hub of the catheter it should be leveled out and advanced parallel with the vein. The entire catheter should be advanced another 2-3 mm to ensure it is traveling the path of the vein and that it is fully seated within the vessel. I often find that people get excited to see blood in the hub and advance too soon. Seeing blood in the hub is not an indication of being well seated in the vessel. So be sure to advance a little further.
If blood is still flowing in to the hub of the catheter and it has advanced smoothly up until this point the catheter only should be advanced off the stylet and in to the vein. The stylet should not be moved at all. Using one finger (usually the index finger) the catheter is pushed off the stylet and all the way in to the vessel sinking the catheter up to the hub.
Once the catheter is fully inserted up to the hub in to the vein it should be flushed, taped in and wrapped to secure it. There are a myriad of ways to tape in a catheter. My warning is that more tape does not equal better. Ideally the hospital should have everyone tape the same way so that it’s easier to unwrap and inspect the catheter if need be. Regardless of how you want to secure the catheter remember the most important rule; TAB YOUR TAPE ON BOTH SIDES! This will create a better relationship with your teammate. Trust me. Lastly, don’t forget an Elizabethan collar. It should be considered in patients that may be prone to forcibly removing the catheter from their leg themselves.