ADV-Lesson 2- Vascular Access

Prompt establishment of vascular access is vital to the successful implementation of resuscitation drugs. Adequate blood levels must be present at the site of action. Also, timely administration is vital. If an IV catheter is not present in the patient, then BLS should begin immediately. The team leader should indicate what type of vascular access is needed. If you have more than one team member present, then more than one person can work to place an IV catheter in multiple sites.

If a patent catheter has already been placed then it should be used, however, the catheter closest to the heart is ideal and should be used to administer the appropriate drugs. A central line (jugular access) will deliver drugs into the venous system closest to the heart and is the best option. If peripheral catheters are your only option, then this is the priority of use, Jugular, Cephalic, Saphenous.

Chest compressions should not be disturbed to place an IV catheter. The ideal location to place a catheter in a patient undergoing chest compressions is a cephalic catheter (if the animal is in lateral recumbency use the DOWN leg) or the

lateral saphenous vein (the UP leg is preferred). A smaller catheter size will likely be needed for peripheral venous catheterization in the cephalic or saphenous veins; it is recommended that you use a 20-22g catheter. Once achieving ROSC, a larger bore catheter may need to be placed. Jugular vein catheterization may be attempted if peripheral venous access is unsuccessful. A jugular catheter provides better access to the central circulation for drug delivery. Jugular catheters should be placed percutaneously during CPR using a 5.25-inch, 14-16-gauge catheter; this is particularly useful in large dogs.

When occluding a vein in spontaneous circulation, the vessel will distend allowing for catheterization. Occlusion of a vein in a patient with CPA is rarely helpful. Poor or absent venous return in the periphery and lack of visible distention can prohibit successful catheterization. In this instance, percutaneous catheter placement must be done by knowledge of normal anatomic position of the vessel as opposed to palpation. Cut downs may be required if catheterization is unsuccessful using other methods. This method is performed by using a surgical scalpel blade to cut through the subcutaneous layers to access the vein directly. Cut downs should only be done by trained personnel.

Interosseous or IO catheters may also be utilized to place a catheter. Common sites include the humerus, femur and tibia. IO catheters in the humerus will provide the fastest access to the heart. If chest compressions are being performed, the femur and tibia may be better options. IO catheters are placed with a bone marrow needle or other types of needles with a stylet to avoid obstruction of the lumen. For kittens and puppies, you should use an 18-20g needle with a stylet. Commercial drill equipment can be used to facilitate rapid IO catheter placement. IO catheters should only be placed by trained personnel.