RVT News - CVMA...RVT News M ost institutions will have a policy for catheter placement and if your...
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RVT News M ost institutions will have a policy for catheter placement and if your clinic doesn’t, it should! Having a policy ensures that all team members are placing catheters in the same manner and avoiding inter-team divisiveness, based on each team member’s particular placement style. Policies will aid in reducing complications. Common Complications 1. Catheter-Associated Bloodstream Infection or Local Site Infection Catheter-associated bloodstream infection risk can be reduced through strict asepsis throughout the placement procedure. The placement of an IV catheter should be preceded by a generous clip of the area to be catheterized and a thorough handwashing. Gloves, preferably sterile gloves, must be worn for catheter placement. Care must be taken to avoid trauma to the skin, most often caused by either misaligned clipper blades or the improper use of the clippers. While some hospitals choose to shave the fur all the way around the limb for a peripheral catheter, this has not been shown to be more effective than a generous clip that is wider and longer than the catheter. Long feathers should always be trimmed to a manageable length (generally to 1–2 cm) to avoid getting caught in the tape. Chlorhexidine versus betadine is an age-old controversy although recent literature identifies the superiority of chlorhexidine (Caldiera et al, 2011). Scrubbing the insertion site with surgical soap to remove gross debris, followed by an appropriate contact time (30-second minimum for chlorhexidine based soap), will increase bactericidal activity. Trauma induced by the scrubbing procedure itself is likely to result in excessive irritation, which may also increase the risk of patient self-mutilation. Unfortunately, we do not yet have a recognized standard for catheter preparation in veterinary medicine, but a minimum of 30 seconds of contact time following the final prep to allow for drying and bactericidal effect is important. All palpation and identification of the vein to be catheterized should be completed prior to the surgical scrub. A clean 4x4 or 3x3 gauze square, opened up and placed at the bottom of the prep site to cover unclipped and prepped hair, will reduce bacterial contamination of the catheter during placement. Catheter maintenance is important in preventing catheter-associated infections. Scheduled removal and replacement of peripheral catheters every 72 hours remains a common policy in many veterinary hospitals, but is no longer recommended in the literature as long as a good quality catheter type, careful placement, and preventive maintenance is ensured (Mathews et al, 1996). Maintenance should include the removal of the bandage material, a direct visual of the insertion site, palpation of the vein, flushing of the catheter, and noting functional problems or pain experienced by the patient. Any suspicious catheter should be removed and replaced as needed. 2. Phlebitis Phlebitis is the inflammation of the innermost layer of a superficial vessel. Phlebitis makes a vein feel thick and hard, often described as “ropey”; may have a reddish discoloration to the skin overlying the vein; and the skin may be warm to the touch. Phlebitis is a painful condition and patients will often flinch or vocalize during the flushing of fluids or medication through the IV catheter. All of these signs are an indication that the catheter should be replaced in a new limb. It can occur through mechanical, chemical, or bacterial means and is a common complication of IV catheters. Thrombophlebitis is phlebitis caused by a blood clot. Clots can form for numerous reasons including the patient’s own clotting ability, the type and material of catheter used, insertion technique, and length of catheterization. 3. Extravasation and Infiltration Even with the most diligent catheter placement and care, extravasation or infiltration of fluid or drugs is a common concern. Extravasation and infiltration are often used interchangeably, however extravasation is a term used to Andrea M. Steele, MSc, RVT, VTS (ECC) | Pacific Veterinary Conference Speaker by Figure 1: An open gauze square is used at the bottom of the prep site to keep the catheter clean and also provide tension to the skin, keeping the vein 36 California Veterinarian • March–April 2017 cvma.net Complications of IV Infusions and Medications
Transcript of RVT News - CVMA...RVT News M ost institutions will have a policy for catheter placement and if your...
RVT News
Most institutions will have a policy for catheter placement and if your clinic doesn’t, it should! Having a policy ensures that all team members
are placing catheters in the same manner and avoiding inter-team divisiveness, based on each team member’s particular placement style. Policies will aid in reducing complications.
Common Complications
1. Catheter-Associated Bloodstream Infection or Local Site InfectionCatheter-associated bloodstream infection risk can be reduced through strict asepsis throughout the placement procedure.
The placement of an IV catheter should be preceded by a generous clip of the area to be catheterized and a thorough handwashing. Gloves, preferably sterile gloves, must be worn for catheter placement. Care must be taken to avoid trauma to the skin, most often caused by either misaligned clipper blades or the improper use of the clippers. While some hospitals choose to shave the fur all the way around the limb for a peripheral catheter, this has not been shown to be more effective than a generous clip that is wider and longer than the catheter. Long feathers should always be trimmed to a manageable length (generally to 1–2 cm) to avoid getting caught in the tape.
Chlorhexidine versus betadine is an age-old controversy although recent literature identifi es the superiority of chlorhexidine (Caldiera et al, 2011). Scrubbing the insertion site with surgical soap to remove gross debris, followed by an appropriate contact time (30-second minimum for chlorhexidine based soap), will increase bactericidal activity. Trauma induced by the scrubbing procedure itself is likely to result in excessive irritation, which may also increase the risk of patient self-mutilation. Unfortunately, we do not yet have a recognized standard for catheter preparation in veterinary medicine, but a minimum of 30 seconds of contact time following the fi nal prep to allow for drying and bactericidal effect is important.
All palpation and identifi cation of the vein to be catheterized should be completed prior to the surgical scrub. A clean 4x4 or 3x3 gauze square, opened up and placed at the bottom of the prep site to cover unclipped and prepped hair, will reduce bacterial contamination of the catheter during placement. Catheter maintenance is important in preventing catheter-associated infections. Scheduled removal and replacement of peripheral catheters
every 72 hours remains a common policy in many veterinary hospitals, but is no longer recommended in the literature as long as a good quality catheter type, careful placement, and preventive maintenance is ensured (Mathews et al, 1996). Maintenance should include the removal of the bandage material, a direct visual of the insertion site, palpation of the vein, fl ushing of the catheter, and noting functional problems or pain experienced by the patient. Any suspicious catheter should be removed and replaced as needed.
2. PhlebitisPhlebitis is the infl ammation of the innermost layer of a superfi cial vessel. Phlebitis makes a vein feel thick and hard, often described as “ropey”; may have a reddish discoloration to the skin overlying the vein; and the skin may be warm to the touch. Phlebitis is a painful condition and patients will often fl inch or vocalize during the fl ushing of fl uids or medication through the IV catheter. All of these signs are an indication that the catheter should be replaced in a new limb. It can occur through mechanical, chemical, or bacterial means and is a common complication of IV catheters.
Thrombophlebitis is phlebitis caused by a blood clot. Clots can form for numerous reasons including the patient’s own clotting ability, the type and material of catheter used, insertion technique, and length of catheterization.
3. Extravasation and Infi ltrationEven with the most diligent catheter placement and care, extravasation or infi ltration of fl uid or drugs is a common concern. Extravasation and infi ltration are often used interchangeably, however extravasation is a term used to
by Andrea M. Steele, MSc, RVT, VTS (ECC) | Pacifi c Veterinary Conference Speaker by
Figure 1: An open gauze square is used at the bottom of the prep site to keep the catheter clean and also provide tension to the skin, keeping the vein
36 California Veterinarian • March–April 2017 cvma.net
Complications of IV Infusions and Medications
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describe the leakage of a vesicant (or blister causing) fluid from one compartment to the next, while infiltration refers to the leakage of a non-vesicant (but potentially irritating) fluid. Extravasation and infiltration may occur when a catheter is not sufficiently seated in the lumen, or if multiple punctures were made in the same vessel.
The veterinary technician must always be critically evaluating IV catheters and ensuring the health of the vein. Removing and replacing them as needed ensures that the patient is not needlessly put through the discomfort of catheter placement.
2017 CVMA Leadership Forum Sparks Interesting Topic Discussions
The CVMA Leadership Forum was held on January 20 and 21 in Sacramento, CA. The CVMA Board of Governors, House of Delegates members, committee chairs, and representatives from state veterinary associations participated in the meeting. Presentation topics included legislation and advocacy, the 2016 CVMA Economic
Issues Survey, and the use of medical marijuana in veterinary practices.
Legislation and AdvocacyCVMA lobbyists Mike Dillon and Christina DiCaro gave a preview of the 2017 legislative season and discussed returning issues such as sales tax on services, family leave, predictable work scheduling, and mandatory veterinarian or RVT presence at state rodeos. There was also discussion of CVMA Legislative Day to take place on April 5. Mr. Dillon and Ms. DiCaro encouraged attendees to be involved in this day as it is a great opportunity to bring veterinary issues in front of legislators.
The 2016 CVMA Economic Issues SurveyMolly O’Shaughnessy, a principal with EMC Research, provided attendees with key findings from the 2016 CVMA Economic Issues Report. She summarized data on job satisfaction and hours worked, pay and benefits, student debt, as well economic trends, to name a few. Some items of note included generational trends regarding a slight decline in veterinarians interested in owning a practice; middle-sized practices experiencing growth while small and large practices remain steady; and a slight tightening of the salary gap between male and female veterinarians. The full survey is accessible to CVMA members at cvma.net.
Marijuana LawsCVMA Director of Regulatory Affairs Dr. Grant Miller gave a presentation on marijuana laws and policies affecting veterinarians followed by tabletop discussions. Discussion was very lively as attendees debated and explored the ramifications of marijuana use in practices.
The CVMA Treasurer’s Report was presented by Dr. George Bishop, updates were given by Dean Michael Lairmore of UC Davis, Dean Phillip Nelson of WesternU, and Board of Governors student representatives Roxana Bordbar from UC Davis and Hygan Baghoyan from WesternU. Led by House of Delegates (HOD) Chair Dr. Jennifer Hawkins, committee reports were presented by committee chairs. The Board of Governors and the HOD conducted separate business meetings.
References: Caldiera, D, C David, C. Sampaio. Skin antiseptics in venous puncture-site disinfection for prevention of blood culture contamination: systematic review with meta-analysis. Journal of Hospital Infection. 2011;77(3):223-232 | Marsh-Ng ML, DP Burney, J Garcia. Surveillance of Infections Associated With Intravenous Catheters in Dogs and Cats in an Intensive Care Unit. J Am Anim Hosp Assoc. 2007;43:13-20 | Mathews KA, Brooks MJ, Valliant AE. A prospective study of intravenous catheter contamination. J Vet Emerg Crit Care 1996;6(1):33–42 | Stinner, DJ, CA Krueger, BD Masini, JC Wenke. Time-dependent effect of chlorhexidine surgical prep. Journal of Hospital Infection. 2011;79(4):313-316.
Figure 2: Infiltration of the area surrounding a catheter, leading to inflammation (obvious as the indentation in the skin by the catheter). Note the leakage in the area and on the bandage material. This catheter should have been placed higher on the prep site and not at the bottom.
View this issue of the California Veterinarian online at cvma.net/publications 37
Ms. Steele has been an ICU technician at the Ontario Veterinary College Teaching Hospital since 1998. She achieved her Veterinary Technician Specialist in Emergency and Critical Care (VTS(ECC)) certification in 2003. Ms. Steele currently serves on the Board of Directors for the Academy of Veterinary Emergency and Critical Care Technicians as a member-at-large.
Andrea M. Steele, MSc, RVT, VTS (ECC) | PacVet Conference Speaker
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