ISSN 2398-2985      

Intravenous / intraosseous catheterization

Jreptile

Introduction

  • Catheter sites in reptiles will vary by species and size of the patient.
  • Intravenous (IV) catheterization is typically difficult in reptiles. Intraosseous catheterization is not possible in snakes.
  • While still difficult, the jugular vein is the preferred site for venous catheterization in reptiles.
  • Alternatively, butterfly catheters can be secured in place in the dorsal or ventral coccygeal vein (same technique as for blood collection) and be used in a similar way to an IV catheter.
  • Poor perfusion, phlebitis, blown vessels or vessels that are just too small will complicate even further the procedure of IV catheterization.
  • Intraosseous catheters are placed in the tibia, femur and humerus in lizards and chelonians.
  • When possible, intraosseous (IO) catheters are preferred to IV catheters in reptiles.
  • IV and IO catheters are placed using aseptic technique.
  • Spinal needles are recommended for IO catheterization as there is a lesser chance of the lumen becoming clogged with a bone core during placement. Alternatively, a regular hypodermic needle can be used when needed (better if some sort of stylet is inserted).
  • Placing an IO catheter is painful and should ideally be done under anesthesia  Anesthesia overview, or at the minimum, heavy sedation with analgesics Analgesia on board.
  • If the patient is crashing and systemic access is needed immediately, the catheter can be quickly placed without the aid of any drugs. In these cases, a septic technique is often not possible. This is not ideal, but a quickly placed IO catheter can save the patient’s life.

Lizards

Intravenous (IV) catheter placement
  • Catheters can be placed into the jugular and cephalic vessels of lizards:
    • These vessels require a surgical cutdown for placement and in many species these veins are often quite small, therefore they are not used very often.
    • Generally limited to medium to large lizards, approximately 20 cm or larger, though one could consider catheterization of smaller lizards with the proper equipment and skill.
  • Some people advocate IV catheter placement into the abdominal vein of lizards, but the technique is even more difficult and may have more complications than jugular catheterization.
Intraosseous (IO) catheter placement
  • Indicated in all lizards needing venous access, more so in smaller lizards or those with anatomy or disease that prohibits IV catheter placement:
    • The bones of choice for IO catheterization is the tibia, although the femur and humerus can also be used.
    • Consideration must be given to the location with respect to the ability of the patient to interfere with or manipulate the catheter while hospitalized.
    • The catheter is inserted using rotator movement through the cranial portion of the tibia and secured in place.
    • Radiography may be useful to assess proper placement of the IO catheter.

Snakes

IV catheter placement
  • A cut-down incision in the jugular vein is required for this procedure.
Heart
  • In an extreme emergency, a catheter can be placed in the heart for a short time using the same technique as for cardiac venipuncture.
  • Once the catheter is placed, it should be secured with suture or tape.
  • The effect of repeated venipuncture of the heart of snakes has been evaluated and has shown that damage is minimal and cardiac muscle recovers well. The effect of cardiac catheterization has not been evaluated in snakes.
IO catheter placement
  • It is not possible to place an IO catheter in snakes.

Chelonia

IV catheter placement
  • Jugular catheterization can be used for medium to large animals.
  • The cervical skin is usually lacking scales in chelonians, and therefore the cut-down technique is usually simpler than in lizards and snakes .
  • Freshwater turtles are particularly difficult to catheterize as their jugular veins are small.
  • Patients that are relatively stable and active may make it difficult to maintain and clean the catheter site.
  • Sedation/anesthesia is required.
  • Poor perfusion, phlebitis, blown vessels or vessels that are just too small will complicate even further the procedure of IV catheterization.
IO catheter placement
  • There are several sites that can potentially be utilized for IO catheterization in chelonian species, but the humerus is the recommended as other sites do not distribute fluids quite well.
  • The use of the carapacial bone (either plastron, bridge or carapace) for IO catheterization is controversial, as one article demonstrated that fluid injected into these sites is poorly absorbed into systemic circulation.

Uses

Advantages

  • IV/IO administration of fluids, drugs or blood (for transfusions) can save the life of a debilitated patient, as SC/ICe/PO/cloacal fluids are poorly absorbed in critical patients.

Disadvantages

  • IV catheters are difficult to place in most reptilian species.
  • IO catheters are difficult to place in chelonians and their placement is not possible in snakes.

Requirements

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Preparation

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Procedure

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Aftercare

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Young B D, Stegeman N, Norby B et al (2012) Comparison of intraosseous and peripheral venous fluid dynamics in the desert tortoise (Gopherus agassizii). J Zoo Wildl Med 43 (1), 59-66.
  • Norton T M (2005) Chelonian emergency and critical care. Semin Avian Exotic Pet Med 14 (2), 106-130.
  • Isaza R, Andrews G A, Coke R L et al (2004) Assessment of multiple cardiocentesis in ball pythons (Python regius). J Am Assoc Lab Anim Sci 43 (6), 35-38.

Other sources of information

  • Cheek R & Crane M (2017) Snakes. In: Exotic Animal Medicine for the Veterinary Technician. 3rd edn. Eds: Ballard B & Cheek R. Wiley-Blackwell. pp 137-181.
  • Nugent-Deal J (2017) Exotic Anesthesia and Analgesia. In: Exotic Animal Medicine for the Veterinary Technician. 3rd edn. Eds: Ballard B & Cheek R. Wiley-Blackwell. pp 11-30.
  • Rivera S (2017) Chelonians. In: Exotic Animal Medicine for the Veterinary Technician. 3rd edn. Eds: Ballard B & Cheek R. Wiley-Blackwell. pp 183-196.
  • Wilson B (2017) Lizards. In: Exotic Animal Medicine for the Veterinary Technician. 3rd edn. Eds: Ballard B & Cheek R. Wiley-Blackwell. pp 95-136.
  • Girling S J (2013) Reptile and Amphibian Handling and Chemical Restraint. In: Veterinary Nursing of Exotic Pets. 2nd edn. Wiley-Blackwell. pp 272-285.
  • Girling S J (2013) An Overview of Reptile and Amphibian Therapeutics. In: Veterinary Nursing of Exotic Pets. 2nd edn. Wiley-Blackwell. pp 319-336.
  • Mader D R (2006) Ed Reptile Medicine and Surgery. Saunders Elsevier, USA. pp 1242.

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