CTA05: W81XWH-13-2-0052 및 CTA06: W81XWH-13-2-0053 상에 따른 AFIRM II 노력과 관련하여 육군, 해군 NIH, 공군, VA 및 보건부의 지원에 감사드립니다. U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick MD 21702-5014는 수여 및 관리 획득 사무소입니다. 의견, 해석, 결론 및 권장 사항은 저자의 것이며 반드시 국방부가 보증하는 것은 아닙니다. 또한 W81XWH-17-1-0280, W81XWH-17-1-0624, W81XWH-17-1-0287 및 W81XWH18-1-0795 상을 통해 국방부 의회 주도 의료 연구 프로그램(CDMRP), 재건 이식 연구 프로그램(RTRP)의 지원에 감사드립니다. 성형외과와 존스 홉킨스 의과대학에도 감사의 말씀을 전합니다. 또한 Melanie Adams, Karen Goss, Haley Smoot, Kayla Schonvisky 및 Victoria Manahan을 포함한 모든 수의사 직원에게 감사드립니다.

돼지의 장기 혈관 접근을 위한 Hickman 카테터

<ol>
	<li>Pontes, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incidents+related+to+the+Hickman&#174;+catheter:+identification+of+damages.">Incidents related to the Hickman&#174; catheter: identification of damages.</a> Revista Brasileira de Enfermagem. 71 (4), 1915-1920 (2018).</li><li>Kolikof, J., Peterson, K., Baker, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Central+Venous+Catheter.">Central Venous Catheter.</a> StatPearls. , (2022).</li><li>Central venous catheters: how, when, why? (Proceedings). DVM 360 Available from: <a target="_blank" href="https://www.dvm360.com/view/central-venous-catheters-how-when-why-proceedings">https://www.dvm360.com/view/central-venous-catheters-how-when-why-proceedings</a> (2011)</li><li>Abrams-Ogg, A. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+use+of+an+implantable+central+venous+(Hickman)+catheter+for+long-term+venous+access+in+dogs+undergoing+bone+marrow+transplantation.">The use of an implantable central venous (Hickman) catheter for long-term venous access in dogs undergoing bone marrow transplantation.</a> Canadian Journal of Veterinary Research. 56 (4), 382-386 (1992).</li><li>Florescu, M. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+technique+of+placement+of+an+external+jugular+tunneled+hemodialysis+catheter+in+a+large+pig+model.">Surgical technique of placement of an external jugular tunneled hemodialysis catheter in a large pig model.</a> The Journal of Vascular Access. 19 (5), 473-476 (2018).</li><li>. Central Venous Catheter Placement: Modified Seldinger Technique Available from: <a target="_blank" href="https://www.cliniciansbrief.com/article/central-venous-catheter-placement-modified-seldinger-technique">https://www.cliniciansbrief.com/article/central-venous-catheter-placement-modified-seldinger-technique</a> (2015)</li><li>Perondi, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bacterial+colonization+of+non-permanent+central+venous+catheters+in+hemodialysis+dogs.">Bacterial colonization of non-permanent central venous catheters in hemodialysis dogs.</a> Heliyon. 6 (1), e03224 (2020).</li><li>Faulkner, R. T., Czajkowski, W. P., Rayfield, E. J., Hickman, R. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Technique+for+portal+catheterization+in+rhesus+monkeys+(Macaca+mulatta).">Technique for portal catheterization in rhesus monkeys (Macaca mulatta).</a> American Journal of Veterinary Research. 37 (4), 473-475 (1976).</li><li>Moss, J. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Central+venous+access+devices+for+the+delivery+of+systemic+anticancer+therapy+(CAVA):+a+randomised+controlled+trial.">Central venous access devices for the delivery of systemic anticancer therapy (CAVA): a randomised controlled trial.</a> Lancet. 398 (10298), 403-415 (2021).</li><li>Dai, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+tunneled+and+nontunneled+peripherally+inserted+central+catheter+placement:+A+randomized+controlled+trial.">Effect of tunneled and nontunneled peripherally inserted central catheter placement: A randomized controlled trial.</a> The Journal of Vascular Access. 21 (4), 511-519 (2020).</li><li>Wu, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tunneled+peritoneal+catheter+vs+repeated+paracenteses+for+recurrent+ascites:+a+cost-effectiveness+analysis.">Tunneled peritoneal catheter vs repeated paracenteses for recurrent ascites: a cost-effectiveness analysis.</a> Cardiovascular and Interventional Radiology. 45 (7), 972-982 (2022).</li><li>Onwubiko, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Small+tunneled+central+venous+catheters+as+an+alternative+to+a+standard+hemodialysis+catheter+in+neonatal+patients.">Small tunneled central venous catheters as an alternative to a standard hemodialysis catheter in neonatal patients.</a> Journal of Pediatric Surgery. 56 (12), 2219-2223 (2021).</li><li>da Silva, S. R., Reichembach, M. T., Pontes, L., de Souza, G. d. e. P. E. S. C. M., Kusma, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Heparin+solution+in+the+prevention+of+occlusions+in+Hickman&#174;+catheters+a+randomized+clinical+trial.">Heparin solution in the prevention of occlusions in Hickman&#174; catheters a randomized clinical trial.</a> Revista Latino-Americana de Enfermagem. 29, e3385 (2021).</li><li>Landoy, Z., Rotstein, C., Lucey, J., Fitzpatrick, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hickman-Broviac+catheter+use+in+cancer+patients.">Hickman-Broviac catheter use in cancer patients.</a> Journal of Surgical Oncology. 26 (4), 215-218 (1984).</li><li>Bawazir, O. A., Altokhais, T. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hickman+central+venous+catheters+in+children:+open+versus+percutaneous+technique.">Hickman central venous catheters in children: open versus percutaneous technique.</a> Annals of Vascular Surgery. 68, 209-216 (2020).</li><li>Cappello, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Central+venous+access+for+haemodialysis+using+the+Hickman+catheter.">Central venous access for haemodialysis using the Hickman catheter.</a> Nephrology Dialysis Transplantation. 4 (11), 988-992 (1989).</li><li>Shastri, L., Kj&#230;rgaard, B., Rees, S. E., Thomsen, L. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Changes+in+central+venous+to+arterial+carbon+dioxide+gap+(PCO2+gap)+in+response+to+acute+changes+in+ventilation.">Changes in central venous to arterial carbon dioxide gap (PCO2 gap) in response to acute changes in ventilation.</a> BMJ Open Respiratory Research. 8 (1), e000886 (2021).</li><li>Smith, A. C., Swindle, M. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Preparation+of+swine+for+the+laboratory.">Preparation of swine for the laboratory.</a> ILAR Journal. 47 (4), 358-363 (2006).</li><li>Swindle, M. M., Makin, A., Herron, A. J., Clubb, F. J., Frazier, K. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Swine+as+models+in+biomedical+research+and+toxicology+testing.">Swine as models in biomedical research and toxicology testing.</a> Veterinary Pathology. 49 (2), 344-356 (2012).</li><li>Hughes, H. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Swine+in+cardiovascular+research.">Swine in cardiovascular research.</a> Laboratory Animal Science. 36 (4), 348-350 (1986).</li><li>Svendsen, O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+minipig+in+toxicology.">The minipig in toxicology.</a> Experimental and Toxicologic Pathology. 57 (5-6), 335-339 (2006).</li><li>Tumbleson, M. E., Schook, L. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Advances in Swine in Biomedical Research. 2, (1996).</li><li>Jensen-Waern, M., Kruse, R., Lundgren, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Oral+immunosuppressive+medication+for+growing+pigs+in+transplantation+studies.">Oral immunosuppressive medication for growing pigs in transplantation studies.</a> Laboratory Animals. 46 (2), 148-151 (2012).</li><li>Ibrahim, Z., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+modified+heterotopic+swine+hind+limb+transplant+model+for+translational+vascularized+composite+allotransplantation+(VCA)+research.">A modified heterotopic swine hind limb transplant model for translational vascularized composite allotransplantation (VCA) research.</a> Journal of Visualized Experiments. (80), e50475 (2013).</li><li>Nordstr&#246;m, C. -. H., Jakobsen, R., M&#248;lstr&#248;m, S., Nielsen, T. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cerebral+venous+blood+is+not+drained+via+the+internal+jugular+vein+in+the+pig.">Cerebral venous blood is not drained via the internal jugular vein in the pig.</a> Resuscitation. 162, 437-438 (2021).</li><li>Habib, C. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=MR+imaging+of+the+yucatan+pig+head+and+neck+vasculature.">MR imaging of the yucatan pig head and neck vasculature.</a> Journal of Magnetic Resonance Imaging. 38 (3), 641-649 (2013).</li><li>Flournoy, W. S., Mani, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+external+jugular+vein+catheterization+in+piglets+using+a+triangulation+technique.">Percutaneous external jugular vein catheterization in piglets using a triangulation technique.</a> The International Journal of Laboratory Animals. 43 (4), 344-349 (2009).</li><li>Kotsougiani, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+angiogenesis+in+porcine+tibial+allotransplantation:+a+new+large+animal+bone+vascularized+composite+allotransplantation+model.">Surgical angiogenesis in porcine tibial allotransplantation: a new large animal bone vascularized composite allotransplantation model.</a> Journal of Visualized Experiments. (126), e55238 (2017).</li><li>Chuang, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+external+catheters+with+subcutaneous+vascular+access+ports+for+chronic+vascular+access+in+a+porcine+model.">Comparison of external catheters with subcutaneous vascular access ports for chronic vascular access in a porcine model.</a> Contemporary Topics in Laboratory Animal Science. 44 (2), 24-27 (2005).</li></ol>

저자 중 누구도 이 원고에 언급된 제품, 장치 또는 약물에 대한 재정적 이해관계가 없습니다.

CVC는 대동물 연구에서 다양한 기능을 수행하지만, 현재 문헌에는 30일 이상의 장기 임상시험에서 안전하고 지속 가능한 사용에 대한 합의된 접근 방식이 부족합니다. 이 프로토콜의 HC 삽입, 피부 고정 및 수제 파우치 보관을 위한 단계적 절차는 품질 향상을 위해 상당한 조정을 거쳤습니다. 따라서 이 프로토콜은 동물 복지를 보장하고 합병증을 최소화하면서 효율적이고 효과적인 정맥 주사를 가?...

환자 치료에서 중심정맥 카테터(CVC)의 필수적인 역할은 편의성, 우수한 안전성 프로파일 및 다양성 덕분입니다1. CVC의 기능에는 전체 비경구 영양, 조혈모세포 이식, 혈장분리술/성분채집술, 효율적인 수액, 혈액 또는 병약 투여에 대한 신뢰할 수 있는 접근이 포함됩니다2. 수의학에서 CVC는 반복적인 정맥 천자 없이 자극성 약물과 혈액 샘플링을 빠르게 희석 하여 동물의 불편함을 최소화합니다3. 광범위한 응용 분야에도 불구하고 대형 동물 연구에서 CVC를 사용하는 것은 여전히 몇 가지 상당한 문제를 야기합니다4.
가이드와이어 또는 유도 카테터를 통한 경피적 CVC 삽입은 비수의학 연구자, 특히 심부 정맥 구조를 가진 동물에서 어려울 수 있다5. 부적절한 CVC 설치 기술은 부주의하게 인근 구조물에 배치되는 결과를 초래할 수 있으며, 초음파 유도 배치 또는 위치 결정의 시술 후 방사선 촬영이 필요할 수 있다(6). 그러나 인간 수술실에 비해 초음파는 많은 대형 동물 연구 실험실에서 쉽게 사용할 수 없습니다. 또한, 유치 카테터를 장기간 사용하면 동물에 의한 라인 꼬임, 천공, 감염 또는 탈출이 발생할 수 있으며, 적시 치료, 임상 모니터링 및 연구 성과가 중단될 수 있습니다 4,7. CVC를 교체하려면 자재 조달, 수술 일정, 금식 시간 및 방사선 사진 접근을 포함한 추가 자원이 필요합니다. 따라서 CVC 관련 합병증은 특히 돼지의 경우 상당한 기술적, 재정적 장벽을 초래하거나 생산적인 중개 연구에 지장을 줄 수 있습니다. 음식이나 배설물에 의한 오염, 케이지 벽을 긁는 것, 자극 부위를 걷어차는 것은 CVC를 손상시킬 수 있으며, CVC 관련 합병증의 위험은 장기간 사용으로 인해 증폭됩니다. 따라서 돼지에서 CVC를 안전하고 복잡하지 않게 유지하려면 CVC 선택, 배치, 고정, 보호, 위생 및 감시를 신중하게 고려해야 합니다.
이 프로토콜에 사용된 히크만 카테터(HC)는 폴리에스테르 커프와 1-3루멘을 가진 터널형 CVC로, 인간과 동물의 장기 정맥 접근에 일반적으로 사용됩니다 1,4,8,9. 터널형 카테터 접근법은 터널링되지 않은 변형에 비해 합병증 발생률 및 유지 관리 비용이 낮다는 것이 밝혀졌다10,11,12. 커프는 피부 출구 부위를 둘러싼 피하 조직에 통합되어 HC 박리를 줄입니다. 다중 루멘 설계는 또한 약물 투여와 채혈을 분리할 수 있어 혈액 샘플 오염 및 부정확성을 최소화합니다. 그럼에도 불구하고 HC 사용에는 골절, 이동, 폐색 및 감염이 가장 흔한 어려움이 있습니다13,14,15,16. 따라서 HC의 적절한 설치 및 유지보수는 중개 연구에 사용될 때 필수적인 기술입니다. 그러나, 현재의 문헌은 장기 임상시험중 돼지에 HC를 사용하기 위한 모범 사례에 대한 지침을 거의 제공하지 않는다 5,6,17.
이 연구의 목적은 돼지의 장기적인 카테터 관련 합병증과 불편함을 최소화하는 내부 경정맥(IJV)에 HC 삽입, 피부 고정 및 내구성 있는 보호를 위한 최적화된 접근 방식을 설명하는 것입니다. HC 사용에 대한 중요한 고려 사항, 발생할 수 있는 잠재적 문제 및 이 접근 방식의 품질을 개선할 수 있는 수정 사항에 대한 설명이 포함되어 있습니다.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>#10 blade</td>
			<td>Medline</td>
			<td>MDS15110</td>
			<td></td>
		</tr>
		<tr>
			<td>0.9% Sterile Sodium Chloride</td>
			<td>Baxter&#160;</td>
			<td>2F7123</td>
			<td></td>
		</tr>
		<tr>
			<td>0-0 Coated and Braided Nonabsorbable Suture</td>
			<td>Covidien</td>
			<td>S-196</td>
			<td></td>
		</tr>
		<tr>
			<td>0-0 Synthetic, Monofilament, Nonabsorbable Polypropylene Suture</td>
			<td>Ethicon</td>
			<td>8690H</td>
			<td></td>
		</tr>
		<tr>
			<td>1 inch Medical Tape</td>
			<td>3M</td>
			<td>1548S-1</td>
			<td></td>
		</tr>
		<tr>
			<td>10 USP units/mL Heparin flush</td>
			<td>Becton, Dickinson and Company</td>
			<td>306424</td>
			<td></td>
		</tr>
		<tr>
			<td>3-0 Braided Absorbable Suture</td>
			<td>Covidien</td>
			<td>SL-636 (cutting needle), GL-122 (taper needle)</td>
			<td></td>
		</tr>
		<tr>
			<td>3-0 Monofilament Absorbable Suture</td>
			<td>Covidien</td>
			<td>SM-922 (cutting needle), CM-882 (taper needle)</td>
			<td></td>
		</tr>
		<tr>
			<td>4-0 Coated and Braided Non-absorbable Suture Ties</td>
			<td>Ethicon</td>
			<td>A303H</td>
			<td></td>
		</tr>
		<tr>
			<td>70% Ethanol</td>
			<td>Vedco</td>
			<td>VINV-IPA7</td>
			<td></td>
		</tr>
		<tr>
			<td>Adson tissue forceps</td>
			<td>MPM Medical Supply</td>
			<td>132-508</td>
			<td></td>
		</tr>
		<tr>
			<td>Adson-Brown forceps</td>
			<td>MPM Medical Supply</td>
			<td>106-2572</td>
			<td></td>
		</tr>
		<tr>
			<td>Air warming blanket and pad</td>
			<td>3M Bair Hugger</td>
			<td>UPC 00608223595770</td>
			<td></td>
		</tr>
		<tr>
			<td>Backhaus towel clamp</td>
			<td>MPM Medical Supply</td>
			<td>117-5508</td>
			<td></td>
		</tr>
		<tr>
			<td>Brown needle holder</td>
			<td>MPM Medical Supply</td>
			<td>110-1513</td>
			<td></td>
		</tr>
		<tr>
			<td>Buprenorphine</td>
			<td>PAR Pharmaceutical</td>
			<td>3003408B</td>
			<td></td>
		</tr>
		<tr>
			<td>Cefazolin</td>
			<td>Hikma Farmacuetica (Portugal)</td>
			<td>PLB 133-WES/1</td>
			<td></td>
		</tr>
		<tr>
			<td>Chlorhexidine</td>
			<td>Vet One</td>
			<td>501027</td>
			<td></td>
		</tr>
		<tr>
			<td>Clave</td>
			<td>Baxter</td>
			<td>7N8399</td>
			<td></td>
		</tr>
		<tr>
			<td>Cotton Padding</td>
			<td>Medline</td>
			<td>NON6027</td>
			<td></td>
		</tr>
		<tr>
			<td>Debakey forceps</td>
			<td>MPM Medical Supply</td>
			<td>106-5015</td>
			<td></td>
		</tr>
		<tr>
			<td>Elastic Adhesive Bandage Tape</td>
			<td>3M</td>
			<td>XH002016489</td>
			<td></td>
		</tr>
		<tr>
			<td>Halstead mosquito forceps</td>
			<td>MPM Medical Supply</td>
			<td>115-4612</td>
			<td></td>
		</tr>
		<tr>
			<td>Hickman Catheter</td>
			<td>Bard Access Systems</td>
			<td>603710</td>
			<td></td>
		</tr>
		<tr>
			<td>Hickman Catheter Repair Kit, 7Fr, Red and White Connectors</td>
			<td>Bard Access Systems</td>
			<td>0601690 (red), 0601680 (white), 502017</td>
			<td></td>
		</tr>
		<tr>
			<td>Kelly hemostatic forceps</td>
			<td>MPM Medical Supply</td>
			<td>115-7014</td>
			<td></td>
		</tr>
		<tr>
			<td>Ketamine</td>
			<td>Vet One</td>
			<td>383010-03</td>
			<td></td>
		</tr>
		<tr>
			<td>Lactated Ringers</td>
			<td>Baxter</td>
			<td>2B2324X</td>
			<td></td>
		</tr>
		<tr>
			<td>Maropitant Citrate</td>
			<td>Zoetis</td>
			<td>106</td>
			<td></td>
		</tr>
		<tr>
			<td>Mayo scissors</td>
			<td>MPM Medical Supply</td>
			<td>103-5014</td>
			<td></td>
		</tr>
		<tr>
			<td>Metzenbaum scissors</td>
			<td>MPM Medical Supply</td>
			<td>132-711</td>
			<td></td>
		</tr>
		<tr>
			<td>Pantoprazole</td>
			<td>JH Pharmacy</td>
			<td>NDC 0143-9284-10</td>
			<td></td>
		</tr>
		<tr>
			<td>Scalpel blade handle</td>
			<td>Medline</td>
			<td>MDS10801</td>
			<td></td>
		</tr>
		<tr>
			<td>Vein Pick</td>
			<td>SAI infusion technologies</td>
			<td>VP-10</td>
			<td></td>
		</tr>
		<tr>
			<td>Veterinary Ophthalmic Ointment</td>
			<td>Dechra</td>
			<td>IS4398</td>
			<td></td>
		</tr>
		<tr>
			<td>Xylazine</td>
			<td>Vet One</td>
			<td>510004</td>
			<td></td>
		</tr>
	</tbody>
</table>

hickman catheter use for long-term vascular access in a preclinical swine model

중심 정맥 카테터(CVC)는 혈액 모니터링, 신뢰할 수 있는 정맥 주사액 및 약물 투여를 포함한 광범위한 의료 응용 분야를 용이하게 하기 때문에 대규모 동물 연구에서 매우 중요한 장치입니다. 특히, 터널링된 다중 루멘 Hickman 카테터(HC)는 낮은 박리율과 합병증 발생률로 인해 돼지 모델에 일반적으로 사용됩니다. 다른 CVC에 비해 합병증이 적음에도 불구하고 HC 관련 이환율은 진행 중인 연구를 크게 지연시키거나 부정적인 영향을 미칠 수 있기 때문에 상당한 문제를 야기합니다. HC의 적절한 삽입 및 유지는 이러한 합병증을 예방하는 데 가장 중요하지만 모범 사례에 대한 합의는 없습니다. 이 프로토콜의 목적은 HC 관련 합병증 및 이환율을 완화하는 돼지에서 터널링된 HC의 삽입 및 유지를 위한 접근 방식을 포괄적으로 설명하는 것입니다. >100마리의 돼지에서 이러한 기술을 사용한 결과 최대 8개월까지 합병증이 없는 특허 라인을 얻을 수 있었고 카테터와 관련된 폐사나 복부 수술 부위의 감염이 없었습니다. 이 프로토콜은 HC의 수명을 최적화하는 방법과 사용 중 문제에 접근하기 위한 지침을 제공합니다.

The indispensable role of central venous catheters (CVCs) in patient care is owed to their convenience, favorable safety profile, and versatility1. Functions of a CVC include reliable access for total parenteral nutrition, hematopoietic stem cell transplantation, plasmapheresis/apheresis, and efficient fluid, blood, or co-drug administration2. In veterinary medicine, CVCs also minimize animal discomfort via the rapid dilution of irritant drugs and blood sampling without repeated venipuncture3. Despite their broad applications, the use of CVCs in large animal research still presents several considerable challenges4.
Percutaneous CVC placement via a guidewire or introducer catheter can be difficult for non-veterinary researchers, particularly in animals with deep venous structures5. An improper CVC installation technique may result in inadvertent placement into nearby structures, necessitating ultrasound-guided placement or a postprocedure radiography of the positioning6. However, compared to human operating rooms, ultrasounds are not readily available in many large animal research laboratories. Further, long-term use of indwelling catheters can result in line kinking, puncture, infection, or extrication by animals, with the possible disruption of timely treatment, clinical monitoring, and research outcomes4,7. Replacement of the CVC requires additional resources, including material procurement, surgical scheduling, fasting time, and radiographic access. CVC-related complications can therefore create significant technical and financial barriers or a disruption to productive translational research, particularly in swine. Contamination by food or feces, scratching against cage walls, and kicking sites of irritation may compromise a CVC, and the risk of CVC-related complications is amplified by long-term use. Thus, safe and uncomplicated maintenance of a CVC in swine requires careful consideration of CVC choice, placement, securement, protection, sanitation, and surveillance.
The Hickman catheter (HC) used in this protocol is a tunneled CVC with a polyester cuff and one to three lumens, that is commonly used for long-term intravenous access in humans and animals1,4,8,9. The tunneled catheter approach has been associated with lower complication rates and maintenance costs relative to non-tunneled variations10,11,12. The cuff reduces HC extrication by incorporating into the subcutaneous tissues surrounding the skin exit site. The multi-lumen design also enables the separation of medication administration and blood draws, thereby minimizing blood sample contamination and inaccuracy. Despite this, HC use is not without challenges, the most common of which include fracture, migration, occlusion, and infection13,14,15,16. Proper installation and maintenance of a HC are therefore indispensable skills when used in translational research. However, the current literature offers little guidance for best-practices for HC use in swine during long-term trials5,6,17.
The purpose of this study is to outline an optimized approach for HC insertion into the internal jugular vein (IJV), skin securement, and durable protection that minimizes long-term catheter-related complications and discomfort in swine. A discussion of the important considerations for HC use, potential challenges that may be encountered, and modifications that may improve the quality of this approach is included.

저자 스포트라이트: 전임상 돼지 모델에서 장기 혈관 접근을 위한 Hickman 카테터 사용  

전임상 돼지 모델에서 장기 혈관 접근을 위한 Hickman 카테터 사용

This protocol describes a reliable and reproducible technique for the insertion and maintenance of a tunnel Hickman catheter for long-term vascular access in a large animal model. The approach allows for convenient daily sampling of whole blood from awake animals and intravenous administration of medication and fluids. Some of the main challenges to the long-term central venous lines in large animals are infection and damages.As large animals are occasionally able to gain access to the lines and cause mechanical trauma. To mitigate these challenges, our group has invented our special pouches that protects the line while still allowing easy access to the same catheter. Central venous catheters are invaluable devices in large animal research as they facilitate a wide range of medical applications, but there is no consensus on the best practices for their insertion and maintenance.In response, we have proposed a protocol that comprehensively describes an approach for proper placement of a tunneled Hickman catheter in pigs that minimizes catheter-related complications and morbidity. The use of our approach in over 100 pigs has resulted in long-term patency and minimal complication rates. This protocol offers a method to optimize the lifespan of the Hickman catheter, and guidance for approaching issues during its use.

100마리 이상의 돼지가 우리 실험실에서 HC 삽입에 성공했습니다. HC는 외과의, 보조원, 서큘레이터 및 마취사와 함께 1시간 이내에 안전하고 정확하게 배치하고 고정할 수 있습니다. 카테터 파우치는 만드는 데 약 15-20분이 걸립니다. 이 기술은 간단하고 가르치기 쉬우며 수의사, 외과 레지던트 및 의대생이 감독 지시에 따라 수행했습니다.
HC는 최대 8개월 동안 합병증이나 재수...

Watch this Scientific Journal Video about Hickman Catheter Use for Long-Term Vascular Access in a Preclinical Swine Model at JoVE.com

돼지의 장기 혈관 접근을 위한 터널형 Hickman 카테터의 삽입 및 유지를 위한 신뢰할 수 있고 재현 가능한 접근법이 설명됩니다. 중심 정맥 카테터를 배치하면 깨어 있는 동물의 전혈을 매일 편리하게 샘플링하고 약물 및 수액을 정맥 투여할 수 있습니다.

Central venous catheters (CVCs) are invaluable devices in large animal research as they facilitate a wide range of medical applications, including blood ...

이 프로토콜은 대형 동물 모델에서 장기 혈관 접근을 위한 터널 Hickman 카테터의 삽입 및 유지를 위한 신뢰할 수 있고 재현 가능한 기술을 설명합니다. 이 접근법을 사용하면 깨어 있는 동물의 전혈을 매일 편리하게 샘플링하고 약물 및 수액을 정맥 투여할 수 있습니다. 대형 동물의 장기적인 중심 정맥 라인에 대한 주요 문제 중 일부는 감염과 손상입니다.큰 동물이 때때로 라인에 접근하여 기계적 외상을 일으킬 수 있기 때문입니다. 이러한 문제를 완화하기 위해 우리 그룹은 동일한 카테터에 쉽게 접근할 수 있도록 라인을 보호하는 특수 파우치를 발명했습니다. 중심 정맥 카테터는 광범위한 의료 응용 분야를 용이하게 하기 때문에 대형 동물 연구에서 매우 중요한 장치이지만 삽입 및 유지 관리에 대한 모범 사례에 대한 합의는 없습니다.이에 대응하여 우리는 카테터 관련 합병증 및 이환율을 최소화하는 터널형 Hickman 카테터를 돼지에 적절하게 배치하기 위한 접근 방식을 포괄적으로 설명하는 프로토콜을 제안했습니다. 100마리 이상의 돼지에 당사의 접근법을 사용한 결과, 장기적인 개통성과 합병증 발생률 최소화를 달성했습니다. 이 프로토콜은 Hickman 카테터의 수명을 최적화하는 방법과 사용 중 문제에 접근하기 위한 지침을 제공합니다.

hickman-catheter-use-for-long-term-vascular-access-preclinical-swine

Research

JoVE Journal

Medicine

Hickman Catheter Use for Long-Term Vascular Access in a Preclinical Swine Model

2.5K 조회수.  Johns Hopkins University School of Medicine. 이 프로토콜은 대형 동물 모델에서 장기 혈관 접근을 위한 터널 Hickman 카테터의 삽입 및 유지를 위한 신뢰할 수 있고 재현 가능한 기술을 설명합니다. 이 접근법을 사용하면 깨어 있는 동물의 전혈을 매일 편리하게 샘플링하고 약물 및 수액을 정맥 투여할 수 있습니다. 대형 동물의 장기적인 중심 정맥 라인에 대한 주요 문제 중 일부는 감염과 손상입니다.큰 동물이 때때...

비디오: 저자 스포트라이트: 전임상 돼지 모델에서 장기 혈관 접근을 위한 Hickman 카테터 사용  

Central venous catheters (CVCs) are invaluable devices in large animal research as they facilitate a wide range of medical applications, including blood monitoring and reliable intravenous fluid and drug administration. Specifically, the tunneled multi-lumen Hickman catheter (HC) is commonly used in swine models due to its lower extrication and complication rates. Despite fewer complications relative to other CVCs, HC-related morbidity presents a significant challenge, as it can significantly delay or otherwise negatively impact ongoing studies. The proper insertion and maintenance of HCs is paramount in preventing these complications, but there is no consensus on best practices. The purpose of this protocol is to comprehensively describe an approach for the insertion and maintenance of a tunneled HC in swine that mitigates HC-related complications and morbidity. The use of these techniques in &gt;100 swine has resulted in complication-free patent lines up to 8 months and no catheter-related mortality or infection of the ventral surgical site. This protocol offers a method to optimize the lifespan of the HC and guidance for approaching issues during use.

A reliable and reproducible approach for the insertion and maintenance of a tunneled Hickman catheter for long-term vascular access in swine is described. Placement of a central venous catheter allows for convenient daily sampling of whole blood from awake animals and intravenous administration of medication and fluids.

연구

의학

Internal Jugular Vein Identification and Catheter Exit Site Preparation

To begin, place the anesthetized swine on the operating table. In the ventral field, make a four-centimeter incision between the trachea and the medial border of the sternocleidomastoid muscle. Divide the platysma and dissect the connective tissue to expose the internal jugular vein, or IJV, on the lateral border of the sternocleidomastoid muscle.Then isolate three to four centimeters of the IJV by dividing its branches with 4.0 coated and braided non-absorbable suture ties. Circumferentially dissect away from the surrounding connective tissue. At the cranial end of the IJV, pass a coated and braided non-absorbable suture tie twice underneath the vessel to create a loop around it.At the coddle end, pass a suture tie once underneath the vessel to create a sling. For catheter exit site preparation. Reposition the swine via lateral tilt toward the non-surgical side to expose the ipsilateral dorsal surgical field.Once the limbs are resecured, with a number 10 blade scalpel, make a 0.5 centimeter puncture in the skin at the desired catheter exit site, three centimeters lateral to the vertebral column, and five centimeter coddle to the head.

내부 경정맥 식별 및 카테터 출구 부위 준비

Introduction and Tunneling of Catheter

For tunneling of the catheter, remove the wet gauze and reidentify the isolated IJV segment, then choose a target entry site for catheter introduction subcutaneously at the same depth as the IJV, deeper than the sternocleidomastoid, and between the two coated and braided non-absorbable suture ties. Hold the Hickman catheter introducer in the dominant hand in the dorsal surgical field and suspend the remaining length of the catheter in the air above the sterile field. The non-dominant hand should be in the ventral surgical field.Insert the introducer into the exit puncture site with the dominant hand, pointing the tip of the device toward the non-dominant hand in the ventral field. Push the tip of the introducer superficially and medially to tunnel the catheter through the adipose tissue, feeling for the emergence of the tip with a non-dominant hand. Once the tip emerges at the target entry site, pull the introducer and catheter through the subcutaneous tunnel until the cuff of the main line is just underneath the surface of the skin of the dorsal field.

카테터의 도입 및 터널링

Insertion and Securing the Catheter

Cut the end of the catheter to approximately the length at which it would reach down to one third of the length of the swine's sternum. Using Adson-Brown forceps, grasp the middle of the isolated IJV segment and make a cut halfway through the vessel with curved Metzenbaum scissors. While holding the IJV segment, insert the vein pick into the caudal segment of the vessel.While maintaining tension on the cranial suture tie. Insert and thread the end of the catheter into the vessel caudally. Once the catheter is fully inserted, knot the caudal suture tie once to temporarily secure the Hickman catheter.Once patency is confirmed, knot the caudal suture tie twice to secure the distal IJV segment around the intravenous catheter. Then knot the cranial suture tie once to occlude blood flow in the IJV segment. Once done to close the ventral surgical site, first suture platysma simple interrupted sutures with a 3-0 braided absorbable suture.Then close subcuticular running sutures with a 3-0 monofilament absorbable suture. To secure the Hickman catheter to the animal's skin, orient the Hickman catheter so that it forms a U shape. Then identify three points.The first point is within two centimeters of the exit site. The second point is over the forked portion of the catheter where the red and white lines diverge. And the third point is at the top of the U between the first two points.At each point, place a three centimeter piece of one inch medical tape over the catheter to create a wing on each side. With a O synthetic monofilament, non-absorbable polypropylene suture, secure each wing to the skin via a single simple interrupted suture. At the second point over the forked portion, add a single interrupted suture through the gap between the two lines and ensure that the knot lies on top of the tape to prevent irritation.Test the patency of the white and red lines outside the sterile field via blood draws and flushes using 10 milliliters of 0.9%normal saline and 10 milliliters of heparinized saline. Once the catheter pouch with the desired number of flaps is created, align the hole and flap one with the point where the lines exit the collar, orienting it so that it's opening is caudal. Ensure the pouch is on the midline or slightly lateral to the dorsal neck.Then pull the red and white lines through the hole and flap one, ensuring the lines lay flat between flaps one and two with flap three facing up. Using a 0 synthetic monofilament, non-absorbable polypropylene suture, secure the pouch to the collar with a simple interrupted suture at each corner and midway along each end. Do not suture through the skin.In a representative cohort of 32 swine with endpoint ranging from eight to 132 days, 78.13 of Hickman catheters remained patent until the experimental endpoint. Small repairs were required in 9.38%of cases, while rates of removal or replacement before and after 30 days were 9.38%and 12.5%respectively. Reasons for line compromises included displacement, puncture, and internal blockage.However, timely repair and replacement demonstrated a 100%functional success rate without significant interference with data collection.