Name: Internal Jugular Vein Identification and Catheter Exit Site Preparation
Uploaded: 2023-03-31T14:00:00
Description: Watch this Scientific Journal Video about Internal Jugular Vein Identification and Catheter Exit Site Preparation at JoVE.com

The video demonstrates a surgical procedure on an anesthetized swine, focusing on the isolation and preparation of the internal jugular vein (IJV) for catheter placement. It includes step-by-step instructions for incision, dissection, and creating a loop and sling for the IJV before establishing a catheter exit site.

internal jugular vein identification and catheter exit site preparation

צנתר היקמן לגישה ארוכת טווח של כלי הדם בחזירים

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.

מחבר זרקור: שימוש בצנתר היקמן לגישה ארוכת טווח לכלי דם במודל חזירי פרה-קליני  

שימוש בצנתר היקמן לגישה ארוכת טווח לכלי דם במודל חזירי פרה-קליני

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.

Watch this Scientific Journal Video about Internal Jugular Vein Identification and Catheter Exit Site Preparation at JoVE.com

Internal Jugular Vein Identification and Catheter Exit Site Preparation  

זיהוי ורידים ג'וגולרי פנימי והכנת אתר יציאה מקטטר

כדי להתחיל, הניחו את החזיר המורדם על שולחן הניתוחים. בשדה הגחון, בצע חתך של ארבעה סנטימטרים בין קנה הנשימה לבין הגבול המדיאלי של שריר sternocleidomastoid . מחלקים את הפלטיזמה ומנתחים את רקמת החיבור כדי לחשוף את הווריד הצווארי הפנימי, או IJV, על הגבול הלטרלי של שריר הסטרנוקלידומסטואיד.לאחר מכן בודדו שלושה עד ארבעה סנטימטרים מה-IJV על ידי חלוקת ענפיו עם 4.0 קשרי תפר מצופים וקלועים שאינם נספגים. יש לנתח באופן היקפי הרחק מרקמת החיבור שמסביב. בקצה הגולגולת של ה- IJV, מעבירים פעמיים מתחת לכלי כדי ליצור לולאה סביבו.בקצה המשוט, העבירו עניבת תפר פעם אחת מתחת לכלי כדי ליצור קלע. להכנת אתר יציאת קטטר. מקם מחדש את החזיר באמצעות הטיה צידית לכיוון הצד הלא ניתוחי כדי לחשוף את שדה הניתוח הגבי האיפסילטרלי.לאחר שהגפיים מאובטחות מחדש, עם אזמל מספר 10 להבים, בצע ניקוב של 0.5 ס"מ בעור במקום יציאת הצנתר הרצוי, שלושה סנטימטרים לרוחב עמוד השדרה, וחמישה סנטימטרים לראש.

Research

JoVE Journal

Medicine

Internal Jugular Vein Identification and Catheter Exit Site Preparation

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

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