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

돼지의 장기 혈관 접근을 위한 Hickman 카테터

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.

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  

내부 경정맥 식별 및 카테터 출구 부위 준비

시작하려면 마취된 돼지를 수술대에 올려 놓습니다. 복부 부위에서 기관과 흉쇄유돌근의 내측 경계 사이에 4cm를 절개합니다. 판간을 나누고 결합 조직을 절개하여 흉쇄유돌근의 측면 경계에 있는 내부 경정맥(IJV)을 노출시킵니다.그런 다음 4.0 코팅 및 편조 된 비 흡수성 봉합사 타이로 가지를 나누어 IJV의 3-4 센티미터를 분리하십시오. 주변 결합 조직에서 원주방향으로 절개합니다. IJV의 두개골 끝에서 코팅되고 꼰 비흡수성 봉합사 넥타이를 혈관 아래에 두 번 통과시켜 주위에 고리를 만듭니다.코들 끝에서 봉합 넥타이를 혈관 아래에 한 번 통과시켜 슬링을 만듭니다. 카테터 출구 부위 준비용. 비수술적 측면을 향한 측면 기울기를 통해 돼지의 위치를 변경하여 동측 등쪽 수술 필드를 노출시킵니다.팔다리가 다시 고정되면 10번 날 메스로 원하는 카테터 출구 부위의 피부에 0.5cm, 척추 옆 3cm, 머리에 5cm 정도 구멍을 뚫습니다.

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 ...