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Fragmentation of intravenous catheters in three horses
,~i;:,: ~;!;iijjji
Reviewed
FRAGMENTATION OF INTRAVENOUS CATHETERS IN THREE HORSES W. Kent Scarratt, DVM; H. David Moll, DVM, MS; R. Scott Pleasant, DVM, MS
SUMMARY Fragmentation of an intravenous, polytetrafluoroethylene catheter occurred in three horses. The retained fragment was identified in the cervical region by radiography and in the jugular vein by ultrasonography. The retained fragment was removed successfully by jugular venotomy. Key words: Equine, intravenous catheter, fragmentation
INTRODUCTION Intravenous catheters are used commonly in the horse to administer fluids, injectable anesthetics and antimicrobials. 15 Complications associated with intravenous catheters occur infrequently in the horse and include thrombosis, thrombo-embolism, thrombophlebitis and periphlebitis.l5 Mechanical cause s of failure of intravenous catheters in horses including fragmentation 6'7 and embolization 8 are reported recently. The purpose of this report is to describe the fragmentation of a polytetrafluoroethylene, intravenous catheter, the location of the catheter fragment with radiography and ultrasonography and the successful surgical retrieval of the fragment by jugular venotomy in three horses.
MATERIALS AND METHODS The medical records were surveyed from the Virginia Authors' address: Department of Large Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, VirginiaTech, Blacksburg, VA 24061. 608
Tech Veterinary Teaching Hospital (VTH) from January 1, 1992 through December 31, 1994. All admissions of horses were reviewed, and horses were selected with a diagnosis of intravenous catheter fragmentation. Three horses were identified of the 1,863 horses admitted to the VTH during this three-year period.
RESULTS Case 1 A one-day-old Tennessee Walking Horse colt was referred to the VTH for weakness and a reduced suckle reflex. At admission, the colt was dehydrated, had failure of passive transfer of immunity and suspected neonatal maladjustment syndrome. A 16 gauge x 8.25 cm, around the needle, polytetrafluoroethylene (PTFE) catheter a was placed aseptically in the jugular vein at admission. The catheter was sutured in place, covered with povidoneiodine ointment placed on 10 x 10 cm gauze squares and an elastic bandage was placed around the neck. Plasma, crystalloid fluids and antimicrobials were administered via an extension set attached to the catheter. There were no problems with the catheter during the first two days after insertion. The catheter broke approximately 1.25 cm from the junction of the hub and the tubing during attempted removal on day 3. A rope tourniquet was placed around the caudal cervical region. Radiography confirmed the catheter fragment in the cervical region. Ultrasonography localized the catheter fragment in the jugular vein, close to the site of insertion. The foal was sedated with xylazine and butorphanol. The skin over the catheter fragment was infiltrated with local anesthetic and prepared for surgery. A five cm incision in the skin was made over the catheter aAngiocath; Becton Dickinson, Sandy, UT.
JOURNAL OF EQUINE VETERINARY SCIENCE
9 iiiiii~~ ~!!~
51 ~!i!~ii~/i
i~ I~I!I
Figure 1, Lateral radiograph of the cervical region of case 2. A linear foreign body (black arrow) was observed at the level of the third and fourth cervical vertebrae. An intravenous catheter (white arrow) was placed in the opposite jugular vein.
fragment. The jugular vein was isolated from surrounding tissue and the catheter fragment was palpated in the wall of the vein. A jugular venotomy was performed and the catheter fragment was removed. The venotomy was closed with absorbable suture placed in an interrupted pattern. The subcutaneous and cuticular tissues were closed with absorbable suture placed in a continuous pattern. The neck was bandaged and broad-spectrum antimicrobials were continued. The incision was healing well when the foal was discharged from the VTH, seven days after the venotomy. A follow-up conversation with the owner, eight months after discharge, did not reveal any complications associated with the incision. Case 2
A seven-year-old Hackney stallion was referred to the VTH for dullness and diarrhea. At admission the stallion was dehydrated and acidotic. A 14 gauge x 13.3 cm, around the needle, PTFE catheter a was placed aseptically in the jugular vein at admission. The catheter was sutured in place and covered with povidone-iodine ointment. An elastic bandage was placed around the neck. Crystalloid fluids, antimicrobials and non-steroidal antiinflammatory drugs were administered via an extension set attached to the catheter. There were no problems with the catheter during the first two days after insertion. The catheter broke during attempted removal on day 3, approximately 1 cm from the junction of the hub and the tubing. A rope tourniquet was placed around the caudal cervical region. A 14 gauge x 13.3 cm, PTFE catheter was placed aseptically
Figures 2a
and 2b. Longitudinal and t r a n s v e r s e ultrasonic examination of the cervical region of case 2 using a 7.5 MHz transducer. A hyperechoic foreign body (arrow) was observed in the jugular vein (J). Volume 17, Number 11, 1997
609
Figure 3. (left) Lateral radiograph of the cervical region of case 3. A linear foreign body (arrow), is observed at the level of the fifth and sixth cervical vertebrae. in the opposite jugular vein. The stallion was sedated with detomidine. Radiography confirmed the catheter fragment in the cervical region (Fig. 1) and ultrasonography localized the catheter fragment in the jugular vein, close to the site of insertion (Fig. 2a and 2b). The stallion was sedated with detomidine and butorphanol. The skin over the catheter fragment was infiltrated with local anesthetic and prepared for surgery. A 7.5 cm incision in the skin was made over the fragment. The jugular vein was isolated and the retained fragment was palpated in the wall of the vein. A jugular venotomy was performed and the catheter fragment was removed. The venotomy was closed with 3-0, polyglycolic acid in a simple interrupted pattern. The subcutaneous space was closed with 2-0, polyglycolic acid in a simple continuous pattern. The skin was closed with 20, polydioxanone in a simple interrupted pattern. A pressure bandage was placed around the neck. Broad-spectrum antimicrobials were continued. The incision was healing well when the stallion was discharged from the VTH, four days after the venotomy. A follow-up conversation with the owners one year later revealed a small swelling at the site of the incision.
Case 3 A one-day-old American Saddlebred filly was referred to the VTH for weakness and dyspnea. At admission, the filly was dehydrated, hypoglycemic and had failure of passive transfer of immunity. A 16 gauge x 8.25 cm, PTFE catheter a was placed aseptically in the left jugular vein at admission. The catheter was sutured and glued in place with cyanoacrylate, and covered with povidone iodine ointment. Plasma, crystalloid fluids and antimicrobials were administered via an extension set attached to the catheter. There were no problems with the catheter during the first two days after insertion. The catheter was removed routinely on day 3. A 16 gauge x 8.25 cm, PTFE catheter a was placed aseptically in the right jugular vein twelve hours prior to discharge. The catheter was sutured 610
and glued in place with cyanoacrylate, and covered with povidone-iodine ointment. An elastic bandage was placed around the neck. Antimicrobials were administered via the extension set attached to the catheter. The foal was discharged from the VTH with instructions to administer the antimicrobials via the extension set attached to the catheter. The owner was unable to aspirate blood into the extension set before administering the antimicrobials, six hours after discharge. The neck bandage was removed. The catheter broke approximately 0.5 cm from the junction of the hub and the tubing. A rope toumiquet was applied to the caudal cervical region and the filly was returned to the VTH. The catheter fragment was identified in the caudal cervical region by radiography (Fig. 3), and was detected in the jugular vein by ultrasonography. The filly was anesthetized with xylazine and ketamine, intubated and maintained on a mixture ofisofluorane and oxygen. A 6 cm incision in the skin was made over the jugular vein. The jugular vein was isolated and the fragment was palpated in the lumen of the vein. A jugular venotomy was performed and the fragment was removed. The venotomy was closed with 4-0, polyglactin in a single interrupted suture. The subcutaneous tissue was closed with 3-0, polyglycolic acid in a simple continuous pattern. The skin was closed with 20, nylon in a horizontal mattress pattern. The antimicrobials were continued and an elastic bandage was placed around the neck. The filly was discharged from the VTH the following day. A follow-up conversation with the owners one year later revealed depigmentation of the hair at the site of the incision.
DISCUSSION
Mechanical causes of failure of intravenous catheters in horses have been reported infrequently, e-8 An experimental study of PTFE catheters inserted into the jugular vein of horses revealed that 4 of 6 catheters had kinks or JOURNAL OF EQUINE VETERINARY SCIENCE
cracks after 14 days, 3 of 3 catheters had kinks and broke after 30 days and all catheters had cracks at the junction of the hub and tubing. 6 It was suggested that PTFE catheters are relatively stiff and that motion at the interface between the catheter and the skin caused a crease in the catheter and its subsequent failure. 6 There were no problems with the PTFE catheters inserted in Cases 1 and 2 in this report prior to the routine removal of the catheters on the third day after insertion. The catheters were observed and the jugular veins were palpated daily for swelling, pain and thrombosis. All catheters broke less than 1.25 cm from the junction of the catheter hub and tubing. The catheters in Cases 1 and 2 broke during attempted removal on the third day after insertion, and the catheter in Case 3 broke within 24 hours after insertion. Radiography and ultrasonography were used to detect the location of the catheter fragment in all horses in this report. The PTFE catheters inserted in the horses in this report were radiopaque and were identified with standard radiographic procedures in the cervical region in all horses. Cervical ultrasonography was used to determine the intravascular or extravascular location of the catheter fragment that was identified by radiography. Cervical ultrasonography revealed a hyperechoic structure, which was presumed to be the catheter fragment, in the jugular vein in all horses. The catheter fragment was located close to the site of insertion of the catheter in Cases 1 and 2, and in the caudal cervical region in Case 3. The location of the skin incision in all horses in this report was based on the radiographic and ultrasonographic location of the catheter fragment. The fragment was palpated via the skin incision in the wall of the jugular vein in Cases 1 and 2, and in the lumen of the jugular vein in Case 3. The fragment was removed successfully by jugular venotomy in all horses. A bandage was placed around the neck of each horse after surgery to minimize swelling, and all horses were treated with broad-spectrum antimicrobial drugs to prevent infection. Follow-up conversations with the owners of Cases 2 and 3 one year after jugular venotomy revealed minor complications at the site of the incision. Embolization of intravenous catheters has been reported infrequently in the veterinary literature, a'9 Reports of catheter embolization in a foal s and a dog 9 revealed the catheter fragments lodged in the heart and were removed nonsurgically. The authors suggest that a rope tourniquet applied to the caudal cervical region of horses with broken intravenous catheters prior to and during jugular venotomy may prevent embolization of the catheter fragment.
CONCLUSION Polytetrafluoroethylene catheters break occasionally
Volume 17, Number 11, 1997
in horses. Radiography and ultrasonography can be used to identify the catheter fragment in the cervical region. Catheter fragments can be removed successfully from the jugular vein by v enotomy. A rope tourniquet placed around the caudal cervical region of affected horses prior to and during jugular venotomy may prevent embolization of the catheter fragment.
REFERENCES 1. Bayly WM, Vale BH: Intravenous catheterization and associated problems in the horse. Compend Cont Educ Pract Vet 1982;4:$227-231. 2. Deem DA: Complications associated with the use of intravenous catheters in large animals. Calif Vet 1981 ;6:19-24. 3. Morris DD:Thrombophlebitis in horses:the contribution of hemostatic dysfunction to pathogenesis. Compend Cent Educ Pract Vet 1989;11:1386-1394. 4. Spurlock SL, Spurlock GH: Risk-factors of catheter-related complications. Comp Cent Educ Pract Vet 1990; 12:241-248. 5. Gabel AA: Intravenous injections: complications and their prevention. Proc Am Assoc Equine Pract 1977;29-38. 6. Spurlock SL, Spurlock GH, Parker G, Ward MV: Longterm jugular vein catheterization in horses. J Am Vet Med Assoc 1990; 196:425-430. 7. Scarratt WK, Moll HD: Diagnosis and management of intravenous catheter fragmentation in two horses. Proc Am Assoc Equine Pract 1996;188-189. 8. Hoskinson JJ, Wooten P, Evans R: Nonsurgical removal of a catheter embolus from the heart of a foal. JAm Vet MedAssoc 1991 ;199:233-235. 9. Fox PR, Sos TA, Bond BR: Nonsurgical removal of a catheter embolus from the heart of a dog. J Am Vet Med Assoc 1985; 187:275-276.
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-
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Reviewed
FRAGMENTATION OF INTRAVENOUS CATHETERS IN THREE HORSES W. Kent Scarratt, DVM; H. David Moll, DVM, MS; R. Scott Pleasant, DVM, MS
SUMMARY Fragmentation of an intravenous, polytetrafluoroethylene catheter occurred in three horses. The retained fragment was identified in the cervical region by radiography and in the jugular vein by ultrasonography. The retained fragment was removed successfully by jugular venotomy. Key words: Equine, intravenous catheter, fragmentation
INTRODUCTION Intravenous catheters are used commonly in the horse to administer fluids, injectable anesthetics and antimicrobials. 15 Complications associated with intravenous catheters occur infrequently in the horse and include thrombosis, thrombo-embolism, thrombophlebitis and periphlebitis.l5 Mechanical cause s of failure of intravenous catheters in horses including fragmentation 6'7 and embolization 8 are reported recently. The purpose of this report is to describe the fragmentation of a polytetrafluoroethylene, intravenous catheter, the location of the catheter fragment with radiography and ultrasonography and the successful surgical retrieval of the fragment by jugular venotomy in three horses.
MATERIALS AND METHODS The medical records were surveyed from the Virginia Authors' address: Department of Large Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, VirginiaTech, Blacksburg, VA 24061. 608
Tech Veterinary Teaching Hospital (VTH) from January 1, 1992 through December 31, 1994. All admissions of horses were reviewed, and horses were selected with a diagnosis of intravenous catheter fragmentation. Three horses were identified of the 1,863 horses admitted to the VTH during this three-year period.
RESULTS Case 1 A one-day-old Tennessee Walking Horse colt was referred to the VTH for weakness and a reduced suckle reflex. At admission, the colt was dehydrated, had failure of passive transfer of immunity and suspected neonatal maladjustment syndrome. A 16 gauge x 8.25 cm, around the needle, polytetrafluoroethylene (PTFE) catheter a was placed aseptically in the jugular vein at admission. The catheter was sutured in place, covered with povidoneiodine ointment placed on 10 x 10 cm gauze squares and an elastic bandage was placed around the neck. Plasma, crystalloid fluids and antimicrobials were administered via an extension set attached to the catheter. There were no problems with the catheter during the first two days after insertion. The catheter broke approximately 1.25 cm from the junction of the hub and the tubing during attempted removal on day 3. A rope tourniquet was placed around the caudal cervical region. Radiography confirmed the catheter fragment in the cervical region. Ultrasonography localized the catheter fragment in the jugular vein, close to the site of insertion. The foal was sedated with xylazine and butorphanol. The skin over the catheter fragment was infiltrated with local anesthetic and prepared for surgery. A five cm incision in the skin was made over the catheter aAngiocath; Becton Dickinson, Sandy, UT.
JOURNAL OF EQUINE VETERINARY SCIENCE
9 iiiiii~~ ~!!~
51 ~!i!~ii~/i
i~ I~I!I
Figure 1, Lateral radiograph of the cervical region of case 2. A linear foreign body (black arrow) was observed at the level of the third and fourth cervical vertebrae. An intravenous catheter (white arrow) was placed in the opposite jugular vein.
fragment. The jugular vein was isolated from surrounding tissue and the catheter fragment was palpated in the wall of the vein. A jugular venotomy was performed and the catheter fragment was removed. The venotomy was closed with absorbable suture placed in an interrupted pattern. The subcutaneous and cuticular tissues were closed with absorbable suture placed in a continuous pattern. The neck was bandaged and broad-spectrum antimicrobials were continued. The incision was healing well when the foal was discharged from the VTH, seven days after the venotomy. A follow-up conversation with the owner, eight months after discharge, did not reveal any complications associated with the incision. Case 2
A seven-year-old Hackney stallion was referred to the VTH for dullness and diarrhea. At admission the stallion was dehydrated and acidotic. A 14 gauge x 13.3 cm, around the needle, PTFE catheter a was placed aseptically in the jugular vein at admission. The catheter was sutured in place and covered with povidone-iodine ointment. An elastic bandage was placed around the neck. Crystalloid fluids, antimicrobials and non-steroidal antiinflammatory drugs were administered via an extension set attached to the catheter. There were no problems with the catheter during the first two days after insertion. The catheter broke during attempted removal on day 3, approximately 1 cm from the junction of the hub and the tubing. A rope tourniquet was placed around the caudal cervical region. A 14 gauge x 13.3 cm, PTFE catheter was placed aseptically
Figures 2a
and 2b. Longitudinal and t r a n s v e r s e ultrasonic examination of the cervical region of case 2 using a 7.5 MHz transducer. A hyperechoic foreign body (arrow) was observed in the jugular vein (J). Volume 17, Number 11, 1997
609
Figure 3. (left) Lateral radiograph of the cervical region of case 3. A linear foreign body (arrow), is observed at the level of the fifth and sixth cervical vertebrae. in the opposite jugular vein. The stallion was sedated with detomidine. Radiography confirmed the catheter fragment in the cervical region (Fig. 1) and ultrasonography localized the catheter fragment in the jugular vein, close to the site of insertion (Fig. 2a and 2b). The stallion was sedated with detomidine and butorphanol. The skin over the catheter fragment was infiltrated with local anesthetic and prepared for surgery. A 7.5 cm incision in the skin was made over the fragment. The jugular vein was isolated and the retained fragment was palpated in the wall of the vein. A jugular venotomy was performed and the catheter fragment was removed. The venotomy was closed with 3-0, polyglycolic acid in a simple interrupted pattern. The subcutaneous space was closed with 2-0, polyglycolic acid in a simple continuous pattern. The skin was closed with 20, polydioxanone in a simple interrupted pattern. A pressure bandage was placed around the neck. Broad-spectrum antimicrobials were continued. The incision was healing well when the stallion was discharged from the VTH, four days after the venotomy. A follow-up conversation with the owners one year later revealed a small swelling at the site of the incision.
Case 3 A one-day-old American Saddlebred filly was referred to the VTH for weakness and dyspnea. At admission, the filly was dehydrated, hypoglycemic and had failure of passive transfer of immunity. A 16 gauge x 8.25 cm, PTFE catheter a was placed aseptically in the left jugular vein at admission. The catheter was sutured and glued in place with cyanoacrylate, and covered with povidone iodine ointment. Plasma, crystalloid fluids and antimicrobials were administered via an extension set attached to the catheter. There were no problems with the catheter during the first two days after insertion. The catheter was removed routinely on day 3. A 16 gauge x 8.25 cm, PTFE catheter a was placed aseptically in the right jugular vein twelve hours prior to discharge. The catheter was sutured 610
and glued in place with cyanoacrylate, and covered with povidone-iodine ointment. An elastic bandage was placed around the neck. Antimicrobials were administered via the extension set attached to the catheter. The foal was discharged from the VTH with instructions to administer the antimicrobials via the extension set attached to the catheter. The owner was unable to aspirate blood into the extension set before administering the antimicrobials, six hours after discharge. The neck bandage was removed. The catheter broke approximately 0.5 cm from the junction of the hub and the tubing. A rope toumiquet was applied to the caudal cervical region and the filly was returned to the VTH. The catheter fragment was identified in the caudal cervical region by radiography (Fig. 3), and was detected in the jugular vein by ultrasonography. The filly was anesthetized with xylazine and ketamine, intubated and maintained on a mixture ofisofluorane and oxygen. A 6 cm incision in the skin was made over the jugular vein. The jugular vein was isolated and the fragment was palpated in the lumen of the vein. A jugular venotomy was performed and the fragment was removed. The venotomy was closed with 4-0, polyglactin in a single interrupted suture. The subcutaneous tissue was closed with 3-0, polyglycolic acid in a simple continuous pattern. The skin was closed with 20, nylon in a horizontal mattress pattern. The antimicrobials were continued and an elastic bandage was placed around the neck. The filly was discharged from the VTH the following day. A follow-up conversation with the owners one year later revealed depigmentation of the hair at the site of the incision.
DISCUSSION
Mechanical causes of failure of intravenous catheters in horses have been reported infrequently, e-8 An experimental study of PTFE catheters inserted into the jugular vein of horses revealed that 4 of 6 catheters had kinks or JOURNAL OF EQUINE VETERINARY SCIENCE
cracks after 14 days, 3 of 3 catheters had kinks and broke after 30 days and all catheters had cracks at the junction of the hub and tubing. 6 It was suggested that PTFE catheters are relatively stiff and that motion at the interface between the catheter and the skin caused a crease in the catheter and its subsequent failure. 6 There were no problems with the PTFE catheters inserted in Cases 1 and 2 in this report prior to the routine removal of the catheters on the third day after insertion. The catheters were observed and the jugular veins were palpated daily for swelling, pain and thrombosis. All catheters broke less than 1.25 cm from the junction of the catheter hub and tubing. The catheters in Cases 1 and 2 broke during attempted removal on the third day after insertion, and the catheter in Case 3 broke within 24 hours after insertion. Radiography and ultrasonography were used to detect the location of the catheter fragment in all horses in this report. The PTFE catheters inserted in the horses in this report were radiopaque and were identified with standard radiographic procedures in the cervical region in all horses. Cervical ultrasonography was used to determine the intravascular or extravascular location of the catheter fragment that was identified by radiography. Cervical ultrasonography revealed a hyperechoic structure, which was presumed to be the catheter fragment, in the jugular vein in all horses. The catheter fragment was located close to the site of insertion of the catheter in Cases 1 and 2, and in the caudal cervical region in Case 3. The location of the skin incision in all horses in this report was based on the radiographic and ultrasonographic location of the catheter fragment. The fragment was palpated via the skin incision in the wall of the jugular vein in Cases 1 and 2, and in the lumen of the jugular vein in Case 3. The fragment was removed successfully by jugular venotomy in all horses. A bandage was placed around the neck of each horse after surgery to minimize swelling, and all horses were treated with broad-spectrum antimicrobial drugs to prevent infection. Follow-up conversations with the owners of Cases 2 and 3 one year after jugular venotomy revealed minor complications at the site of the incision. Embolization of intravenous catheters has been reported infrequently in the veterinary literature, a'9 Reports of catheter embolization in a foal s and a dog 9 revealed the catheter fragments lodged in the heart and were removed nonsurgically. The authors suggest that a rope tourniquet applied to the caudal cervical region of horses with broken intravenous catheters prior to and during jugular venotomy may prevent embolization of the catheter fragment.
CONCLUSION Polytetrafluoroethylene catheters break occasionally
Volume 17, Number 11, 1997
in horses. Radiography and ultrasonography can be used to identify the catheter fragment in the cervical region. Catheter fragments can be removed successfully from the jugular vein by v enotomy. A rope tourniquet placed around the caudal cervical region of affected horses prior to and during jugular venotomy may prevent embolization of the catheter fragment.
REFERENCES 1. Bayly WM, Vale BH: Intravenous catheterization and associated problems in the horse. Compend Cont Educ Pract Vet 1982;4:$227-231. 2. Deem DA: Complications associated with the use of intravenous catheters in large animals. Calif Vet 1981 ;6:19-24. 3. Morris DD:Thrombophlebitis in horses:the contribution of hemostatic dysfunction to pathogenesis. Compend Cent Educ Pract Vet 1989;11:1386-1394. 4. Spurlock SL, Spurlock GH: Risk-factors of catheter-related complications. Comp Cent Educ Pract Vet 1990; 12:241-248. 5. Gabel AA: Intravenous injections: complications and their prevention. Proc Am Assoc Equine Pract 1977;29-38. 6. Spurlock SL, Spurlock GH, Parker G, Ward MV: Longterm jugular vein catheterization in horses. J Am Vet Med Assoc 1990; 196:425-430. 7. Scarratt WK, Moll HD: Diagnosis and management of intravenous catheter fragmentation in two horses. Proc Am Assoc Equine Pract 1996;188-189. 8. Hoskinson JJ, Wooten P, Evans R: Nonsurgical removal of a catheter embolus from the heart of a foal. JAm Vet MedAssoc 1991 ;199:233-235. 9. Fox PR, Sos TA, Bond BR: Nonsurgical removal of a catheter embolus from the heart of a dog. J Am Vet Med Assoc 1985; 187:275-276.
TREES FOR KIDS Buy
a
tree
-
help
a
kid!
Austree Inc will donate 2.5% to the North American Riding for Handicapped Association for every tree sold in California.
A u s t r e e Inc. 8 0 0 - 6 3 8 - 1 4 4 1 or 650-879-2004 O u t s i d e of C a l i f o r n i a call 8 0 0 - 7 8 3 - 7 2 8 1
6 - 8 foot Austree~ Hybrids in production
AUSTREE| a fast-growing pasture tree thal is non-toxic, nutritional, and can be used as wind breaks, dust control, privacy screens, and even as a living fire break. 50,000 sold in California alone. Very reasonably priced! 611