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Intraosseous Catheters
Intraosseous Catheters
561
SMALL MAMMALS
SMALL MAMMALS
Intraosseous Catheters OVERVIEW AND GOAL It may be difficult to place an IV catheter in patients in critical condition with low blood pressure. Fluids and some medications may be given intraosseously until an intravenous catheter can be established.
• Betadine and alcohol to prepare area aseptically • Male adapter • Tape to secure catheter. • Antimicrobial ointment • Fluids • E-collar
INDICATIONS
ANTICIPATED TIME
Critically ill patients
10 minutes
CONTRAINDICATIONS
PREPARATION: IMPORTANT CHECKPOINTS
This is a very painful procedure; therefore, appropriate analgesia has to be used.
Best location is in the greater trochanter of the femur or tibial crest.
EQUIPMENT, ANESTHESIA
PROCEDURE
• Anesthesia (if needed; many critically ill patients will not need sedation) Use isoflurane only. • Spinal needle Ideal to prevent bone plugs • Teflon catheter, 18 to 23 gauge, 1 to 1.5 inches in length If spinal needle is not available • Saline • Lidocaine for topical analgesia • Surgical blade
• Sedate or anesthetize. • Clip hair over selected site and prepare aseptically. • If indicated, inject lidocaine as a local anesthetic. • Glove. • Palpate top of the greater trochanter or the tibial crest with your finger. • Create a stab incision with a surgical blade.
• Pass the needle (size is patient dependent: 18 to 23 gauge and 1 to 1.5 inches in length). • Insert needle anterograde, parallel to the long axis of the femur and into the medullary cavity. Once the needle is in the marrow cavity, no resistance should be noted. If you meet resistance, you are hitting the cortical bone. Withdraw the needle and redirect it. • Flush needle gently with saline and attach a male adapter. • Apply antimicrobial ointment to the insertion site, and place dressing over the entire unit. • Replacement fluids can be administered by slow drip. When the patient is rehydrated, replace with IV catheter and remove IO catheter. • Place an E-collar on the patient to prevent IO removal.
POST-PROCEDURE • Fluid requirements: 20-25 mL/d plus deficit correction • Shock: 25-40 mL/kg/24 h • Pain medication
Rabbits Butorphanol 0.1-1.0 mg/kg SC, IM, IV q 4-6 h Buprenorphine 0.01-0.05 mg/kg SC, IM, IV q 6-12 h Morphine 2-5 mg/kg SC, IM q 2-4 h Carprofen 1-2.2 mg/kg PO q 12 h Ibuprofen 2-7.5 mg/kg PO q 12-24 h
Meloxicam 0.5 mg/kg SC, PO q 24 h Ferrets Butorphanol: 0.05-0.5 mg/kg SC, IM, IV q 8-12 h Buprenorphine 0.01-0.03 mg/kg SC, IM, IV q 8-12 h Morphine: 0.5-5 mg/kg SC, IM q 2-6 h
Carprofen: 1.0 mg/kg PO q 12-24 h Ibuprofen: 1 mg/kg PO q 12-24 h • Remove catheter within 72 hours.
AUTHOR & EDITOR: JÖRG MAYER
561
SMALL MAMMALS
SMALL MAMMALS
Intraosseous Catheters OVERVIEW AND GOAL It may be difficult to place an IV catheter in patients in critical condition with low blood pressure. Fluids and some medications may be given intraosseously until an intravenous catheter can be established.
• Betadine and alcohol to prepare area aseptically • Male adapter • Tape to secure catheter. • Antimicrobial ointment • Fluids • E-collar
INDICATIONS
ANTICIPATED TIME
Critically ill patients
10 minutes
CONTRAINDICATIONS
PREPARATION: IMPORTANT CHECKPOINTS
This is a very painful procedure; therefore, appropriate analgesia has to be used.
Best location is in the greater trochanter of the femur or tibial crest.
EQUIPMENT, ANESTHESIA
PROCEDURE
• Anesthesia (if needed; many critically ill patients will not need sedation) Use isoflurane only. • Spinal needle Ideal to prevent bone plugs • Teflon catheter, 18 to 23 gauge, 1 to 1.5 inches in length If spinal needle is not available • Saline • Lidocaine for topical analgesia • Surgical blade
• Sedate or anesthetize. • Clip hair over selected site and prepare aseptically. • If indicated, inject lidocaine as a local anesthetic. • Glove. • Palpate top of the greater trochanter or the tibial crest with your finger. • Create a stab incision with a surgical blade.
• Pass the needle (size is patient dependent: 18 to 23 gauge and 1 to 1.5 inches in length). • Insert needle anterograde, parallel to the long axis of the femur and into the medullary cavity. Once the needle is in the marrow cavity, no resistance should be noted. If you meet resistance, you are hitting the cortical bone. Withdraw the needle and redirect it. • Flush needle gently with saline and attach a male adapter. • Apply antimicrobial ointment to the insertion site, and place dressing over the entire unit. • Replacement fluids can be administered by slow drip. When the patient is rehydrated, replace with IV catheter and remove IO catheter. • Place an E-collar on the patient to prevent IO removal.
POST-PROCEDURE • Fluid requirements: 20-25 mL/d plus deficit correction • Shock: 25-40 mL/kg/24 h • Pain medication
Rabbits Butorphanol 0.1-1.0 mg/kg SC, IM, IV q 4-6 h Buprenorphine 0.01-0.05 mg/kg SC, IM, IV q 6-12 h Morphine 2-5 mg/kg SC, IM q 2-4 h Carprofen 1-2.2 mg/kg PO q 12 h Ibuprofen 2-7.5 mg/kg PO q 12-24 h
Meloxicam 0.5 mg/kg SC, PO q 24 h Ferrets Butorphanol: 0.05-0.5 mg/kg SC, IM, IV q 8-12 h Buprenorphine 0.01-0.03 mg/kg SC, IM, IV q 8-12 h Morphine: 0.5-5 mg/kg SC, IM q 2-6 h
Carprofen: 1.0 mg/kg PO q 12-24 h Ibuprofen: 1 mg/kg PO q 12-24 h • Remove catheter within 72 hours.
AUTHOR & EDITOR: JÖRG MAYER