Factors Influencing the Occurrence of Thrombophlebitis After Post‐Surgical Long‐Term Intravenous Catheterization of Colic Horses: a Study of 38 Cases

Abstract

Thrombophlebitis is a well-known complication of the use of long-term in-dwelling catheters. In humans, catheter material has been shown to strongly influence the occurrence of thrombophlebitis. In the horse, the influence of catheter material has been studied in healthy experimental animals, but information on the relative importance of this factor is lacking. To investigate which factors have most impact on the frequency of jugular vein thrombosis in post-surgical colic horses, a clinical study was performed on 38 animals. Horses were randomly divided into two groups. In one group a polytetrafluoroethylene catheter was used, in the other a polyurethane catheter. Both groups were clinically monitored and screened for signs of thrombophlebitis. Seven out of 38 horses developed thrombophlebitis. The type of catheter material used had no influence on thrombophlebitis development. Dwell time was significantly longer in horses that developed thrombophlebitis compared with those that did not. There was no relationship between the occurrence of thrombophlebitis and underlying disease or surgical treatment, suggesting that the general state of debilitation these horses experienced was the most important determinant for the development of thrombophlebiris. This was further stressed by the fact that seven horses developed thrombophlebitis of the contralateral vein that had been used for the induction of anaesthesia (this incidence is much higher than in horses anaesthetized for elective surgery). It is concluded that the state of debilitation is the most important determining factor for the occurrence of thrombophlebitis after the use of long-term in-dwelling intravenous catheters. This makes a substantial reduction of the incidence of thrombophlebitis difficult, but some progress can be made by consequently restricting dwell time.

Tromboflebite jugular em equinos submetidos à laparotomia para o tratamento de afecção gastrointestinal

“…A rede de fibrina inicia sua formação no orifício formado pela punção em apenas 30 minutos (Spurlock & Spurlock 1990); portanto, o cateter age como estímulo contínuo de lesão endotelial e, caso haja mais um fator da tríade de Virchow presente, como a alteração dos fatores de coagulação sanguínea associada à sepse, o risco para o desenvolvimento de tromboflebite se torna até 18 vezes maior (Dolente et al 2005). Lankveld et al (2001), relataram que o tempo de permanência do cateter é um fator importante para o desenvolvimento de tromboflebite em equinos submetidos a laparotomia para correção de afecção do TGI, não observando influência do material da cânula. Estes autores diagnosticaram tromboflebite em todos os equinos que permaneceram 5 dias com um cateter implantado na veia jugular, não estando de acordo com os achados do presente estudo, no qual 93% dos animais não desenvolveram tromboflebite, mesmo permanecendo 7 dias com o cateter e apresentando pequenos trombos.…”

“…A tromboflebite em equinos acomete mais comumente a veia jugular, pois o vaso é o acesso principal à circulação venosa. Os fatores predisponentes para o desenvolvimento da afecção refletem diretamente a tríade de Virchow: venipunção inadequada, cateterização prolongada ou injeção de fármacos irritantes, que causam injúrias mecânicas ou químicas ao endotélio (Cannon et al 1983, Ettlinger et al 1992, Knottenbelt & Pascoe 1994, Rijkenhuizen & Swieten 1998, Divers 2003, Moreau & Lavoie 2009; desidratação e distúrbios hemodinâmicos, promovendo alterações no fluxo sanguíneo (Lankveld et al 2001); condições que causam coagulopatias, como endotoxemia e hipoproteinemia (Dolente et al 2005).…”

“…Primeiro fator, lesão endotelial: uma das principais indicações para o uso prolongado de cateteres intravenosos em equinos se refere aos cuidados pós-operatórios de animais submetidos à laparotomia exploratória para o tratamento de afecções do TGI (Lankveld et al 2001). Segundo fator, alterações no fluxo sanguíneo: lesões gastrointestinais estão comumente associadas à desidratação e hipovolemia, quando há aumento da viscosidade do sangue reduzindo seu fluxo (Southwood 2006).…”

Blood gases of horses subjected to jugular vein occlusion during treadmill exercise

“…Impairment of blood flow due to reduction of the vascular lumen via partial or complete occlusive thrombus could lead to head venous congestion and the development of upper airway edema and consequent dyspnea, especially when both jugular veins are involved (EDENS, 1999;BONAGURA, 2010). This condition may evolve to recanalization of the vein when blood flow is restored, or the thrombus may become fibrous, resulting in permanent occlusion, either followed by the development of collateral circulation or not (LANKVELD et al, 2001;MOREAU;LAVOIE, 2009;RUSSELL et al, 2010;HUSSNI et al, 2012;DIAS et al, 2014). If the horse resumes its physical activities while presenting a jugular thrombotic occlusion, and collateral vascularization does not occur, its performance is suspected to be limited (MOREAU;LAVOIE, 2009;DIAS et al, 2013).…”

Effects of Jugular Vein Occlusion on Cardiovascular Parameters in Horses During Exercise on a Treadmill

“…This thrombus may evolve into complete recanalization of the vein, thrombus fibrous organization without recanalization or collateral circulation [7,11,12]. If the jugular thrombotic occlusion persists and collateral vascularization does not occur, especially when both jugular veins are involved, the resulting dysphagia and dyspnea due to the impaired venous return of the head will likely limit athletic performance [4,10,13].…”