Jugular Central Venous Catheter Placement Through a Modified Seldinger Technique for Long-Term Venous Access in Chelonians

Abstract

Long-term or repeated venous access in chelonians is difficult to obtain and manage, but can be critically important for administration of medications and blood sampling in hospitalized patients. Jugular catheterization provides the most rapid and secure route for vascular access, but catheters can be difficult to place, and maintaining catheter patency may be challenging. Long multilumen polyurethane catheters provide flexibility and sampling access, and minimize difficulties, such as catheter displacement, that have been encountered with traditional over-the-needle catheters. We describe placement of 4 Fr. 13-cm polyurethane catheters in three chelonians with the use of a modified Seldinger technique. Venous access was obtained with the use of an over-the-needle catheter, which allowed placement of a 0.018-in.-diameter wire, over which the polyurethane catheter was placed. Indwelling time has ranged between 1 and 4 mo currently. All tortoises were sedated for this procedure. Polyurethane central catheters provide safe, long-term venous access that allows clinicians to perform serial blood sampling as well as intravenous administration of medications, anesthetic agents, and fluids. A jugular catheter can also allow central venous pressure measurement. Utilization of central line catheters was associated with improvements in diagnostic efficiency and therapeutic case management, with minimal risks and complications.

Disseminated Candidiasis and Candidemia Caused by Candida palmioleophila in a Green Sea Turtle (Chelonia mydas)

“…Certain species, such as C. parapsilosis , are strongly associated with CVC-related candidemia [ 28 ]. Although a CVC might stay in place without any complications for months in chelonians with proper care [ 9 ], regular monitoring for potential complications, such as infection, phlebitis, hematoma, artery or nerve damage, or subcutaneous extravasation, is warranted.…”

“…Certain species, such as C. parapsilosis, are strongly associated with CVC-related candidemia [28]. Although a CVC might stay in place without any complications for months in chelonians with proper care [9], regular monitoring for potential complications, such as infection, phlebitis, hematoma, artery or nerve damage, or subcutaneous extravasation, is warranted. Some risk factors for candidemia have been identified in humans, including long length of hospital stay, abdominal surgery, femoral artery catheterization, blood transfusions, parenteral nutrition, and previous use of meropenem or other broad-spectrum antibiotics [29][30][31].…”

“…The turtle was then anesthetized using 10 mg/kg intravenous (IV) propofol (Propofol ® Lipuro 1%, 10 mg/mL, B. Braun Melsungen AG, Berlin, Germany) for the placement of a long-term jugular polyurethane central venous catheter (CVC) (CAREFLOW™ 2 Lumen Central Venous Catheter, Argon Medical Devices, Singapore) using the modified Seldinger technique, as described previously [ 9 ]. After CVC placement, the patient was initially treated with butorphanol 0.5 mg/kg IV q24 h for 2 weeks (Torbugesic ® 10 mg/mL, Zoetis, Kalamazoo, MI, USA) and intramuscular (IM) meloxicam 0.2 mg/kg q24 h (Mobic ® inj.…”

Emergency and Critical Care in Sea Turtles

“…Yapılan bir çalışmada, özellikle de yoğun bakım gereken kritik hastalarda kullanılabilecek merkezi juguler ven kataterizasyonunda modifiye Seldinger tekniği tanımlanmıştır. 27 Brahial ven, dorsal servikal sinüs ve subkarapasiyal ven gibi diğer venöz alanlardan lenf dilüsyonu ve giriş enfeksiyonu riskinin, juguler vene göre daha fazla olduğu bildirilmiş-tir. 12,27 Ultrasonografi (USG) eşliğinde juguler ve sefalik venlerin kataterizasyonu da tanımlanmıştır.…”

“…27 Brahial ven, dorsal servikal sinüs ve subkarapasiyal ven gibi diğer venöz alanlardan lenf dilüsyonu ve giriş enfeksiyonu riskinin, juguler vene göre daha fazla olduğu bildirilmiş-tir. 12,27 Ultrasonografi (USG) eşliğinde juguler ve sefalik venlerin kataterizasyonu da tanımlanmıştır. 25 Kateter uygulaması 72 saati aşmamalıdır.…”