PERCUTANEOUS ULTRASOUND-GUIDED TRANS-SPLENIC CATHETERIZATION OF THE PORTAL VEIN IN THE DOG

The purpose of this investigation was to develop a safe and reliable technique for percutaneous catheterization of the portal vein via a major splenic vein using ultrasound guidance. Three separate catheter systems were evaluated on five anesthetized dogs. At least five attempts at catheterization of the splenic vein and subsequently the portal vein were attempted on each animal. Following the procedure the dogs were necropsied to assess for intrasplenic and intraabdominal hemorrhage. A technique using an introducer system and a large catheter was not successful on seven attempts. A technique using an over the needle catheter was successful in gaining access to the splenic vein on two out of five attempts; however the catheter could not be advanced into the portal vein. A technique utilizing 19 or 17 gauge needles with 22 or 19 catheter through-the-needle-catheters was successful in catheterization of the splenic vein and advancement to the portal vein on twelve of fifteen attempts. The smaller gauge needle and catheter system provided for easier access to the splenic vein and subsequent catheter manipulation facilitating access to the portal circulation.     

Central venous access to the cranial vena cava via the omobrachial vein in the dog

Background– The omobrachial vein is a superficial vein that crosses the brachial region of the dog. It terminates in the cranial vena cava, offering a novel site for central venous catheterization into the cranial thorax. Case Summary– The omobrachial vein served as a point of access to the cranial vena cava for treatment and monitoring of a critical canine patient in this report. The omobrachial vein was catheterized using the modified‐Seldinger technique due to contamination of or lack of availability of commonly used central venous catheter insertion sites. Conclusion– Access to the cranial vena cava via the omobrachial vein was easily achieved, and the catheter was maintained without complication for 10 days. Although the site was successfully used in the patient in this report, omobrachial vein anatomy is not consistent in all dogs.     

Technique for percutaneous pulmonary arterial catheterization in conscious dogs

A technique was developed to allow percutaneous placement and exchange of pulmonary arterial catheters in conscious dogs. Seven dogs were catheterized weekly for 5 weeks, using a 10-gauge over-the-needle cannula. A No. 7 F flow-directed catheter was passed through the cannula to measure right heart and pulmonary arterial pressures and to calculate cardiac output. The flow-directed catheter was removed and replaced with an arteriographic catheter, and a pulmonary arteriogram was performed. Placement in alternate jugular or saphenous veins each week resulted in successful catheterizations in all dogs evaluated.     

Comparison of blood glucose concentrations after administration of a glucose solution via the jugular vein and portal vein in cows

The goals of the present study were to determine whether the infusion of a glucose solution into the portal vein is tolerated in cows and whether the glucose concentration differs after administration of glucose into the jugular vein and portal vein. Fifteen healthy Swiss Braunvieh cows were used. An indwelling catheter was placed in both jugular veins and a balloon-tipped indwelling catheter with a diameter of 2 mm was placed in the portal vein under the guidance of ultrasonography. Three cows received 500 ml of 20% glucose solution over 60 min via the left jugular vein. Three other cows received the same solution over 60 min via the portal vein. Blood samples were collected from the right jugular vein before and for 24 h after the infusion of glucose for the determination of the concentrations of glucose and bilirubin and the activities of glutamate dehydrogenase, sorbitol dehydrogenase and gamma-glutamyl transferase. Infusion via the portal vein did not result in abnormalities in the general condition of the cows or increases in the concentration of bilirubin or the activities of liver enzymes. The blood glucose concentration increased to the same extent after both intraportal and intrajugular infusion. Over a 12-h period, three cows received 10 l of 20% glucose solution via the left jugular vein and three others received the same solution over a 12-h period via the portal vein. Blood samples were collected from the right jugular vein before and for 30 h after the start of infusion. Infusion via the portal vein did not affect the general condition of the cows or the activities of the liver enzymes. There was no significant difference in the blood glucose concentration between the two groups throughout the study.     

Transsplenic Portal Catheterization Surgical Technique and Use in Two Dogs With Portosystemic Shunts

The portal vasculature can be accessed by using a through-the-needle catheter system to pass a catheter through the splenic parenchyma and into a major splenic vein at the hilus. The authors have termed this technique transsplenic portal catheterization (TPC). Transsplenic portal catheterization is indicated for portal angiography, portal pressure measurement, and chronic portal blood sampling. Clinical applications of this technique include use in diagnosis and surgical management of portosystemic shunts and differentiation of prehepatic, hepatic, and posthepatic hypertension. This report describes the technique of transsplenic portal catheterization. Clinical use of this technique in two cases of portosystemic shunts are included.     

Measurement of portal and hepatic blood flows using a modified method for surgical placement of catheters in the major splanchnic vessels of sheep

A modified catheterization and para-aminohippurate dye dilution technique was used to measure portal and hepatic blood flows in sheep. Blood flows (mean +/- 1SD) for 7 healthy sheep were 1.54 +/- 0.71 L/min and 1.98 +/- 0.75 L/min for portal and hepatic flows, respectively. Blood flow measurement was facilitated when dye injection rates produced blood para-aminohippurate acid concentrations greater than 15 mg/L. Uniform mixing of dye with blood was confirmed in 1 sheep with 2 portal vein catheters. Surgery to place the catheters was facilitated by using a ventral para-costal approach. Blood gas analysis was useful in confirming the placement of the catheters. Useful catheter life in this experiment was 41 days, which was longer than in previous reports. Treating the catheters with an organo-silane preparation, protecting the catheters against dislodgement, and use of a belly bandage to minimize damage to the external parts of the catheter may have prolonged catheter life in this experiment.     

Ultrasonographic examination of the liver in cows

The size of the liver, as well as the situation and diameter of vessels in cattle were determined by use of ultrasonography. Ultrasonographic examinations of the liver were performed on 10 cows 10 times within 2 weeks, using a 3.5-MHz linear transducer on the right side in the 12th, 11th, and 10th intercostal spaces. Dorsal and ventral margin of the liver as well as localization and diameter of the caudal vena cava and the portal vein were determined in each intercostal space. Furthermore, the angle of the liver in the ventral area between the visceral surface and the diaphragmatic surface, the dorsal margin, and the circumference of the gall bladder were determined. The ultrasonographic values of liver size and localization in healthy cows can be used as reference values for the diagnosis of changes in liver size attributable to illness.     

Minimally-invasive catheterization of the portal, hepatic and cranial mesenteric veins and the abdominal aorta for quantitative determination of hepatic metabolism in dairy cows

The objective of this study was to establish a minimally-invasive, ultrasound (US)-guided technique for the placement of indwelling catheters into the portal, hepatic, and cranial mesenteric veins as well as the abdominal aorta. Catheters were placed in eight healthy dairy cows on day 1. The patency of catheters was tested daily until day 14 when a necropsy was carried out. On day 6, energy intake and hepatic net output of glucose, removal of lactate, and oxygen were determined in seven cows. Post mortem examination revealed that all implanted catheters were in the intended locations. Loss of patency in one portal vein catheter on day 9 was attributable to a fibrin clot. Significant correlations were found between mean energy intake and mean hepatic plasma flow (r=0.91; P=0.004), hepatic glucose output (r=0.81; P=0.027) and hepatic removal of lactate (r=-0.70; P=0.08) and oxygen (r=-0.77; P=0.039), as well as between hepatic glucose net output and removal of lactate (r=-0.92; P=0.004). Minimally-invasive, US-guided transcutaneous catheter placement into the cranial mesenteric, portal and hepatic veins as well as the technique for catheterization of the abdominal aorta appear to be safe, and suitable for studies of quantitative hepatic metabolism in cattle.     

Echo-guided studies on portal and hepatic blood in cattle

The objectives of the present study were (1) to establish and maintain catheters non-surgically in the portal and hepatic veins of cattle for long-term monitoring of postprandially absorbed metabolites, and (2) to assess the safety of the technique used. Aspiration and catheterization were not performed if there was risk of bleeding, as determined by hemostatic data and enlargement of portal and hepatic veins. In five Holstein cattle, before and 60-min after feeding, percutaneous ultrasound-guided aspiration of portal and hepatic blood, together with jugular blood, was performed utilizing 17G x 17.5 cm needles. Concentration of ammonia nitrogen tended to be higher after feeding, but that of urea nitrogen and glucose were not significantly changed. In five other Holstein cows liver veins were catheterized with 14 x 16.5 cm guide-needles attached with 50 cm polyethylene tubes and blood samples were collected from portal, hepatic and jugular veins at 30-min intervals for 4.5 hr. The concentration of plasma acetate and 3-hydroxybutyrate (3-HB) were significantly increased after feeding, while that of lactate was not changed. Catheters in the portal and hepatic veins enabled the collection of blood samples up to 15 days (mean, 7 days). After a 7-day observation period, five cows were euthanised and necropsied. Changes in the intercostal musculature, peritoneum and liver were negligible. During the observation period, clinical profiles, aspartate aminotransferase, alanine aminotransferase and total and differential WBC counts were within normal ranges.     

Factors influencing the development of jugular thrombophlebitis in cattle and comparison of 2 types of catheter

Two studies were conducted to evaluate the factors associated with the development of thrombophlebitis in cattle following intravenous catheterization of the jugular vein. In study 1, 20 healthy animals were catheterized with 2 different types of catheter (polytetrafluoroethylene (PTE) versus polyvinylchloride (PVC)) for a period of 120 hours. In study 2, 50 dairy cows referred for treatment to the Large Animal Veterinary Teaching Hospital at the University of Montreal were catheterized with a commercial PTE catheter, using a standardized technique, for a period varying from 3 to 6 days, and inherent risk factors were evaluated. A clinical and echographical evaluation of the 2 groups in study 1 demonstrated a higher frequency of thrombosis in the PTE group than in the PVC group. In study 2, the primary factors associated with the development of thrombophlebitis in sick cows were the experience of the manipulator and the severity of the disease.     

Evaluation of a polyurethane jugular catheter in cats placed using a modified Seldinger technique

OBJECTIVE: To describe and evaluate the placement of a new design of polyurethane jugular catheter in cats using a modification of the technique of Seldinger. The maintenance and use of these catheters for repeated blood sampling over several days in healthy and diabetic cats is reported. PROCEDURE: Thirty polyurethane jugular catheters were placed in 10 clinically healthy cats and 10 cats with diabetes mellitus using the modified Seldinger technique. Catheters were placed while the cats were under general anaesthesia. RESULTS: The catheters remained in place for a range of 2 to 14 days (median 5 days) with no major complications. In all cats patency of the catheters was maintained until removal. All cats examined had patent jugular veins when assessed 4 or more weeks after the catheters were removed. CONCLUSIONS: These polyurethane jugular catheters, when placed by a modified Seldinger technique, are effective and safe in cats, and jugular patency returns after the catheters are removed.     

Intravenous catheterisation of conventional pigs without application of antimicrobial agents

In six experiments 43 castrated male conventional pigs weighing 25-41 kg were catheterised by inserting a cannula via the jugular vein into the cranal caval vein. The catheters were taped to the spinal neck region where the tap stops were located. Antimicrobial agents were not applied. One pig died 32 hour after surgery from Porcine Stress Syndrome. The catheters remained patent for at least nine days in 38 of the remaining 42 animals (90%). In two animals the catheter by mistake was not inserted into the jugular vein. Two animals got catheters with a one-way blockage four days after surgery. In these animals autopsy revealed thrombosis and phlebitis of the occluded vein and a valve-like thrombus at the tip of the catheters. In seven of the 43 pigs the effects of anaesthesia, surgery and catherisation were followed using rectal temperature and haematological and some blood biochemical parameters for nine days after the surgery. It is concluded that this catheterisation technique, without application of antimicrobial agents, can be used well for experimental infections and pharmacokinetic studies.     

The influence of a fermentation-resistant glucose diet on the glucose concentration and other metabolites in portal and jugular blood in cows

The goal of this study was to determine the effect of fermentation-resistant glucose on the glucose concentration and other metabolites in portal and jugular blood in 15 non-lactating cows. In all cows, an indwelling catheter was placed in the left jugular vein and the portal vein for collection of blood samples. Five control cows were fed hay as a normal diet, five control cows were fed straw to induce an energy deficit and five cows were fed hay and they received additionally 2000 g of a fermentation-resistant D-glucose product. The glucose concentration in jugular and portal blood was not influenced by feeding. The concentration of urea and bile acids were significantly higher in portal blood than jugular blood. There was no difference between portal and jugular blood of glucose and total solids. Diet had a significant effect on the concentrations of ammonia, urea, free fatty acids and triglycerides. The concentrations of ammonia and urea were higher in blood of cows fed straw than in blood of cows fed either hay or a fermentation-resistant glucose product. The concentration of urea remained constant in cows fed hay, but increased in cows fed straw and decreased in cows fed a fermentation-resistant glucose product. The concentration of free fatty acids and triglycerides were significantly higher in cows fed a fermentation-resistant glucose product than in cows fed hay. In the present study, a single administration of 300 g of fermentation-resistant glucose did not affect the concentration of blood glucose. Therefore, despite ongoing promotion of such products, there is no indication at this time that administration of fermentation-resistant glucose to cows at the start of lactation results in an increase in blood glucose concentration.     

Percutaneous retrieval of a jugular catheter fragment from the pulmonary artery of a foal

A 49-kg (107.8-lb) sexually intact male Arabian foal was evaluated at 3 days of age because of profuse watery diarrhea, anorexia, and signs of abdominal pain. Physical examination findings were unremarkable except for evidence of diarrhea. A catheter was placed in the right jugular vein for administration of antimicrobials and lactated Ringer's solution. The foal was discharged with instructions to the owner to continue antimicrobial administration and fluid therapy; at home, the owner inadvertently cut the catheter at the level of the hub during attempted removal, and the catheter fragment migrated distally in the jugular vein and subsequently lodged in the pulmonary artery. The foal was readmitted to the hospital for retrieval of the fragment, using a percutaneous retrieval technique. Catheter fragmentation is a well-recognized risk of catheterization in horses. Catheter fragments can be retrieved somewhat easily from the jugular vein; however, if the fragment migrates to the heart or pulmonary artery, imaging the fragment to locate and retrieve it can be difficult. Complications associated with catheter fragmentation include septicemia, endocarditis, lung abscesses, pulmonary embolism, dysrhythmias, cardiac perforation, pulmonary or caval thrombosis, and death. To our knowledge, this is the first report of successful retrieval of a catheter fragment from the pulmonary artery in a horse.     

Percutaneous ultrasound-guided over-the-wire catheterization of the portal and hepatic vessels in cattle

A new method for catheterization of the portal and hepatic veins in cattle by means of the over-the-wire system was investigated to maintain more reliable long-term patency of catheters. Four cattle were used to evaluate the success rate, patency and safety of the procedure. The catheters, coated by urokinase were patent as long as they were in situ. In addition, the introducer was useful to prevent the catheter from being broken. No complications developed during the10 days after the procedure. Two cows were then euthanized. Post mortem findings were minimal. The results of the study reported here are promising, the benefits are significant and there is no apparent disadvantage to its use.     

Ultrasound-guided percutaneous portocentesis in 21 cows

An ultrasound-guided portocentesis was performed in 21 clinically healthy cows, and blood was collected for haematological, biochemical and blood-gas analyses. At the same time blood samples were collected from the left jugular vein of each cow for the same analyses. Immediately after the centesis, portal blood pressure was measured. The cows were examined daily thereafter for eight days and then slaughtered for postmortem examination of the internal organs. The mean (sd) portal blood pressure was 37.1 (5.47) mmHg, and ranged from 24 to 49 mmHg. There were small but significant differences between many of the haematological and biochemical parameters in jugular and portal blood, and the concentration of bile acids was on average 2.7 times higher, and the concentration of ammonia was 19.3 times higher in portal blood. The demeanour and behaviour of the cows, and their appetite and rectal temperature remained normal during the eight-day observation period. The haematocrit, total and differential leucocyte counts, and the concentrations of total solids and fibrinogen were not affected by portocentesis. On postmortem examination, no lesions were apparent in the peritoneum, liver and portal vein.     

Ultrasound-guided vessel catheterization in adult Yorkshire cross-bred pigs

Objective

To describe an ultrasound-guided approach for venous and arterial vascular access and catheterization in anesthetized adult Yorkshire cross-bred pigs.

Diagnosis by ultrasonography of congestion of the caudal vena cava secondary to thrombosis in 12 cows

This paper describes the clinical, ultrasonographic, radiographic and postmortem findings in 12 cows with thrombosis of the caudal vena cava. The principal clinical signs were chronic bronchopneumonia and fever in 11 cows; one cow had epistaxis and one cow bled from the mouth; eight cows had anaemia and leucocytosis, and the clotting time for the glutaraldehyde test was markedly decreased in all the cows; in nine of the cows the activity of gamma-glutamyltransferase was high, suggesting chronic hepatic congestion. The most important ultrasonographic finding was congestion of the caudal vena cava attributable to thrombosis of the vein. In all the cows the caudal vena cava was round to oval on cross-section, rather than the normal triangular shape. The hepatic, splenic and portal veins were dilated in five, three and one cow, respectively. The results of radiography and endoscopy supported a diagnosis of bronchopneumonia, but there were radiographic changes in the diaphragmatic lung lobes that supported a diagnosis of vena caval disease in only four cows. Postmortem there was a thrombosis of the caudal vena cava in all the cows, and the thrombi were located in the thoracic, subphrenic and abdominal part of the caudal vena cava at the level of the liver in four, one and seven cows, respectively. In three cows, the thrombus was situated where a hepatic abscess had broken into the caudal vena cava, and in one cow it was at the site of a diaphragmatic abscess. In another cow, there was a fistula between the major bronchus of the right diaphragmatic lung lobe and the caudal vena cava where the thrombus was situated. Three cows had liver abscesses that had not broken into the caudal vena cava. There was severe bronchopneumonia in 11 of the cows, some of which also had multiple pulmonary abscesses.     

Hepatic ultrasonography and blood changes in cattle with experimentally induced hepatic abscesses.

Hepatic abscesses were induced experimentally in 5 steers by inoculating Fusobacterium necrophorum via ultrasonography-guided, percutaneous catheterization of the portal vein. Hepatic ultrasonography was performed to determine the onset and progression of abscessation. Blood samples were collected before and after inoculation for performing leukocyte counts and hepatic function tests. Ultrasonographic evidence of liver abscesses was observed as early as 3 days after inoculation. Abscesses appeared as hyperechoic centers (cellular debris and pus) surrounded by hypoechoic or anechoic areas (fluid). Increases in rectal temperature, leukocyte counts, fibrinogen, globulin, bilirubin, gamma-glutamyltransferase, and sorbitol dehydrogenase concentrations were detected. Hepatic dysfunction was evidenced by decrease in serum albumin concentration and low sulfobromophthalein clearance. The ultrasonographic diagnosis of abscesses correlated well with necropsy findings.     

An experimental model for simultaneous chronic sampling of portal and systemic blood and gastrointestinal lymph via cannulae in conscious swine

Surgical techniques are described whereby safe chronic cannulations of the portal vein, the external iliac artery and vein and the cisterna chyli of pigs were performed. The pigs tolerated the operations well and there was a short recovery period. They were unrestrained during the subsequent feeding experiments, when large sequential blood and lymph samples were withdrawn readily. The experimental periods varied from 3 to 46 days (mean : 13.4 days, SE: 2.0). All of 22 arterial cannulae remained patent (mean : 16 days, SE : 2.2), nineteen of 22 portal cannulae (mean : 15 days, SE : 1.8) and eighteen of 22 venous cannulae (mean : 14 days, SE : 1.9). The lymph cannula patency varied from 2 to 7 days, but lymph samples were easily obtained through all but one of them during the third postoperative day.