Effects of 5% and 10% Guaifenesin Infusion on Equine Vascular Endothelium

Twelve horses of various breeds and either sex were anesthetized with xylazine and ketamine injected into a median or lateral thoracic vein. During anesthesia, with the horse in sternal recumbency, a 14-gauge, 8.9 cm catheter was inserted into each jugular vein by using aseptic technique. Guaifenesin in water (100 mg/kg or a maximum dose of 50 grams) was infused into one jugular vein and an equal volume of 0.9% saline solution was infused into the other jugular vein. Seven horses received 10% guaifenesin, and five horses received 5% guaifenesin. The catheters were removed before the horses recovered from anesthesia. The horses were euthanatized approximately 48 hours later, and the jugular veins were removed for histologic examination. Adherent thrombus material was observed in all veins exposed to 10% guaifenesin and in one vein exposed to 5% guaifenesin. No evidence of thrombus was observed in four veins infused with 5% guaifenesin or in those infused with saline solution. These findings are of particular significance with horses at increased risk for thrombosis or thrombophlebitis.     

Catheters: a review of the selection, utilisation and complications of catheters for peripheral venous access

Intravenous catheters are used for the administration of medications and fluids and are an integral part of veterinary practice. The aim of catheter use is to optimise administration of medication and minimise complications such as thrombus formation, thrombophlebitis and sepsis. Catheters made from teflon are less flexible, less durable and stimulate more tissue reaction than polyurethane or silicon. However silicon catheters are more expensive and complicated to insert. Generally, for veterinary practice, the biostability and cost of polyurethane catheters make them preferable for short and long-term use. The smallest diameter catheter should be selected to minimise internal vessel wall contact and irritation without compromising medication delivery. The site of insertion varies with individual preference, vessel access and patient compliance. The jugular, cephalic, saphenous, ear, lateral thoracic and subcutaneous abdominal veins are accessible. Hair removal and a thorough aseptic skin preparation should be performed prior to catheter insertion. Daily maintenance is required to detect complications and maximise catheter longevity. Potential complications include thrombus formation, thromboembolism, bacterial colonisation and septicaemia, blood loss and air embolism. Permanent or transient skin dwelling bacteria are commonly isolated if sepsis occurs. The development of novel antiseptic and antibiotic impregnated catheters may reduce the complications associated with catheter infection in the future.     

Polyarthritis secondary to septic thrombophlebitis in an Arabian mare

A 3‐year‐old Arabian mare presented with diarrhoea and depression. During hospitalisation, the mare developed septic thrombophlebitis associated with a jugular catheter. One week later, she developed secondary bilateral tarsocrural joint septic arthritis. Following surgical intervention and intensive medical therapy, the mare recovered successfully. The case highlights an unusual and previously unreported complication of septic thrombophlebitis.     

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 risk factors for development of catheter-associated jugular thrombophlebitis in horses: 50 cases (1993-1998)

OBJECTIVE: To evaluate risk factors associated with development of catheter-associated jugular thrombophlebitis in hospitalized horses. DESIGN: Retrospective case-control study. ANIMALS: 50 horses with thrombophlebitis and 100 control horses. PROCEDURE: Medical records from 1993 through 1998 were searched for horses with thrombophlebitis. Horses that were hospitalized for at least 5 days, had an i.v. catheter placed in a jugular vein (other than for solely anesthetic purposes), and had no evidence of thrombophlebitis during admission or hospitalization were chosen as controls. Signalment, history, clinicopathologic findings, primary illness, and treatment were obtained from the medical records. Data were analyzed by use of logistic regression to perform univariate and multivariate analyses. RESULTS: For a horse with endotoxemia, the odds of developing thrombophlebitis were 18 times those for a similar horse without endotoxemia. For a horse with salmonellosis, the odds of developing thrombophlebitis were 68 times those for a similar horse without salmonellosis. For a horse with hypoproteinemia, the odds of developing thrombophlebitis were almost 5 times those for a similar horse without hypoproteinemia. For a horse in the medicine section, the odds of developing thrombophlebitis were 16 times those for a similar horse in the surgery section. For a horse with large intestinal dise, the odds of developing thrombophlebitis were 4 times those for a similar horse without large intestinal disease. For a horse receiving antidiarrheal or antiulcerative medications, the odds of developing thrombophlebitis were 31 times those for a similar horse not receiving these medications. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that patient factors, including large intestinal disease, hypoproteinemia, salmonellosis, and endotoxemia, were associated with development of catheter-associated thrombophlebitis in horses.     

Ultrasonographic findings in a cow with ascites due to thrombosis of the caudal vena cava.

This case report describes a three-year-old Swiss Braunvieh cow with ascites due to thrombosis of the caudal vena cava. Ultrasonography verified the ascites and revealed dilatation of the abdominal portion of the caudal vena cava (4.8 cm). It was presumed that the caudal vena cava was occluded by a thrombus or by perivenous compression cranial to the dilatation. Post mortem findings included: a massive accumulation of fluid in the abdominal cavity; a 15 cm long thrombus in the subphrenic region of the caudal vena cava; multiple pulmonary abscesses; severe thrombosis of the pulmonary vasculature; hepatic congestion; oedematous abomasal folds; and severe thrombophlebitis of the left jugular vein and both udder veins, due to poor intravenous injection technique. Ascites caused by thrombosis of the caudal vena cava is rare because collateral routes of venous return, including the udder veins, are usually established. It was therefore concluded that the ascites was attributable to bilateral thrombosis of the udder veins.     

Transsplenic portal catheterization combined with a jugular double-lumen catheter for pharmacokinetic and presystemic metabolization studies in pigs

The reliability of a silicone double-lumen catheter implanted into the external jugular vein and tunnelled towards the neck region was investigated in eight pigs. Surgery was uneventful without interference with the normal homoeostasis during 8 days. After injection of amoxicillin/clavulanic acid through the distal port of the catheter, analysis of drug components in the simultaneous blood samples obtained by the proximal port and a Venoject^® system were comparable in one pig. Histological control of the catheterized jugular veins pointed to an acceptable tissue reaction while bacteriological examination of the tip of the catheters was negative in only three animals. A moulding of the intestinal veins was made in a pig cadaver to determine the optimal length of insertion of a silicone portal catheter from the splenic vein towards the portal vein. Surgery was straightforward in four pigs whereby the catheter was exteriorized towards the back region. No complications were encountered during and after surgery for 9 days. The technique of a double-lumen catheter placed into the jugular vein and a transsplenic portal catheter is a useful tool for the study of the pharmacokinetics and also the first-pass effect of drugs in experimental pigs.     

Staphylococcus-associated abortions in ewes with long-term central venous catheterization

Forty-two ewes had an intravenous catheter sewn in place in a prepared area over the jugular vein and beginning at 60 days of gestation received an infusion 3 times daily. The infusion consisted of sterile saline or sterile saline containing arginine. Twenty-six ewes in both control and treatment groups aborted between 81 days of gestation and term. Fetuses from 16 ewes that aborted were examined. Most were autolyzed or had early mummification. Macroscopic placentitis and noncollapsing lungs were noted. Large numbers of coagulase-positive Staphylococcus were isolated from fetal abomasal content, lungs, brains, or placentas. Histologically, suppurative placentitis with necrosis and pulmonary aspiration of meconium and amniotic debris often with suppurative bronchopneumonia were observed in abortuses. Four ewes euthanized and examined after abortion had suppurative endometritis. Three ewes had severe, chronic, jugular thrombophlebitis from which coagulase-positive Staphylococcus was isolated. The fourth ewe had mild phlebitis, and Staphylococcus aureus was isolated from both the catheter and the blood. Catheter-associated staphylococcal abortion was diagnosed.     

Head and neck abscessation and thrombophlebitis following cheek tooth extraction in a pony

Due to their long hypsodont reserve crowns, extraction of equid cheek teeth can be difficult and result in more complications than the extraction of their shorter brachydont counterparts although the more recent resumption of oral extraction has greatly reduced such complications. The more common post-extraction sequelae in equids include non-healing alveoli due to retained dental or alveolar sequestrae which may lead to oromaxillary or oronasal fistula formation, chronic external sinus tract formation or osteomyelitis of the supporting bones. Collateral damage to adjacent teeth has also occasionally been reported during dental repulsion. Systemic complications following equine cheek tooth extraction have been infrequently described, including a small number of cases of exodontia-related bacterial meningioencephalitis. This is surprising, as dental manipulation can lead to bacteraemia in many species, including horses. Infections at distant sites related to the spread of dental pathogens have been well described in humans and in small animals. This report describes deep abscessation of the masseter muscles followed by extensive thrombophlebitis of the jugular, facial and rostral cervical veins following oral cheek tooth extraction in a pony affected by pituitary pars intermedia dysfunction (PPID) that was successfully treated by abscess drainage and thrombectomy of the affected veins.     

Time‐related changes in post‐operative equine morbidity: A single‐centre study

Our objective was to test the hypothesis that the prevalence and type of post‐operative equine morbidity at a single centre does not change over time with a retrospective and prospective observational study. The post‐operative case records of 92 (of 96) horses undergoing nonabdominal procedures, and surviving to discharge, were compared with previous data from the same centre. Predefined morbidities were recorded from horses undergoing surgery between August 2013 and July 2014. This was compared with data collected from the same institute from April 2004 to June 2005 and published in a previous study. The overall prevalence of morbidities increased from 13.4% to 25%. The prevalence of post‐anaesthetic colic, thrombophlebitis, pyrexia, lameness, neuropathy and myopathy increased while the proportion of incidence of diarrhoea, respiratory distress and wounds sustained in recovery decreased. There was a statistically significant association (P = 0.045) between the duration of surgery and the prevalence of post‐anaesthetic colic. Geldings were less likely (odds ratio 0.12, 95% confidence interval 0.02–0.84) to develop swelling at the catheter site and the likelihood of thrombophlebitis increased by 1.20 (95% confidence interval 1.01–1.41) for every year of life. Tracking morbidities and changes in their prevalence may elucidate their possible causation and allow prophylactic measures to be taken.     

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.     

Vascular ultrasonographic findings in canine patients with clinically diagnosed phlebitis

Peripheral vein phlebitis (inflammation) is a relatively frequent complication in dogs, however, published information on the ultrasonographic characteristics is currently lacking. This prospective, observational study describes the ultrasound (US) characteristics of normal canine cephalic veins, and veins with clinical phlebitis. Correlations among US findings and between US findings versus time that the intravenous catheter was in place were investigated. Safety of the US procedure was evaluated. Fifty patients were prospectively recruited for the study and 18 met the final inclusion criteria. Each patient underwent daily US examinations and was assessed for multiple criteria (vascular wall appearance, compressibility, spontaneity of flow, color fill, and presence/absence of filling defects, flow contour, direction, non‐pulsatility). Characteristics of normal canine cephalic veins were as follows: smooth and thin wall, complete compressibility, no flow disturbances, no filling defects, smooth flow contours, and unidirectional, non‐pulsatile flow with no turbulence. Characteristics of cephalic veins with clinical phlebitis were as follows: wall thickening (83%), decreased compressibility (55%), filling defects consistent with intraluminal thrombus (55%), vessel wall hyperechogenicity (44%), and abnormal color Doppler flow (39%). Significant correlations were found between Doppler filling defects and compressibility, Doppler filling defects and presumed thrombosis, and compressibility and presumed thrombosis (P = .001, P = .001, P = .000, respectively). No correlation was found between the US findings and time the intravenous catheter was in place. Findings indicated that duplex and compressibility US are feasible and safe methods for characterizing and monitoring cephalic veins in dogs with clinical phlebitis.     

Surgical Treatment of Septic Jugular Thrombophlebitis in Nine Horses

Objective: To report a technique for surgical treatment of septic jugular thrombophlebitis unresponsive to medical treatment. Study Design: Case series. Animals: Horses (n=9) with septic jugular thrombophlebitis unresponsive to medical treatment. Methods: Jugular vein thrombectomy was performed under standing sedation and local anesthesia. The contents of the affected portion of vein were removed by multiple incisions in the vein, with the incisions left open to drain and heal by second intention. Results: The technique was curative in all instances, although 2 horses required a 2nd procedure. One horse required ligation of the linguofacial vein to control postsurgical hemorrhage. Conclusions: The technique is an effective surgical treatment for septic jugular thrombophlebitis unresponsive to medical treatment. Clinical Relevance: Jugular vein thrombectomy is a straightforward technique, and has minimal postoperative complications. It allows expedient and cost‐effective resolution of medically recalcitrant cases of septic jugular thrombophlebitis.     

Long-term jugular vein catheterization in horses

The use of soft catheter materials in large-bore veins has allowed safe long-term venous access in human patients. Similar principles were applied to groups of horses; the jugular vein was catheterized for 14 days (group 1) and for 30 days (group 2). Three catheter materials were compared, and the clinical and histologic findings indicated that the least reaction was associated with silastic, followed by polyurethane; polytetraflouroethylene caused marked reaction. Our results suggest that by using catheters made of materials (especially silastic) that are less stiff or rigid, the duration of catheterization can be increased to 14 days or longer with minimal complications.     

Extravasation injury associated with parenteral nutrition in a cat with presumptive gastrinomas

Objective – To describe the pathologic consequences of parenteral nutrition (PN) extravasation into the mediastinum of a cat. Case Summary – An 8‐year‐old domestic short hair cat with persistent vomiting and anorexia was initiated on PN for nutritional support. PN was being administered at a rate of 12.9 mL/h when inadvertent jugular catheter migration resulted in thrombophlebitis and cellulitis and 40–80 mL of PN extravasated into the SC and mediastinal tissues. The cat was euthanized 36 hours after the extravasation of PN due to poor prognosis related to the gastric complications associated with a presumed primary gastrinoma. Grossly there was excessive mediastinal lymphatic drainage and pronounced edema in the cervical SC and mediastinal tissue. Histopathologic examination of the PN‐extravasated area revealed a severe mixed inflammatory reaction, represented by a severe neutrophilic and mild histiocytic infiltrate with lymphoplasmacytic perivascular cuffing. No bacterial agents were observed or cultured from this area. Unique Information Provided – This is the first case report of a foreign body‐type reaction due to extravasation of PN (extravasation injury) in a cat. Extravasation of PN is not without pathologic consequence, and can result in a severe inflammatory reaction in affected tissues.     

Influence of nitric oxide on the blood flow in the porcine uterine artery; an in vivo study

The aim of this study was to investigate the role of nitric oxide (NO) in the regulation of blood flow in the porcine uterine artery during the course of the oestrous cycle. Experiments were carried out on animals on days 1-5, 8-13 and 17-20 of the oestrous cycle. After induction of anesthesia and opening of the abdominal cavity, blood samples were collected from the ovarian and uterine arteries and veins to determine nitrate and nitrite concentrations; on the opposite side to the blood sampling the branch of the uterine artery was prepared and a venous catheter was inserted into the artery. For measuring the changes in the blood pressure the catheter was connected via a polyvinyl cannula to a pressure transducer. Sodium nitroprusside (NP; 2.4 microg, 24 microg and 240 microg; a NO donor) or Nomega-nitro-L-arginine methyl ester (L-NAME; 2.2 microg, 22 microg, 220 microg and 2200 microg; an irreversible inhibitor of neuronal and endothelial NO synthase and reversible inhibitor of macrophage NO synthase) was administered via a bolus into the uterine artery. Nitrite/nitrate concentrations were: higher (P < 0.05) in the uterine vein as compared to the uterine artery on days 1-5 of the oestrous cycle; lower (P < 0.05) in the uterine artery as compared to the ovarian and uterine veins as well as in the ovarian artery as compared to the ovarian vein on days 8-13 of the cycle; lower (P < 0.05) in the uterine artery as compared to the ovarian artery and uterine and ovarian veins on days 17-20. Administration of NP at doses of 2.4 microg and 24 microg and L-NAME at all doses examined did not affect (P > 0.05) the blood pressure in the uterine artery in all periods examined. NP at a dose of 240 microg decreased (P < 0.001) the blood pressure in the arteries in all periods examined as compared to blood pressure before NP treatment. The results obtained indicate that NO is involved in the regulation of blood flow through the porcine reproductive tract. Moreover, our results suggest that the action of NP in the porcine uterine artery is not dependent on the phase of the oestrous cycle.     

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.     

A Reproducible Venous Thrombosis Model in Horses Induced by the Combination of an Endothelial Lesion and Blood Flow Stasis

Because of the high incidence of thromboembolic diseases in humans, experimental models of thrombosis have been widely developed in different animal species. The pathogenesis of thrombosis is associated with three components, first outlined by Virchow in 1856: vessel injury, stasis, and hypercoagulability. Based on this concept, the purpose of the present investigation was to create an innovative model of jugular thrombophlebitis in horses that included components of Virchow's triad and excluded surgical procedures. Eighteen horses were subjected to blood vessel injury through the coadministration of sclerosing agents (glucose and ethanolamine oleate) and transitory occlusion of the jugular flow by manual compression. Thrombus formation was followed by ultrasonography imaging, and all horses developed jugular thrombophlebitis, showing that the proposed model was effective. Once occlusive thrombophlebitis was induced, jugular venous pressure cranial to the lesion was evaluated and yielded increased values, suggesting cephalic hypertension. Biochemical tests were performed to verify hepatotoxicity and nephrotoxicity after the ethanolamine injection, but no abnormalities were observed. Five horses were then euthanized to evaluate the vascular, hepatic, and renal tissues. The jugular vein wall had increased thickness, inflammatory cell influx, endothelial destruction, and thrombus firmly adhered to the vessel intima. Histological evaluation of the hepatic and renal tissues was normal. The present thrombophlebitis model in the jugular vein of the horse is simple and reproducible, providing a useful tool for investigating acute and chronic venous thrombosis because the model allows evaluation of different aspects of the prevention, pathogenesis, and treatment of this disease.     

Pulmonary embolism as a complication after abdominal surgery and colitis in a foal

This report describes a fatal pulmonary embolism in a foal, as a sequela of septic thrombophlebitis of the right jugular vein and/or a generalised hypercoagulable state. The foal underwent abdominal surgery and suffered from severe and prolonged colitis. Despite intense supportive care, the colt developed venous thrombophlebitis and subsequently died suddenly 12 days after discharge from the hospital, following an initial improvement. On post‐mortem examination, a large pulmonary embolism was discovered. Pulmonary thromboembolism is a potentially fatal sequelae of thrombus formation. It is difficult to detect and therefore likely to be underdiagnosed.     

Nitric oxide generation in a rat model of acute portal hypertension

OBJECTIVE: To document blood nitric oxide concentrations in the portal vein and systemic circulation in a rat model of acute portal hypertension and compare values with a control group and a sham surgical group. ANIMALS: 30 rats; 10 controls (group 1), 10 sham surgical (group 2), and 10 rats with surgically induced acute portal hypertension (group 3). PROCEDURE: Following induction of anesthesia, catheters were placed surgically in the carotid artery, jugular, and portal veins of group 2 and 3 rats and in the carotid artery and jugular vein of group 1 rats. Baseline heart and respiratory rates, rectal temperature, and vascular pressure measurements were obtained, and blood was drawn from all catheters for baseline nitric oxide (NO) concentrations. Acute portal hypertension was induced in the group 3 rats by tying a partially occluding suture around the portal vein and a 22-gauge catheter. The catheter was then removed, resulting in a repeatable degree of portal vein impingement. After catheter placement, all variables were remeasured at 15-minute intervals for 3 hours. RESULTS: Blood nitric oxide concentrations were greater in all vessels tested in group 3 than in group 2 rats. CONCLUSIONS AND CLINICAL RELEVANCE: Acute portal hypertension in this experimental model results in increased concentrations of NO in the systemic and portal circulation. On the basis of information in the rat, it is possible that increased NO concentrations may develop in dogs following surgical treatment of congenital portosystemic shunts if acute life-threatening portal hypertension develops. Increased NO concentrations may contribute to the shock syndrome that develops in these dogs.