How to obtain vascular access: the importance of good placement and aseptic technique

The catheterization of peripheral veins in small animals is a procedure most veterinary nurses perform on a regular basis, but that is often performed in sub-optimal conditions. The consequences of poor placement and aseptic technique are often not fully appreciated, and this article provides a step-by-step approach for achieving a good placement technique of peripheral catheters. It explains the clinical significance of a good aseptic technique and post placement management to prevent catheter-related complications occurring.

The species and breed of patient may influence the location of catheter placement. Breed conformity can impair visualization, accessibility and practicality of catheter placement.

Previous or recent catheterization of a vessel may make it unsuitable for repeated use. Patients with conditions such as diarrhoea and polyuria have a higher risk of catheter contamination if catheter placement is performed into a hind limb vessel.

Catheter-related infections are one of the most frequently reported causes of hospital acquired infection seen in humans and animals that are hospitalized (Marsh et al, 2007). A study revealed factors that contribute to the bacterial contamination of peripherally placed intravenous catheters in dogs and cats. Factors examined included whether blood was collected from the catheter immediately after insertion, and infection rate associated with T-connector use, compared with Y-connector use (Jones et al, 2009a). Introduction of bacteria into the catheter hub and migration to the catheter tip, and into the bloodstream has been proposed as the most common route of peripheral catheter-related infection in veterinary patients (Johnson, 2002). This highlights the importance of thoughtful catheter placement and after care to reduce the possibility of infection. Skin microflora has been shown to be the most common contaminant of intravenous catheters in humans (Raad, 1998) therefore it must be concluded that the skin and hair of an animal are also a potential source of contamination. Contamination from the hands of the person placing the catheter has also been reported (Blaiset and Pena, 1995;Raad, 1998; Eggimann et al, 2004).