Comparison of the modified Seldinger and through-the-needle jugular catheter placement techniques in...

Original Study

Comparison of themodified Seldinger and through-the-needle jugular catheter placement techniquesin the dogErin Portillo, MS, DVM, Andrew Mackin, BVMS, DVSc, DACVIM, P. K. Hendrix, DVM, PhD,

DACVA, Carolyn Boyle, PhD and Lisa Chrestman, CVT

Abstract

Objectives:

� To compare the ease of placement of central intravenous catheters in the dog using 2 techniques: themodified Seldinger jugular catheter placement technique and the through-the-needle jugular catheterplacement technique.

� To evaluate the ease and effectivness of teaching the 2 jugular catheter placement techniques.

� To determine the utility of a synthetic vascular access model for teaching the 2 techniques to veterinarystudents.

Design: Students were taught 2 jugular catheter placement techniques using a synthetic jugular venipuncturemodel and were then observed placing catheters using each technique in live dogs enrolled in a terminalsurgery laboratory. Time taken for catheter placement, success or failure of catheter insertion, indicators ofcatheter viability (time required for blood to be collected through the catheter and for fluid to flow through thecatheter), and complications associated with catheter insertion (hematoma presence/size post-mortem) wereobjectively evaluated by the authors, and ease of catheter placement was subjectively evaluated by thestudents.

Setting: Surgical techniques laboratory in a veterinary teaching hospital.

Animals: Dogs destined for a terminal student surgery laboratory (n 5 35).

Intervention: Jugular catheterization.

Measurements and main results: Catheter placement was successful for 27/35 (77.1%) first attempts on a livedog with the modified Seldinger technique, and for 26/35 (74.3%) first attempts on a live dog with thethrough-the-needle technique. The modified Seldinger technique took significantly longer (mean 452 seconds)than the through-the-needle technique (mean 273 seconds). There was no significant difference in time takento aspirate 5 mL of blood through catheters placed by either technique. Time required to flow 25 mL of fluidthrough the catheter was slightly longer for the modified Seldinger technique (mean 133 seconds) than for thethrough-the-needle technique (mean 113 seconds). Post-mortem hematomas were detected at 26/26 (100%)of through-the-needle insertion sites and at 24/27 (89%) of modified Seldinger insertion sites. Hematomadiameter at the through-the-needle insertion site (mean 2.2 cm) was significantly greater than at the modifiedSeldinger insertion site (mean 1.1 cm). Student assessments of the comparable difficulties of the 2 jugularcatheter placement techniques were not significantly different, and both techniques were assessed to be onlyslightly more difficult than placement of a cephalic catheter.

Conclusions: Jugular catheter placement by either the modified Seldinger or through-the-needle techniquecan be relatively easily mastered by entry-level veterinarians. Hematoma formation is common with bothtechniques. The teaching of jugular catheter placement is facilitated by the use of a synthetic jugularvenipuncture model.

(J Vet Emerg Crit Care 2006; 16(2): 88–95) doi: 10.1111/j.1476-4431.2005.00147.x

Keywords: central line, complications, jugular catheter, j-wire, vascular access model

& Veterinary Emergency and Critical Care Society 200588

Address correspondence and reprint requests to:Dr. Erin Portillo, MS DVM, Iowa State University, College of VeterinaryMedicine, Veterinary Teaching Hospital, Ames, IA 50011.E-mail: [email protected]

From the College of Veterinary Medicine, Iowa State University, Ames, IA(Portillo), and Mississippi State University, Mississippi State, MS (Mackin,Hendrix, Boyle, Chrestman).

Journal of Veterinary Emergencyand Critical Care 16(2) 2006, pp 88–95

doi:10.1111/j.1476-4431.2005.00147.x

Introduction

The central intravenous (IV) catheter is a valuable tool

that is increasingly utilized in referral and emergency

veterinary practice. Central lines are extremely useful

for collection of multiple blood samples, measurement

of central venous pressures, rapid fluid delivery, andadministration of hyperosmolar fluids such as total

parenteral nutrition solutions. Central lines, by defini-

tion, must terminate within a body cavity (either the

thoracic or abdominal cavity), typically within the cra-

nial or caudal vena cava.1

There are many different techniques available for

placement of central venous catheters. Two commonly

used percutaneous insertion techniques are the through-the-needle technique and the modified Seldinger tech-

nique.2 The through-the-needle technique involves

placement of a large bore needle into a jugular or sap-

henous vein, with the catheter then threaded through

the needle to terminate in a body cavity. The modified

Seldinger technique involves placement of an intro-

ducer needle or catheter into an accessible vein.

A guide wire used as a place-holder is then threadedthrough the introducer and subsequently a catheter

is passed over the guide wire to terminate in a body

cavity.

In the authors’ experience, central lines tend to be

under-utilized by many veterinary practitioners. Po-

tential impediments to the routine use of central lines

include a lack of familiarity with catheter placement

techniques, the perception that central catheter place-ment is a difficult or advanced procedure, and discom-

fort with the perceived risks associated with catheter

placement. Under-utilization of central lines leads to

the neglect of diagnostically and therapeutically im-

portant procedures such as the measurement of central

venous pressure and the administration of total paren-

teral nutrition. Practitioner utilization of central lines

may be enhanced by a greater awareness of catheterinsertion techniques and familiarity with the risks and

benefits associated with catheter placement.

The immediate objective of this study was to evaluate

the ability to teach 2 standard central catheter place-

ment techniques in dogs, and to objectively compare

the ease of placement of central IV catheters using the

two techniques. This study was designed to teach jun-

ior and senior veterinary students, as models for naiveveterinarians, the through-the-needle and modified Sel-

dinger catheter placement techniques on a synthetic

jugular venipuncture model, and to then observe the

students placing catheters using each technique in live

dogs enrolled in a terminal surgery lab. Time taken for

catheter placement, success or failure of catheter inser-

tion, indicators of catheter viability and complications

associated with catheter insertion were objectively eval-

uated by the authors, and ease of catheter placement

was subjectively evaluated by the students. The overall

goal of the project was to demonstrate, in as clear and

practical a fashion as possible, whether the adoption of

one or both central catheter placement procedures was

feasible for practitioners with limited or no experiencewith either technique.

Materials and Methods

Junior and senior veterinary students at Mississippi

State University, College of Veterinary Medicine were

recruited to participate in the study. Students were first

taught the through-the-needle and modified Seldinger

catheter placement techniques on a synthetic jugularvenipuncture modela (Figure 1) in a 1 or 2 hour teach-

ing laboratory. Each student was given written instruc-

tions describing the steps of both procedures, and both

techniques were then demonstrated to the students.

The students were allowed to practice catheter place-

ment using both techniques on the synthetic model

until they were comfortable with the procedures. Then,

in the main study, scheduled days to weeks after theteaching laboratory, the students were evaluated using

both techniques in live anesthetized dogs. The students

were taught and then evaluated by 2 of the authors,

(E.P. and L.C.), both of whom have had several years

experience placing and teaching both catheter place-

ment techniques in the university setting.

Instructions for catheter placement techniques

The through-the-needle catheter placement technique

utilizes a single lumen 16 gauge, 8 inch Intravets

cath-

Figure 1: Vascular access training model used to teach students

jugular catheter placement techniques.

& Veterinary Emergency and Critical Care Society 2005, doi: 10.1111/j.1476-4431.2005.00147.x 89

Comparison of seldinger and catheter placement techniques in dog

Figure 2: (a) Through-the-needle technique basic equipment: 14-gauge 2 in. introducer needle, 16-gauge 8 inch catheter with

protective sleeve, and adjacent plastic needle guard. (b) Through-the-needle technique demonstrated on vascular access training

model. A 14-gauge introducer needle is advanced through the skin into the vein until a fluid flashback is seen. (c) A 16-gauge 8 in.

catheter is then advanced through the needle to the needle hub. (d) The outer plastic sleeve is then removed from the needle hub. (e)

The stylet is removed from the center of the catheter. (f) A T-port is attached to the catheter and needle is backed out of the vein (in the

anesthetized dogs utilized in the study, a luer-lock injection cap was used rather than a T-port). (g) A needle guard is secured around

the needle to prevent shearing. (h) Once the needle guard is secure, it is glued to the skin with tissue adhesive.

& Veterinary Emergency and Critical Care Society 2005, doi: 10.1111/j.1476-4431.2005.00147.x90

E. Portillo et al.

eterb (Figures 2a–h). The desired length of the catheter

is predetermined by measuring from the approximate

jugular insertion site to the first intercostal space. The

through-the-needle catheter is maintained within its

sterile protective sheath, although the attachment of the

sheath to the needle hub is loosened in order to facil-

itate later removal. Once the jugular vein is identified,the skin is nicked over the vein with a #15 scalpel blade

to allow easy placement of the catheter. An introducer

needle (14 g, 200) is inserted aborally into the jugular

vein. Once blood is observed in the catheter lumen (a

flashback), the catheter is advanced aborally through

the introducer needle into the vein to its predetermined

location. The protective sleeve is removed exposing the

hub of the catheter and the central stylet, and the cen-

tral stylet is removed and discarded. The introducerneedle is then removed from the skin by backing the

needle out of the vein while still over the catheter. An

Figure 3: (a) Modified Seldinger technique basic equipment: 18-gauge 1 in. peripheral catheter used as introducer, 16-gauge 8 in.

catheter, guidewire (in protective plastic coil), and dilator. (b) Modified Seldinger technique demonstrated on vascular access training

model. An 18-gauge, 2 in. peripheral catheter is placed into the jugular vein (a-in. catheter was utilized in the anesthetized dogs). (c) A

guidewire is then advanced through the introducer catheter into the jugular vein. (d) The introduced catheter is removed and a

dilator is passed over the guidewire to facilitate easy passage of the catheter. (e) The dilator is removed and a 16-gauge 8 in. catheter is

passed over the guidewire into the vein. The guidewire is then removed. (f) An extension set with an injection port is attached to the

catheter (in the anesthetized dogs utilized in the study, a luer-lock injection cap was used rather than an extension set), after which the

catheter is sutured to the skin.



Intravets

needle guard is applied to cover the needle

and protect the skin. Skin adhesivec is then used to

secure the catheter hub to the needle hub and the nee-

dle to the needle guard to prevent rotational movement

or accidental disconnection. A luer-lock injection cap is

secured to the hub of the Intravets

catheter, and the

catheter is flushed with heparinized saline. The Intra-vet

s

catheter and needle guard are secured to the skin

using skin adhesive.c

The modified Seldinger catheter placement technique

utilizes a single lumen 16 gauge, 8 inch Milas

catheterd

(Figures 3a–f). The desired length of the catheter is

predetermined by measuring from the approximate

jugular insertion site to the first intercostal space, and

the skin is nicked over the jugular vein with a #15scalpel blade. An 18 g, 100 over-the-needle peripheral

cathetere is advanced aborally into the jugular vein as

the introducer, and the stylet is removed. A 20 g J-wiref

is passed aborally through the peripheral catheter. The

peripheral introducer catheter is removed, so that only

the guide wire remains in the vein as a place-holder. A

dilatorg is passed over the J-wire to ensure sufficient

dilation to enable easy passage of the Milas

jugularcatheter. The dilator is then removed, and the Mila

s

catheter is passed over the J-wire to its predetermined

location. The J-wire is then removed. A luer-lock injec-

tion cap is secured to the hub of the Milas

catheter, and

the catheter is flushed with heparinized saline. The

Milas

catheter is then sutured to the skin via suture

anchors built into the catheter hub.

Once the students were comfortable using both cath-eter placement techniques in the synthetic model, they

were asked to place a jugular catheter by each tech-

nique in anesthetized dogs (weight range from 10 to

23 kg) immediately prior to a Mississippi State Univer-

sity Institutional Animal Care and Use Committee ap-

proved terminal surgery laboratory. After anesthetic

induction, intubation, and connection to inhalant an-

esthesia, the dogs were placed in lateral recumbency.The dogs’ necks were clipped and surgically prepared

using Operands

scrub and solution.h An assistant dig-

itally occluded the jugular vein at the level of the tho-

racic inlet. The students, while wearing latex gloves,

attempted to place a jugular catheter by one technique

in one jugular vein. The dog was then turned on its

other side, and the students attempted to place a sec-

ond jugular catheter via the second technique in theother jugular vein. The side (left versus right) and the

order (through-the-needle versus modified Seldinger

technique) in which the catheters were placed were

randomized.

Following catheter placement, the students were

asked to score the jugular catheters for ease of place-

ment based on a 1–8 scale comparing jugular catheter

placement to peripheral (cephalic) catheter placement

(Appendix 1). The students also subjectively reported

which catheter technique seemed the least difficult.

During the live dog catheter placement laboratory,

the authors timed all catheter placements starting from

the time the skin was nicked until the time the last

suture was tied or the catheter was glued to the skin.Students were aware that they were being timed. Place-

ment was considered to be a failure if the catheter could

not be placed during the original venipuncture attempt.

Immediately after successful placement, the catheters

were first evaluated for ease of blood sample collection

by timing how long it took to aspirate 5 mL of blood

through the catheter, and then for ease of fluid flow by

timing 25 mL of fluid (0.9% salinei) running into thecatheter through a measured fluid administration

chamberj and 10 drops/mL IV line.k The fluid admin-

istration chamber was positioned at a standard height

above the animal (3600), and contained a standard vol-

ume of fluid (25 mL). The dogs were then moved onto a

student terminal surgery teaching laboratory for a va-

riety of surgical procedures, after which they were eu-

thanized. After the terminal surgery laboratory wasconcluded (approximately 4 hours after catheter inser-

tion), a limited necropsy was performed to determine

the degree of trauma at the insertion site.

After completion of the project, an additional survey

of the students was taken to obtain more information

about past catheter placement experience. Students

were asked to estimate the number of cephalic and

jugular catheters that they had successfully placed priorto enrolment in this study. Students were also asked

whether they were right handed or left handed.

The effect of catheter placement technique on ease of

use and on effectiveness variables was analyzed using

the paired t-test. The residuals from this model were

examined using frequency histograms and normal

probability plots to validate the normality assumption.

The clinical importance of observed differences wasassessed using confidence intervals.3 All calculations

were performed using SASs

Version 8.2;l all statistical

tests used the 0.05 level of significance.

Results

Results of the study are summarized in Table 1. In the

introductory catheter placement teaching laboratory,

most students were comfortable placing the cathetersvia both techniques after practicing once or twice on the

model. Jugular catheter placement was attempted in 35

anesthetized dogs by 35 junior and senior veterinary

students, leading to 35 attempts at the through-

the-needle technique and 35 attempts at the modified

Seldinger technique. Catheter placement was unsuc-


E. Portillo et al.

cessful for 9/35 (25.7%) attempts with the through-the-needle technique, and for 8/35 (22.3%) with the mod-

ified Seldinger technique. Two students were unsuc-

cessful at both techniques. Failure of accurate

venipuncture because of inability to enter the vein af-

ter skin puncture was subjectively assessed by the stu-

dents and authors to be the cause of failure in all failed

catheterization attempts.

Catheter placement by the modified Seldinger tech-nique took significantly longer (mean 452 seconds, me-

dian 455 seconds, range 267–690 seconds) than catheter

placement by the through-the-needle technique (mean

273 seconds, median 188 seconds, range 103–858 sec-

onds). The mean insertion time using the through-

the-needle technique was about 210 seconds less, with a

95% confidence interval of 144–275 seconds less, than

the insertion time using the modified Seldinger tech-nique. There was no significant difference in time taken

to aspirate 5 mL of blood through catheters placed by

the through-the-needle technique (mean 8 seconds, me-

dian 5 seconds, range 2–44 seconds) and catheters

placed by the modified Seldinger technique (mean 13

seconds, median 8 seconds, range 3–64 seconds). The

mean time taken to aspirate 5 mL of blood through

catheters placed by the through-the-needle techniquewas about 4 seconds less, with a 95% confidence inter-

val of 10 seconds less to 2 seconds greater, than through

catheters placed by the modified Seldinger technique.

Time to flow 25 mL of fluid through the catheter was

significantly longer for the modified Seldinger tech-

nique (mean 133 seconds, median 131, range 69–186

seconds) than for the through-the-needle technique

(mean 114 seconds, median 116 seconds, range 43–194

seconds). The mean time to flow 25 mL of fluid throughthe catheter using the through-the-needle technique

was about 20 seconds less, with a 95% confidence in-

terval of 3–36 seconds less, than using the modified

Seldinger technique.

The mean subjective score for ease of placement for

the Seldinger technique was 4.39, and for the through-

the-needle technique was 4.74, where a score of 4 in-

dicated a level of difficulty comparable with that asso-ciated with the placement of a cephalic catheter, and a

score of higher than 4 indicated a procedure that was

more difficult than the placement of a cephalic catheter.

Student scores for difficulty for the through-the-needle

and modified Seldinger techniques were not signifi-

cantly different. The mean difficulty score for the

through-the-needle technique was about 0.4 greater,

with a 95% confidence interval of 0.5 less to 1.2 greater,than the mean difficulty score for the modified Se-

ldinger technique. Of the 35 students participating in

the project, 19 (54%) of the students thought the mod-

ified Seldinger technique was easier to place and 16

(46%) thought the through-the-needle technique was

easier.

Post-mortem dissection of successful catheter inser-

tion sites revealed local hematoma formation at 26/26(100%) of through-the-needle insertion sites and at 24/

27 (89%) of modified Seldinger insertion sites. Hemat-

oma diameter at the through-the-needle insertion site

(mean 2.2 cm, range 0.5–5.5 cm) was significantly great-

er than at the modified Seldinger insertion site (mean

1.1 cm, range 0–2.0 cm). The mean hematoma diameter

with the through-the-needle technique was 1.4 cm larg-

er, with a 95% confidence interval of 0.9–2.0 cm larger,

Table 1: Results of catheter placement study

Variable

Modified Seldinger technique Through-the-needle technique Difference

P-valuen

Mean

(1SD) Median n

Mean

(1SD) Median n Mean

95% CI

(lower limit,

upper limit)

Successful catheter

placement

27/35

(77.7%)

26/35 (74.3%)

Time for catheter

placement (seconds)

27 452.4 � 96.1 455 26 273.2 � 179.1 188 20 209.4 (144.0, 274.8) o.0001n

Time to flow 25 mL

of fluid (seconds)

27 133.3 � 23.6 131 26 113.6 � 32.0 116 20 19.5 (3.1, 35.8) 0.0222n

Time to aspirate 5 mL

of blood (seconds)

27 12.8 � 13.1 8 26 8.5 � 9.2 5 20 4.2 (� 1.9, 10.2) 0.1705

Scores for difficulty of

placement

35 4.4 � 1.8 35 4.7 � 1.8 35 �0.4 (� 1.2, 0.5) 0.3872

Easiest technique 19/35 (54%) 16/35 (46%)

Hematoma present 23/26 (88.5%) 25/25 (100%)

Hematoma diameter (cm) 26 1.1 � 0.6 25 2.2 � 1.3 19 �1.4 (� 2.0, � 0.9) o.0001n

Note: SD, standard deviation; CI, confidence interval.nSignificant difference between the two groups (0.05 level of significance).



than the hematoma diameter formed with the modified

Seldinger technique. No other gross evidence of signif-

icant vascular or tissue trauma was detected.

All 32 students that responded to the post-study sur-

vey reported that they had successfully placed cephalic

catheters on multiple occasions prior to this study. The

estimated number of successful placements rangedfrom 5 to 600, with a median of 42.5 placements. Only 1

student, however, had previously attempted to place a

jugular catheter, and this attempt was unsuccessful. The

majority of the students were right handed (28/32 stu-

dents). Interestingly, of the 4 left-handed students, 3

(75%) thought the through-the-needle catheter was eas-

ier to place, whereas 17 (61%) of the right-handed stu-

dents thought the modified Seldinger was easier toplace. This observation, however, was not statistically

significant.

Discussion

In addition to performing similar functions as periph-

eral lines, central lines are valuable tools for rapid fluid

resuscitation, evaluating central venous pressure in pa-

tients receiving fluid therapy (particularly in patientssubject to volume overload, including those with con-

ditions such as renal failure or congestive heart failure),

for obtaining multiple blood samples from patients re-

quiring regular monitoring of blood samples (i.e., dur-

ing the performance of a glucose curve in diabetic

patients), and for delivering IV hyperosmolar fluids

such as total parenteral nutrition solutions. Catheter

research in human medicine also suggests that, com-pared with peripheral lines, central lines can be left in

for a longer time period with limited risk.4 Many fac-

tors contribute to the need for a long-term vascular ac-

cess method, including a limited number of IV injection

sites, difficulties handling some animals, personnel

time, patient trauma associated with the placement

of multiple catheters, and complications associated

with the perivascular administration of some drugs be-cause of inadvertent dislodgement of the peripheral

catheter.5

The 2 different techniques for catheter placement de-

scribed in this paper come with some inherent advan-

tages and disadvantages. Compared with the modified

Seldinger technique, the through-the-needle technique

is faster and involves fewer steps, and the catheters

themselves are less expensive (Intravets

through-the-needle catheter cost is about $12, compared with $20 for

the Milas

single lumen catheter set used for the mod-

ified Seldinger technique). However, through-the-nee-

dle catheters are more difficult to secure to the animal

because of the cumbersome needle guard, and they are

only available with a single lumen. Catheters placed by

the modified Seldinger technique are easier to secure to

the animal via suture because, unlike in the through-

the-needle technique, there is no needle guard (which

can be difficult to secure). Furthermore, when using the

modified Seldinger technique, clinicians can potentially,

at a later date, re-insert the guide wire and exchange

catheters without the need for a second venipuncture inanother vein. In order to facilitate direct comparison

between techniques, our study used single lumen

catheters of comparable dimensions for each catheter

placement method. However, one significant clinical

advantage conferred by the use of the modified Se-

ldinger technique compared with the through-the-

needle technique is that multiple lumen (double, tri-

ple, or quadruple lumen) catheters can be inserted us-ing an identical technique. The ability to use multiple

lumen catheters can significantly improve the quality of

patient care in those patients that require the use of a

single dedicated line (i.e., for administering parenteral

nutrition) while simultaneously requiring IV fluid ther-

apy, IV medications, through-the-catheter blood sample

collection, or measurement of central venous pressure.

Disadvantages of the modified Seldinger technique in-clude increased catheter cost, and a longer placement

time requiring more steps and equipment (such as ster-

ile gloves, sterile drapes, and sutures). In this study, it

took students on average more than 3 minutes longer to

place catheters using the modified Seldinger technique

compared with the through-the-needle technique. Stu-

dents commented on the difficulty associated with han-

dling the long guide wire used in the modified Seldingertechnique. Many reported that the guide wire was cum-

bersome and found it difficult to maintain sterility.

This study revealed a significant difference in the

time it took to run fluid through the line for catheters

placed by the 2 different techniques. The time differ-

ence can be explained by the design of the catheters

used for the modified Seldinger technique. Although

the catheters used for both techniques were the samelength and gauge, there was decreased length of the

through-the-needle catheter in the animal because 200 of

the catheter remained in the introducer needle which

was backed out of the skin. Additionally, the Milas

catheters used in the modified Seldinger technique are

tapered slightly at the distal end of the catheter. The

slightly slower fluid flow observed through the cathe-

ters placed by the modified Seldinger technique, how-ever, is unlikely to be of clinical importance.

A significant finding in this study was the difference

in the size of hematomas formed at the catheter inser-

tion site for the 2 techniques. The through-the-needle

technique was associated with the formation of larger

hematomas than the modified Seldinger technique.

Hematoma formation may have been exacerbated by


E. Portillo et al.

the larger introducer needle used with the through-the-

needle technique.1 Once the introducer was removed in

the through-the-needle technique, a smaller gauge cath-

eter remains in the vein, possibly allowing for some

leakage of blood out of the vein at the catheter entry

site. Hematoma formation may also reflect the veni-

puncture skill of the students. Many students com-mented that it was easier to place the 100 18 g over-the-

needle catheter used for the modified Seldinger tech-

nique, and that the over-the-needle catheter seemed to

cause less trauma than the 200 14 g needle used for the

through-the-needle technique. The smaller introducer

needle used in the modified Seldinger technique may

be beneficial in reducing insertion-related hemorrhage,

especially in patients with abnormal hemostasis.Although the students involved in this study report-

ed some difficulties associated with learning to use the

2 jugular catheter placement techniques, most students

(approximately 75%) were able to competently place

the catheters on their first attempt in a live dog. None of

the junior and senior students enrolled in this study

had previously successfully placed a jugular catheter.

All students had, however, as part of their standardpreclinical and clinical training, previously placed ce-

phalic catheters in dogs. It is interesting to note that,

even on a first attempt, most students in this study

reported jugular catheter placement to be only slightly

more difficult than cephalic catheter placement. Both

jugular catheter placement techniques were subjective-

ly scored between 4 and 5, with 4 indicating the same

level of difficulty as cephalic catheter placement, and 5indicating slightly more difficulty.

This study also describes the use of a synthetic jug-

ular venipuncture model as a teaching aid. Prior train-

ing with the synthetic model enabled most students to

insert jugular catheters on their first attempt in a live

dog. The synthetic model may have potential as a

teaching tool that could serve to reduce the use of live

dogs for venipuncture training purposes, and furtherstudies that specifically evaluate the utility of this mod-

el are warranted.

Central venous catheters are an underutilized diag-

nostic and therapeutic tool in veterinary medicine. Our

study indicates that catheters inserted by either the

through-the-needle or the modified Seldinger tech-

niques are relatively easy to place. Furthermore, the

techniques can be readily learned by entry-level clini-

cians with limited clinical experience. Our study did

not compare the advantages and disadvantages associ-

ated with the long-term use of catheters placed by the 2

methods. A second phase of this study, currently underway, is evaluating the utility and complication rates

between the 2 techniques in clinic patients in the in-

tensive care setting.

Grant Support

This study was supported by the Mississippi State Uni-

versity, College of Veterinary Medicine Intern GrantFund and the Dr. Hugh G. Ward Memorial Chair Fund.

Footnotesa Vascular Access Training Model, UC Davis School of Veterinary

Medicine, Davis, CA.b Intracath, Becton Dickinson Vascular Access, Sandy, UT.c Mainstays

s

projects Superglue, Bentonville, AR.d MILA International Inc., Florence, KY.e Terumo Surflo

s

, Terumo Corporation, Tokyo, Japan.f J wire, MILA International Inc., Florence, KY.g Dilator, MILA International Inc., Florence, KY.h Operand, Aplicare Inc., Branford, CT.i 0.09% Saline, Abbott Laboratories, North Chicago, IL.j Baxter

s

Healthcare Corporation, Deerfield, IL.k Primary I.V. Set, Abbot Laboratories, North Chicago, IL.l SAS

s

is a registered trademark of the SAS Institute Inc., Cary, NC.

References

1. Beal MW, Hughes D. Vascular access: theory and techniques in thesmall animal emergency patient. Clin Tech Small Anim Pract 2000;15:101–109.

2. Valk WJC, Liem KD, Geven WB. Seldinger technique as an alter-native approach for percutaneous insertion of hydrophilic poly-urethane central venous catheters in newborns. J Parent Ent Nutr1995; 19:151–155.

3. Braitman LE. Confidence intervals assess both clinical significanceand statistical significance. Ann Intern Med 1991; 114(6):515–517.

4. Bregenzer T, Conen D, Sakmann P, et al. Is routine replacement ofperipheral intravenous catheters necessary? Arch Intern Med 1998;158:151–156.

5. Blaiset MA, Couto CG, Evans LK. Complications of indwelling,silastic central venous access catheters in dogs and cats. J Am AnimHosp Assoc 1995; 31:379–384.

Appendix 1

Subjective scoring system used by students toevaluate difficulty associated with jugular cathetertechniques

1 Extremely easy to place, much easier than a pe-

ripheral catheter

2 Moderately easier than a peripheral catheter

3 Slightly easier than a peripheral catheter

4 Same difficulty as a peripheral catheter5 Slightly more difficult than a peripheral catheter

6 Moderately more difficult than a peripheral cath-

eter

7 Extremely difficult to place, much more difficult

than a peripheral catheter

8 Impossible to place



Comparison of the modified Seldinger and through-the-needle jugular catheter placement techniques in...

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Transcript of Comparison of the modified Seldinger and through-the-needle jugular catheter placement techniques in...