Vascular access

image of Vascular access
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The placement and maintenance of intravascular access is one of the most important skills for any veterinary surgeon (veterinarian) and veterinary nurse working in emergency and critical care medicine. This chapter addresses the different types of vascular access (catheter placement and maintenance) and summarizes complications that may occur.

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2.1 Butterfly needles are suitable for short-term vascular access to deliver anaesthetic agents or intravenous medications.
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2.2 Over-the-needle catheters are easily placed in peripheral veins and suitable for short- or longer-term administration of drugs or fluid therapy.
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2.3 An example of a through-the-needle catheter with attached introducer and needle guard.
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2.4 An example of a peel-away catheter. (Courtesy of E Leece)
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2.5 An example of a catheter kit which utilizes an over-the-wire (Seldinger) placement technique.
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2.6 Placement of a central line in the jugular vein using the Seldinger (over-the-wire) technique. (a) The area is surgically prepared and draped. (b) A facilitative skin incision is made and a large introducer needle or catheter placed into the vein. In this case an introducer catheter with flow switch is used. (c) A long wire is inserted through the introducer needle/catheter. (d) The needle/catheter is removed, leaving the wire in place. (e) A dilator is passed into the vein over the wire to enlarge the subcutaneous tunnel. The dilator is then removed. Note that some central vein catheters do not require use of a dilator as the catheter itself has a ‘self-dilating’ tip. The manufacturer’s instructions should be followed. (f) The catheter is advanced into the vein over the wire. The wire is then removed. (g) The catheter is sutured into place. (h) Blood is withdrawn from each port of the catheter into a syringe prefilled with heparinized saline to guarantee intravascular placement. The ports are then flushed and the catheter bandaged carefully in place.
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2.8 An example of an extension set.
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2.9 Examples of needle-free injection caps and closed caps.
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2.11 An illustration of a cut-down technique. (a) The jugular vein is shown dissected free from the subcutaneous tissues. Stabilization of the vein with a pair of artery forceps or suture can aid subsequent catheter placement. (b) The catheter is placed into the vein, advanced and secured carefully before use.
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2.12 An example of an intraosseous cannula.
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2.14 Placement of an arterial catheter in the dorsal pedal artery. The artery is palpated during insertion and the catheter is aligned with the artery to facilitate feeding.
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2.15 Constant flushing of an artery via microtubing.
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