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Welcome to our monthly VetLit Clinical Publication update, where Dr Simon Cook, founder of VetLit.org, provides an overview and update on recently released studies from a wide range of veterinary publications.
This is a review article about peripheral IV catheter associated phlebitis. Phlebitis can be categorised into infective, mechanical or chemical in origin, but these can readily potentiate each other. Grading schemes can be used to qualify the severity – usually from redness and pain through to there being a palpable venous chord and pyrexia, discharge etc. Treatment for extravasations are also covered.
(If you are interested in the topic then we did even record a podcast on IV catheter complications – it’s here)
The authors of this study created clear criteria to help recognise correct tube placement.
They recommend the following guidelines for identifying correctly positioned tubes (using a lateral radiograph including the neck and thorax)
They also generated a useful infographic which can also be downloaded here in PDF format.
These are brilliant to see. So much scope for reducing antimicrobial prescriptions! Some spoilers here:
In the following situations peri- and post-operative antimicrobials are specifically advised against by this group:
Peri-operative antimicrobials have been suggested in clean-contaminated gastrointestinal surgeries, but post-operative antimicrobials are advised against.
(There is also a VetLit podcast pending on this article!)
This retrospective study of 258 dogs ventilated at 5 centres in the US specifically explores those being ventilated for more than 24 hours. As they document, many deaths and euthanasias occur within the first 24 hours, so those being ventilated for longer was the target sample. Of 258 dogs included, 128 were ventilated for less than 24 hours and 130 were ventilated for more than 24 hours. Of the 128 ventilated for less than 24 hours, 111 died or were euthanased. Amongst those ventilated beyond 24 hours, over half (68/130) survived.
So, amongst dogs that survived and needed ventilating beyond 24 hours the survival rate was not as low as the overall (ball-park) 30% that we might often quote for a dog being ventilated for pulmonary disease. Survival was highest for hypoventilatory states as is expected, followed by other disease states without severe parenchymal injury eg. congestive heart failure (See Table 1).
Most drop the dose of DOCP, some prolong the interval too, and some will tailor even more to the individual. Whilst it’s possible to tailor, owners often appreciate the clarity of fixed intervals, for example. This study suggests (in conjunction with previous reports) that even though you can extend the interval by some margin, waiting for the electrolyte derangements to recur over-estimates the pharmacodynamics of DOCP (in first time dosing).
Simon graduated from the University of Bristol in 2011 with degrees in veterinary science and veterinary pathogenesis. After a rotating internship at the Royal Veterinary College and two years in a busy 24 hour small animal hospital, he completed a residency in emergency and critical care at the Royal Veterinary College. He is currently a senior lecturer in emergency and critical care at the Royal Veterinary College, London. Clinical and research interests combined include immunomodulation, cardiovascular monitoring, patient side ultrasonography and aspiration pneumonia. VetLit.org is his passion project, making literature more accessible to anyone and everyone.
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