scott@vtx-cpd.com

This is a really good point. I have just been downstairs to check out what the data sheet actually says currently…

I think the issue was that when these catheters first came out there was no issue using them as longer term indwelling catheter. It was only after there was some instances of detachment that there became an issue. As Gail has said, the data sheen now specifically says that:

“the catheter and silicone hub are not permanently affixed to each other. The hub can be secured to the patient using the secure holes, but it is advised not to leave the catheter in place for more than 6 hours and the patient must be observed at all times”

The biggest problem comes now that the data sheet says this, we would have little come back if the catheter detached and we had to surgically retrieve from the bladder.

Hope that helps.

Scott x

Thanks again for this question. I have pulled a few thoughts together.

Plasma is occasionally used in dogs and cats to transfuse albumin as a colloid to treat hypovolemia, but synthetic colloids are preferred. Plasma is not used in humans as a colloid, but this is because albumin solutions are available for this use. Human and bovine albumin solutions have been used in dogs and cats without side effects, but severe acute and delayed hypersensitivity reactions have also been reported. Commercial canine albumin is available as an alternative.

Canine albumin has been tested in healthy dogs and dogs with hypoalbuminemia and septic peritonitis. In healthy dogs, intravenous canine albumin administration caused no adverse effects (AEs). In the sick dogs, postsurgical canine albumin treatment markedly raised albumin levels without owner-reported AEs. Unfortunately, canine albumin is not readily available.

BSA is readily available yet reportedly has caused anti-albumin antibody development and hypersensitivity reactions in healthy dogs.

Plasma and albumin solutions may also be used to improve plasma oncotic pressure and reduce oedema. Unfortunately this is inefficient, but will provide short-term benefit. About 22.5 mL/kg is required to raise plasma albumin by 0.5 mg/dL (5 g/L). 40% of total body albumin is normally found in the plasma and 60% in the interstitium, with the ratio shifted towards plasma in hypoproteinaemia. Upon albumin transfusion, the ratio shifts back towards the interstitium. Frequent large volume plasma transfusions or albumin transfusions are needed to maintain albumin levels, especially if hypoproteinaemia is caused by protein loss.

Hope this helps.

Scott x

Thansk again.

Essentially it’s not a problem drawing up benzodiazepines and leaving them in syringes until you use them.

Historically, syringes in the 1970s and 80s contained a lot more rubber than the ones we use now which could react with diazepam if allowed to sit together for some time. Unfortunately, it’s been accepted into the received wisdom people cite without an update for modern materials. Therefore I wouldn’t worry about it if it’s just for a few hours.

Hope that helps.

Scott x

Thanks for this Gail.

I would agree. Do not think a VHS would be first thing on my mind when dealing with a dyspnoeic patient. I would struggle to think of the last time I calculated one in the emergency setting.

Another question for Liz… how useful are VHS generally in cats?

Scott 🙂

It is essential that initial treatment of systemic hypotension always be aimed at correction of the underlying physiologic problem: decreased preload, cardiac dysfunction, or peripheral vasodilation. Differentiation of cardiac and noncardiac causes of systemic hypotension is a critical first step. If the animal is hypovolemic, intravenous fluids and/or blood products should be administered until euvolemia has been attained. If hypovolemia is severe enough to cause hypotension, a shock bolus should be given, up to 60 to 90 mL/kg for dogs and 45 to 60 mL/kg for cats (given incrementally as you know!).

If the animal remains hypotensive once euvolaemia has been achieved, the use of pressors should be considered. Commonly used pressors for treating vasodilation include dopamine (5-15 mcg/kg/min), epinephrine (0.05-1 mcg/kg/min), norepinephrine (0.1-1 mcg/kg/min), or phenylephrine (0.5-5 mcg/kg/min), administered for their alpha-agonist effects, as constant-rate IV infusions. Only phenylephrine is a pure alpha-agonist; the others have varying degrees of beta effects in addition to their alpha effects. Vasopressin (0.5-5 mU/kg/min) also can be used in cases with vasodilatory shock and may be especially useful in cases of sepsis/SIRS as the vessels can become refractory to catecholamines. These drugs need to be titrated to effect, requiring frequent blood pressure monitoring. They should never be used in place of adequate volume expansion, because most patients with hypovolemic shock already have compensatory vasoconstriction.

My first choice drug wise would probably be norepinephrine.

Hope that helps.

Scott x

This is an excellent point.

I think that is such a good discussion point… there might be more than one factor contributing to the acidaemia!

Scott 🙂

Thank you so much for this excellent question Gail!

Scott 🙂