Length of hospitalization, APPLE score, and number of intravenous catheters placed at admission are associated with increased odds of peripheral intravenous catheter complications in dogs.

OBJECTIVE: To identify risk factors associated with peripheral intravenous catheter (PIVC) complications in dogs hospitalized in the critical care unit (CCU). ANIMALS: 107 dogs admitted to the CCU between October 2022 and March 2023. METHODS: This prospective, observational clinical trial was performed at a single veterinary teaching hospital. Dogs hospitalized in the CCU for at least 24 hours were evaluated for enrollment. PIVC were placed following a standardized protocol and monitored for complications. PIVC complications were classified as extravasation, phlebitis, dislodgement, occlusion, line breakage, or patient removal. RESULTS: Median PIVC dwell time was 46.50 hours (range, 24.25 to 159.25 hours). Overall PIVC complication rate was 12.1% (13/107), with phlebitis (4/107 [3.7%]) and extravasation (4/107 [3.7%]) being the most frequently recorded complications. Multivariable analysis identified increasing length of hospitalization (LOH; OR, 1.43; 95% CI, 1.04 to 1.97; P = .029), an acute patient physiologic and laboratory evaluation full (APPLEFULL) score > 35 (OR, 4.66; 95% CI, 1.09 to 19.90; P = .038), and having 2 PIVCs placed at admission (OR, 10.92; 95% CI, 1.96 to 60.73; P = .006) as risk factors for PIVC complication. CLINICAL RELEVANCE: Increasing LOH, an APPLEFULL score > 35 and having 2 PIVCs placed at admission were associated with increased odds for PIVC complication in this study. Although these are independent risk factors for PIVC complication, the combination of increasing LOH, an APPLEFULL score > 35, and having 2 PIVCs placed at admission may represent a more severely ill population, drawing attention to a vulnerable group of dogs at risk for PIVC complication.

Incidence and type of peripheral intravenous catheter complications documented in hospitalised dogs.

OBJECTIVE: To report the incidence and type of peripheral intravenous catheter complications in hospitalised dogs. METHODS: A prospective, observational trial was performed. Peripheral intravenous catheters were monitored for complications. Complications were documented and classified as extravasation, phlebitis, dislodgement, occlusion and line breakage. If phlebitis was present, the Visual Infusion Phlebitis Scale was used to assign a grade (0 to 5). Fisher's exact test was used to compare the type of complications between the critical care unit and the intermediate care unit. A univariate logistic model was used to compare the incidence of complications between the critical care unit and the intermediate care unit and adjusted odds ratios were used to compare the groups. RESULTS: The incidence of peripheral intravenous catheter complications was 24.2% in the Critical Care Unit and 13.1% in the Intermediate Care Unit, with an overall incidence of 19.9%. Phlebitis was the most common peripheral intravenous catheter complication in the Critical Care Unit, and line breakage was the most common complication in the Intermediate Care Unit. Length of hospitalisation and weight had a significant effect on the likelihood of complication. In a multivariable logistic regression model, the odds of a peripheral intravenous catheter complication was not significantly higher in CCU than IMCU, accounting for length of hospitalisation and weight (adjusted odds ratio, 1.84; 95% confidence interval, 0.98 to 3.48). CLINICAL SIGNIFICANCE: Peripheral intravenous catheter complications are common in hospitalised dogs and may result in an increased expense for owners, failure to deliver prescribed treatments, venous depletion (lack of peripheral vessels for intravenous catheter placement) and pain experienced by the patient. Techniques to reduce peripheral intravenous catheter complications should be further evaluated and may include the use of peripheral intravenous catheter placement and maintenance checklists, use of force-activated separation devices, or patient sedation.

Partial hepatectomy for treatment of multiple liver abscess in a calf: a case report.

BACKGROUND: Umbilical vein bacterial infections may cause liver abscesses during bacterial ascent. A single liver abscess can be surgically treated by marsupialization, but a risk of recurrence or non-healing remains. Moreover, there is no effective treatment for multiple abscesses. CASE PRESENTATION: A 17-day-old Holstein female calf exhibited reduced general condition, swelling and drainage of the umbilicus, and pressure sores in the area of the carpus, resulting in reluctance to stand up. The umbilicus showed pain at palpation; deep abdominal palpation indicated a swollen umbilical vein coursing from the umbilicus toward the liver. Ultrasonography confirmed a swollen umbilical vein with pus accumulation and multiple abscesses in the liver. Contrast-enhanced computed tomography (CT) examination confirmed that the swollen umbilical vein with fluid continued to the liver, and multiple unenhanced lesions, most likely abscesses, were confirmed in the liver. Partial hepatectomy was performed to remove as many abscesses as possible. For the resection, a vessel sealing device (LigaSureTM) was used to excise a part of the left liver lobe. As we could not remove all the abscesses in the liver during the operation, cefazolin sodium (5 mg/kg) was administered for 14 days after surgery. Post-operatively, blood accumulation was observed in the abdominal cavity, but no signs of peritonitis were found. The calf returned to the farm on day 38 after surgery. Follow-up information was obtained after 1 year, and complications were not reported. CONCLUSIONS: To our knowledge, this is the first report of partial hepatectomy using a vessel sealing device for a calf with multiple liver abscesses. This case report suggests that the combination of partial hepatectomy and long-term administration of antibacterial drugs may restore the health of calves with multiple liver abscesses.

Peripheral Intravenous Catheter Complications in Hospitalized Cats: An Observational Pilot Study.

OBJECTIVES: There is little information about complications associated with peripheral catheter use in cats. The primary objective of this study was to determine the main reason for catheter removal in cats hospitalized in the Intensive Care Unit at a university teaching hospital. The secondary objective was to describe catheter-associated complications in cats hospitalized. METHODS: All feline patients with peripheral intravenous catheters admitted to the Intensive Care Unit between June and August 2017 were prospectively enrolled in this study. All catheters were evaluated at least 3 times a day per institutional Intensive Care Unit protocol. The catheters were monitored throughout the cat's hospitalization period for development of complications, including occlusion, phlebitis and extravasation. Data collected included patient signalment, reason for hospitalization, catheter size and location, number of hours the catheter remained in place, reason for removal and if the catheter was replaced once removed. RESULTS: Thirty-four cats were enrolled in the study, and a total of 42 catheters were placed in those cats. Median peripheral IV catheter duration was 23.8 hours (interquartile range [IQR] 13.8-41.3 hours). The most frequent reason for catheter removal was patient discharge from the hospital (24/42, 57.1%). Overall catheter complication rate was 21.4% (9/42). Complications observed included phlebitis, extravasation, patient removal, occlusion, and edema formation. CLINICAL SIGNIFICANCE: The results of this study conclude that the majority of peripheral IV catheters in cats are removed due to discharge from hospitalization. More studies with a larger population of cats are needed to see if there is a relationship between length of indwelling catheterization and risk of catheter-associated complications.

Vascular ultrasonographic findings in canine patients with clinically diagnosed phlebitis.

Peripheral vein phlebitis (inflammation) is a relatively frequent complication in dogs, however, published information on the ultrasonographic characteristics is currently lacking. This prospective, observational study describes the ultrasound (US) characteristics of normal canine cephalic veins, and veins with clinical phlebitis. Correlations among US findings and between US findings versus time that the intravenous catheter was in place were investigated. Safety of the US procedure was evaluated. Fifty patients were prospectively recruited for the study and 18 met the final inclusion criteria. Each patient underwent daily US examinations and was assessed for multiple criteria (vascular wall appearance, compressibility, spontaneity of flow, color fill, and presence/absence of filling defects, flow contour, direction, non-pulsatility). Characteristics of normal canine cephalic veins were as follows: smooth and thin wall, complete compressibility, no flow disturbances, no filling defects, smooth flow contours, and unidirectional, non-pulsatile flow with no turbulence. Characteristics of cephalic veins with clinical phlebitis were as follows: wall thickening (83%), decreased compressibility (55%), filling defects consistent with intraluminal thrombus (55%), vessel wall hyperechogenicity (44%), and abnormal color Doppler flow (39%). Significant correlations were found between Doppler filling defects and compressibility, Doppler filling defects and presumed thrombosis, and compressibility and presumed thrombosis (P = .001, P = .001, P = .000, respectively). No correlation was found between the US findings and time the intravenous catheter was in place. Findings indicated that duplex and compressibility US are feasible and safe methods for characterizing and monitoring cephalic veins in dogs with clinical phlebitis.

Temporal characterization of wooden breast myopathy ("woody breast") severity and correlation with growth rate and lymphocytic phlebitis in three commercial broiler strains and a random-bred broiler strain.

Wooden breast myopathy (WBM), or "woody breast" or "wooden breast" affects modern, rapidly growing, high breast-yield broiler chickens. Decreased meat quality due to undesirable organoleptic properties and condemnation of affected breast meat cause economic losses. The pathogenesis of WBM remains unknown. In this study, WBM lesion development was determined in three modern broiler strains and Athens Canadian Random Bred (ACRB) broilers, a 1950s unselected broiler chicken. Correlations between WBM severity and incubation temperature profile, sex, strain, body weight, and lymphocytic phlebitis were also determined. At 2, 4, 6, and 8 weeks of age, samples of breast muscle from 10 male and 10 female birds from each strain, incubated under optimal or low-early, high-late temperatures, were scored histologically for severity of WBM and lymphocytic phlebitis. WBM lesions, identified as early as 2 weeks, became progressively more severe with age and growth in the three commercial broiler strains. WBM severity was significantly correlated with lymphocytic phlebitis and body weight. Lymphocytic phlebitis and minimal WBM were present in the ACRB broilers at all samplings, but did not progress in severity over time. There were no significant differences in severity of WBM among the commercial broiler strains, between sexes, or between incubation temperature profiles. The positive correlation between WBM severity and lymphocytic phlebitis indicates vascular injury is likely an important factor in the pathogenesis. Mild muscle lesions in ACRB birds without overt clinical signs indicate subclinical muscle disease may have been present in broilers prior to the description of WBM.

Evidence and role of phlebitis and lipid infiltration in the onset and pathogenesis of Wooden Breast Disease in modern broiler chickens.

Wooden Breast Disease (WBD), a myopathy that frequently affects modern broiler chickens, is a disorder that has been associated with significant economic losses in the poultry industry. To examine tissue changes associated with the onset and early pathogenesis of this disorder, a time-series experiment was conducted using chickens from a high-breast-muscle-yield, purebred commercial broiler line. Birds were raised for up to seven weeks, with a subset of birds sampled weekly. Breast muscle tissues were extracted at necropsy and processed for analysis by light microscopy and transmission electron microscopy. Histologic presentation indicated localized phlebitis with lipogranulomas in Week 1, focal single-myofibril degeneration in Week 2 preceding an inflammatory response that started in Week 3. Lesions in Week 4 were characterized by multifocal to diffuse muscle fibre degeneration, necrosis, interstitial oedema accompanied by increased lipid and inflammatory cell infiltration. Lesions in Weeks 5-7 revealed diffuse muscle degeneration, necrosis, fibrosis and fatty infiltration with lipogranulomas. Ultrastructural examination showed myofibrillar splitting and degeneration, irregular, displaced and degenerated Z-lines, mitochondrial degeneration and interstitial fibrosis with dense regular collagen fibres. This study, therefore, demonstrates that WBD exhibits an earlier onset in modern broilers than when detectable by clinical examination. Further, this study shows that the disease assumes a progressive course with acute vasculitis, lipid deposition and myodegeneration occurring in the earlier stages, followed by a chronic fibrotic phase.

Surgical Management of Omphalophlebitis and Long Term Outcome in Calves: 39 Cases (2008-2013).

OBJECTIVE: To describe and evaluate the surgical management of omphalophlebitis and to report the short and long term outcomes in calves. STUDY DESIGN: Retrospective case series. ANIMALS: Calves (n = 39). METHODS: Medical records (2008-2013) of calves diagnosed with omphalophlebitis and that underwent surgical correction were reviewed. Short term (hospital discharge) and long term (≥6 months after surgery) survival rates were obtained. Descriptive statistics were used to describe the population and a Fisher's exact test was used to evaluate the relationship between clinical signs, surgical management, and outcome. RESULTS: Thirty-nine calves (median age 30 days) were included in the study. Eleven calves had septic arthritis associated with omphalophlebitis and 18 had evidence of liver abscesses on ultrasound. Complete surgical en bloc resection was achieved in 18 calves and umbilical vein marsupialization was performed on the other 21 calves. Thirty-five calves were discharged from the hospital and long term followup was obtained for 30 of them. Twenty-nine animals were performing according to the owner's expectation at least 6 months after surgery (14 for marsupialization and 15 for en bloc resection). A better prognosis was detected when en bloc resection was performed (100% survival); however, when marsupialization was performed, the prognosis was good (74%; P = .05). Septic arthritis had a significant negative effect on overall survival (P < .001). CONCLUSION: The overall survival is good with both surgical options, and even calves with liver involvement and septic arthritis associated can be successfully treated with a combination of long term antibiotics and umbilical vein marsupialization.

MANAGEMENT OF OMPHALOPHLEBITIS AND UMBILICAL HERNIA IN THREE NEONATAL GIRAFFE (GIRAFFA CAMELOPARDALIS).

Umbilical disorders, including omphalophlebitis, omphaloarteritis, external umbilical abscesses, urachal abscesses, patent urachus, and umbilical hernias, represent a significant challenge to the health and well-being of a neonate. The three neonatal giraffe (Giraffa camelopardalis) in this report were evaluated for umbilical swellings. Two developed omphalophlebitis, and one had an uncomplicated umbilical hernia. Omphalophlebitis is an inflammation and/or infection of the umbilical vein. Giraffe calves with a failure of passive transfer may be predisposed and should be thoroughly evaluated for the condition. Umbilical hernias result from a failure of the umbilical ring to close after parturition or from malformation of the umbilical ring during embryogenesis. These problems were surgically corrected for all three individuals, although one died due to postsurgical complications. The risks involved include anesthetic complications, surgical dehiscence, and maternal rejection. Early detection and surgical intervention are recommended for the correction of omphalophlebitis and umbilical hernias in neonatal giraffe.

Investigation of the roles of fascioliasis and food allergy in intrahepatic eosinophilic proliferative pylephlebitis in Japanese Black cattle.

Intrahepatic eosinophilic proliferative pylephlebitis (EPP) in Japanese Black (JB) cattle generally has been considered to be an atypical form of fascioliasis. However, there are many cases of EPP in which no Fasciola spp. have been detected in the livers of affected cattle. The aims of this study were to ascertain the relationship between EPP and hepatic fascioliasis and to investigate the role of food allergy in the disease. Histologically, EPP lesions were characterised by severe endothelial proliferation of the interlobular veins, accompanied by varying degrees of fibrosis and eosinophilic infiltration in portal areas, which could be differentiated from chronic cholangiohepatitis, the typical lesion of hepatic fascioliasis. In addition to hepatic lesions, all cases of EPP had varying degrees of eosinophilic infiltration in the perilymphoid red pulp of the spleen, whereas both affected and unaffected animals had eosinophilic infiltrates in the mucosa of the small intestine. Antibodies against Fasciola spp. were detected in 1/14 EPP cases by ELISA; the seropositive case had EPP in combination with chronic cholangitis. There was no significant difference in total concentration of IgE between cases of EPP and unaffected cattle. Serum IgE levels specific to curly dock (Rumex crispus) and oats (Avena sativa) were higher in EPP cases than in unaffected cattle by allergen profiling screening testing and ELISA. The results of this study suggest that hepatic fascioliasis is unlikely to be the cause of EPP in JB cattle and that food allergens should be investigated as possible aetiological agents.

Jugular thrombophlebitis developed from buccal ulcer in a thoroughbred horse.

A 22-year-old Thoroughbred stallion had severe left jugular thrombophlebitis. Macroscopic and microscopic examinations revealed extension of the lesions from a penetrating ulcer on the left buccal mucosa to the underlying muscle and local vein, and sequentially to the left jugular vein. This was a rare case of equine jugular thrombophlebitis caused by direct extension of infection from a traumatic oral lesion.

Obliterative endophlebitis in mute swans (Cygnus olor) caused by Trichobilharzia sp. (Digenea: Schistosomatidae) infection.

Schistosome infections in mammals cause chronic proliferative vascular lesions associated with the presence of adult parasites in the lumen of mesenteric and portal veins. In birds, however, this has never been reported. In this study, we found obliterative endophlebitis associated with the presence of adult schistosomes (Trichobilharzia sp., probably Trichobilharzia filiformis) as the main pathologic finding in five of eight mute swans (Cygnus olor). On histologic examination, the intestinal and portal veins of these swans showed moderate to severe, diffuse, hyperplastic endophlebitis, characterized by myointimal hyperplasia, often with obliteration of the vascular lumen. In addition, moderate to severe lymphocytic and granulocytic enteritis occurred in all eight swans associated with the presence of schistosome eggs in the intestinal mucosa. Other findings included hepatic and splenic hemosiderosis and high hepatic copper levels. The vascular lesions associated with Trichobilharzia sp. infection may have contributed to the emaciation and death of those mute swans by obstruction of venous return in the intestinal and portal veins.

Prevention and treatment of thrombosis, phlebitis, and laminitis in horses with gastrointestinal diseases.

Organ thrombosis and laminitis are life-threatening complications in horses with acute gastrointestinal disease, especially those diseases that cause disruption of the protective mucosal barrier. Prevention of these complications should be a high priority when treating horses with gastrointestinal diseases because even with proper and intensive treatments, laminitis or organ thrombosis may not be curative. Preventative therapy should include expedient and appropriate treatment of the primary disease, normalization of tissue perfusion and oxygenation, and inhibition of gut-derived toxins or their systemically activated biologic products along with i.v. replacement of depleted anticoagulant proteins. Additionally, several risk factors for thrombophlebitis in horses with intestinal disease have been identified, and those risk factors should be minimized during the illness.

[Ultrasonographic findings of perivascular jugular vein diseases in cattle]. / Sonographisches Bild perivaskulärer Jugularvenenerkrankungen beim Rind.

Ultrasonographic examinations were used to characterise and describe perivascular changes of the jugular vein like abscess, hematoma and periphlebitis. Well circumscribed masses with irregular, multiple, hypoechogenic areas, corresponding to fluids and necrotic tissues, suggested an abscess. A fresh hematoma, adjacent to the wall of the vein was shown as a clearly delineated structure with a hyperechogenic content. Cases with periphlebitis were characterised by a diffuse anechoic accumulation of fluids infiltrating the perivascular tissue. The diagnoses were proven by needle aspiration biopsy using ultrasound control.

Ultrasonography of the umbilicus in calves. Part 2: Ultrasonography, diagnosis and treatment of umbilical diseases.

In 80 calves presented with clinical signs of umbilical disease, the umbilicus was examined by palpation and by ultrasonography using a 5 Mhz or a 7.5 Mhz sector scanner. Diagnosis was confirmed during surgery or at post mortem examination. The various diseases of the intraabdominal umbilical structures found in these calves and the therapeutic procedures performed are described in detail by use of schematic representations, photographs of anatomical preparations, and ultrasonograms. In 29 calves with an enlarged extraabdominal umbilicus, ultrasonographic examination provided additional information to determine the choice of therapy, and it was particularly helpful in calves with irreducible hernias and with umbilical abscesses. In 51 calves with diseases of the intraabdominal umbilical structures, an exact description of the extent of the disease and of the involvement of other structures, as the liver and the urinary bladder, was made possible by ultrasonography. In calves with omphalitis, early recognition of the involvement of intraabdominal umbilical structures could be determined. Umbilical ultrasonography can be performed easily and is a very reliable and informative aid not only in the diagnosis of umbilical disease but also in determining the choice of therapy. Additionally, the owner can be informed in advance about the expense and the prognosis of the planned therapy.

Marsupialization of umbilical vein abscesses with involvement of the liver in 13 calves.

Omphalophlebitis with liver involvement was diagnosed by ultrasonography in 13 calves. In the initial surgical procedure, the infected umbilical vein was marsupialized by cranial translocation in a median celiotomy and was flushed daily until healing occurred. In a second surgical procedure, the contracted umbilical vein was removed. Nine calves were clinically healthy after treatment. One had reformation of two abscesses because of inadequate post-surgical treatment. One calf was euthanatized because of an intussusception of the small intestine, and two calves had adverse reactions and developed septic shock when some of the lavage fluid, which was applied under pressure, entered the systemic circulation. It was concluded that umbilical vein abscesses should not be flushed under pressure in calves younger than 2 months of age. The principal advantages of cranial translocation of the umbilical vein in a median celiotomy are that only one abdominal incision is required and that the infected umbilical vein tissue does not have to be passed intraabdominally to a paramedian position.

Long-term jugular vein catheterization in horses.

The use of soft catheter materials in large-bore veins has allowed safe long-term venous access in human patients. Similar principles were applied to groups of horses; the jugular vein was catheterized for 14 days (group 1) and for 30 days (group 2). Three catheter materials were compared, and the clinical and histologic findings indicated that the least reaction was associated with silastic, followed by polyurethane; polytetraflouroethylene caused marked reaction. Our results suggest that by using catheters made of materials (especially silastic) that are less stiff or rigid, the duration of catheterization can be increased to 14 days or longer with minimal complications.

Omphalophlebitis and osteomyelitis associated with Klebsiella septicemia in a premature foal.

Gram-negative neonatal septicemia was diagnosed in a premature Standardbred colt. Clinical signs included lethargy, weakness, loss of suckle reflex, tachypnea, and injected mucous membranes. Sequelae included pneumonia, omphalophlebitis, septic arthritis, and osteomyelitis. Prepartum maternal uterine infection, premature delivery, abnormal parturition with premature fetal membrane separation, and failure of passive transfer of colostral immunoglobulins increased the foal's risk for developing sepsis. Treatment included administration of moxalactam disodium and cefadroxil. The clinical efficacy of cephalosporin antibiotics in the treatment of gram-negative sepsis is discussed.