{"id":128045,"date":"2025-09-04T18:45:38","date_gmt":"2025-09-04T18:45:38","guid":{"rendered":"https:\/\/todaysveterinarynurse.com\/?p=128045"},"modified":"2026-01-27T18:15:24","modified_gmt":"2026-01-27T18:15:24","slug":"placing-central-and-picc-lines-in-companion-animals","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/emergency-medicine-critical-care\/placing-central-and-picc-lines-in-small-animals\/","title":{"rendered":"Placing Central and PICC Lines in Small Animals"},"content":{"rendered":"<div class=\"su-spacer\" style=\"height:20px\"><\/div><div class=\"su-note\"  style=\"border-color:#d8d8d8;border-radius:3px;-moz-border-radius:3px;-webkit-border-radius:3px;\"><div class=\"su-note-inner su-u-clearfix su-u-trim\" style=\"background-color:#f2f2f2;border-color:#ffffff;color:#333333;border-radius:3px;-moz-border-radius:3px;-webkit-border-radius:3px;\"><b>Abstract<\/b><\/p>\n<p class=\"p1\">Central venous catheters (central lines and peripherally inserted central catheters) play a vital role in the management of critically ill veterinary patients. Either the modified Seldinger or the peel-away technique can be used for placing central venous catheters; with training and practice, veterinary nurses and technicians can use them to enhance patient care in emergency and intensive care settings.<\/p>\n<p><b>Take-Home Points <\/b><\/p>\n<ul>\n<li class=\"p1\">Central and peripherally inserted central catheter (PICC) lines can enhance the care of patients who need frequent venous blood sampling, hyperosmolar or multiple incompatible medications, central venous pressure measurements, or parenteral nutrition.<\/li>\n<li class=\"p1\">Aseptic technique when placing and handling central and PICC lines is crucial because they are typically left in place much longer than peripheral intravenous catheters.<\/li>\n<li class=\"p1\">A solid understanding of anatomy and placement techniques can reduce anxiety around central and PICC line use.<\/li>\n<\/ul>\n<\/div><\/div>\n<p class=\"p1\"><span class=\"s1\">A <\/span><span class=\"s1\">central line is a long-line catheter placed in a central vein, such as the jugular vein, and fed into the central circulation via the cranial vena cava. A peripherally inserted central catheter (PICC) line is placed in a peripheral vein, such as the saphenous vein, and fed into the central circulation via the caudal vena cava (<\/span><span class=\"s2\"><b>FIGURE 1<\/b><\/span><span class=\"s1\">).<\/span><\/p>\n<div id=\"attachment_128049\" style=\"width: 360px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig1.jpg\"><img fetchpriority=\"high\" decoding=\"async\" aria-describedby=\"caption-attachment-128049\" class=\" wp-image-128049\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig1.jpg\" alt=\"\" width=\"350\" height=\"258\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig1.jpg 863w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig1-300x221.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig1-768x567.jpg 768w\" sizes=\"(max-width: 350px) 100vw, 350px\" \/><\/a><p id=\"caption-attachment-128049\" class=\"wp-caption-text\">FIGURE 1. Venous circulation in a dog. Alexander_P\/shutterstock<\/p><\/div>\n<h2 class=\"p3\">Indications for Central and PICC Lines<\/h2>\n<p class=\"p2\">Central and PICC lines are indicated for administration<span class=\"s1\"> of medications with osmolarity of &gt;<\/span><span class=\"s3\">\u2009<\/span><span class=\"s1\">600\u00a0mOsm\/L, such as dextrose &gt;<\/span><span class=\"s3\">\u2009<\/span><span class=\"s1\">10% (maximum through a peripheral vein is 10%), or medications with a high risk of causing <\/span>phlebitis\/thrombophlebitis should they be extravasated,<sup>1<\/sup><span class=\"s1\"> such as vasopressors. Many lines have multiple lumens for delivery of several or incompatible medications. They are ideal for patients that require frequent blood sampling (e.g., patients with diabetic ketoacidosis, parvovirus infection, or hypoglycemia). Central lines inserted into the jugular vein also enable measurement of central venous pressure and administration of parenteral nutrition.<sup>2<\/sup><\/span><\/p>\n<p><iframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" allow=\"autoplay\" src=\"https:\/\/w.soundcloud.com\/player\/?url=https%3A\/\/api.soundcloud.com\/tracks\/soundcloud%253Atracks%253A2255128610&#038;color=%23ff5500&#038;auto_play=false&#038;hide_related=false&#038;show_comments=true&#038;show_user=true&#038;show_reposts=false&#038;show_teaser=true\"><\/iframe><\/p>\n<div style=\"font-size: 10px; color: #cccccc;line-break: anywhere;word-break: normal;overflow: hidden;white-space: nowrap;text-overflow: ellipsis; font-family: Interstate,Lucida Grande,Lucida Sans Unicode,Lucida Sans,Garuda,Verdana,Tahoma,sans-serif;font-weight: 100;\"><a href=\"https:\/\/soundcloud.com\/vetfolio\" title=\"VetFolio\" target=\"_blank\" style=\"color: #cccccc; text-decoration: none;\">VetFolio<\/a> \u00b7 <a href=\"https:\/\/soundcloud.com\/vetfolio\/placing-central-lines-its-not-as-scary-as-it-sounds\" title=\"Placing Central Lines: It\u2019s Not as Scary as It Sounds\" target=\"_blank\" style=\"color: #cccccc; text-decoration: none;\">Placing Central Lines: It\u2019s Not as Scary as It Sounds<\/a><\/div>\n<h2 class=\"p3\">Contraindications and Complications of Central and PICC Lines<\/h2>\n<p class=\"p2\"><span class=\"s1\">Contraindications and complications of central and PICC lines are similar in many respects but differ in others.<\/span><\/p>\n<h3 class=\"p4\">Contraindications<\/h3>\n<p class=\"p2\"><span class=\"s1\">Central line contraindications include skin infection over the desired insertion site, increased intracranial pressure, or suspected or confirmed bleeding disorder. PICC line contraindications include skin infection over the desired insertion site, edema, mobility at the site, frequent urination, or diarrhea.<sup>3<\/sup><\/span><\/p>\n<h3 class=\"p4\">Complications<\/h3>\n<p class=\"p2\"><span class=\"s1\">Central line complications include arrhythmias secondary to placement, phlebitis, embolism, bleeding, and\/or infection. PICC line complications include phlebitis, embolism, bleeding, and\/or infection.<sup>4<\/sup><\/span><\/p>\n<h2 class=\"p3\">Techniques for Central and PICC Line Placement<\/h2>\n<p class=\"p2\"><span class=\"s1\">Many techniques can be used for inserting central and PICC lines. This article discusses the modified Seldinger and peel-away techniques. The modified Seldinger technique uses catheterization, guidewire placement, vessel dilation, and line insertion. The peel-away technique involves placing an introducer catheter, inserting the line, then \u201cpeeling away\u201d the introducer.<\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Although both techniques can be used for central and PICC lines, for clarity the author describes the modified Seldinger technique for central lines and the peel-away technique for PICC lines. Both techniques begin with the same first 7 steps.<\/span><\/p>\n<h3 class=\"p4\">Shared Foundational Steps<\/h3>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 1:<\/b><\/span><span class=\"s1\"> Initiate sedation and monitoring as appropriate for the patient (i.e., have staff\/multiparameter monitor available).<\/span><\/p>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 2: <\/b><\/span><span class=\"s1\">Position the patient in lateral recumbency.<\/span><\/p>\n<p class=\"p5\"><span class=\"s4\"><b>STEP 3: <\/b><\/span><span class=\"s1\">Shave over the desired vein to be used.<\/span><\/p>\n<ul>\n<li class=\"p6\"><span class=\"s1\">Central lines<\/span>\n<ul>\n<li class=\"p7\"><b>Dogs and cats:<\/b> From mandible to thoracic inlet<\/li>\n<\/ul>\n<\/li>\n<li class=\"p6\"><span class=\"s1\">PICC lines<\/span>\n<ul>\n<li class=\"p7\"><span class=\"s1\"><b>Dogs:<\/b> Lateral saphenous vein<\/span><\/li>\n<li class=\"p8\"><span class=\"s1\"><b>Cats:<\/b> Medial saphenous vein<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 4: <\/b><\/span><span class=\"s1\">To determine the correct location, don examination gloves, hold off the vein, and palpate\/visualize the site of insertion (which if too high or low may cause problems with insertion), securing the site and patient comfort.<\/span><\/p>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 5: <\/b><\/span><span class=\"s1\">Still wearing the examination gloves, use aseptic technique to prepare the insertion site.\u00a0<\/span><\/p>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 6: <\/b><\/span><span class=\"s1\">Open the kit and verify that all needed parts are present.<\/span><\/p>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 7: <\/b><\/span><span class=\"s1\">The person placing the catheter should don sterile gloves, and the assistant, wearing examination gloves, holds off the vein far above the venipuncture site.<\/span><\/p>\n<h3 class=\"p4\">Secondary Steps Specific to the Modified Seldinger Technique<\/h3>\n<p class=\"p5\"><span class=\"s1\">The modified Seldinger technique is used for placement of a central line in the jugular vein. Follow the first 7 steps under <\/span><span class=\"s2\"><b>Techniques<\/b><\/span><span class=\"s1\"> and then the steps below. See also <\/span><span class=\"s2\"><b>VIDEOS\u00a01 AND 2<\/b><\/span><span class=\"s1\">.<\/span><\/p>\n<div class=\"su-youtube su-u-responsive-media-yes\"><iframe width=\"600\" height=\"400\" src=\"https:\/\/www.youtube.com\/embed\/uY1fhLnoPTs?\" frameborder=\"0\" allowfullscreen allow=\"autoplay; encrypted-media; picture-in-picture\" title=\"\"><\/iframe><\/div>\n<div class=\"su-youtube su-u-responsive-media-yes\"><iframe width=\"600\" height=\"400\" src=\"https:\/\/www.youtube.com\/embed\/fMcsknj1SU4?\" frameborder=\"0\" allowfullscreen allow=\"autoplay; encrypted-media; picture-in-picture\" title=\"\"><\/iframe><\/div>\n<p class=\"p5\"><span class=\"s4\"><b>STEP 8:<\/b><\/span><span class=\"s1\"> Measure the guidewire (keeping it sterile) from the planned entry site to the 3rd to 4th intercostal space, and visually note the location on the guidewire. Lines are marked on the guidewire to help track the length inserted (<\/span><span class=\"s2\"><b>FIGURE 2<\/b><\/span><span class=\"s1\">).<sup>5<\/sup><\/span><\/p>\n<div id=\"attachment_128050\" style=\"width: 360px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig2.png\"><img decoding=\"async\" aria-describedby=\"caption-attachment-128050\" class=\" wp-image-128050\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig2.png\" alt=\"\" width=\"350\" height=\"466\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig2.png 720w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig2-225x300.png 225w\" sizes=\"(max-width: 350px) 100vw, 350px\" \/><\/a><p id=\"caption-attachment-128050\" class=\"wp-caption-text\">FIGURE 2. Measuring the guidewire for the modified Seldinger technique.<\/p><\/div>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 9:<\/b><\/span><span class=\"s1\"> Keeping it sterile, measure the central line from the planned entry site to the 3rd to 4th intercostal space (to the right atrium), and visually note the centimeter mark on the central line, or use a tape measure if available in the kit.<\/span><\/p>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 10:<\/b><\/span><span class=\"s1\"> Remove the drape window, if needed, and place the drape on the patient, putting the desired entry point in the center of the fenestration. <b>Note:\u00a0<\/b>Visualization can be difficult after draping\u2014be diligent in selecting a spot.<\/span><\/p>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 11:<\/b><\/span><span class=\"s1\"> To facilitate initial catheter placement, perform a cutdown over the desired entry point (<\/span><span class=\"s2\"><b>FIGURE 3<\/b><\/span><span class=\"s1\">). <b>Note:<\/b> A larger cutdown can be performed if needed for visualization.<\/span><\/p>\n<div id=\"attachment_128051\" style=\"width: 360px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig3.png\"><img decoding=\"async\" aria-describedby=\"caption-attachment-128051\" class=\" wp-image-128051\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig3.png\" alt=\"\" width=\"350\" height=\"264\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig3.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig3-300x226.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig3-768x579.png 768w\" sizes=\"(max-width: 350px) 100vw, 350px\" \/><\/a><p id=\"caption-attachment-128051\" class=\"wp-caption-text\">FIGURE 3. Cutdown in the modified Seldinger technique.<\/p><\/div>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 12:<\/b><\/span><span class=\"s1\"> Have the assistant hold off the vein at the jugular furrow with a sterile-gloved hand under the drape (<\/span><span class=\"s2\"><b>FIGURE 4<\/b><\/span><span class=\"s1\">).<\/span><\/p>\n<div id=\"attachment_128052\" style=\"width: 360px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig4.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-128052\" class=\" wp-image-128052\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig4.png\" alt=\"\" width=\"350\" height=\"368\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig4.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig4-285x300.png 285w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig4-768x808.png 768w\" sizes=\"(max-width: 350px) 100vw, 350px\" \/><\/a><p id=\"caption-attachment-128052\" class=\"wp-caption-text\">FIGURE 4. Holding off at the jugular furrow to visualize the jugular vein during the modified Seldinger technique.<\/p><\/div>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 13:<\/b><\/span><span class=\"s1\"> Insert the catheter at the desired location; when blood appears, advance the catheter and remove the stylet. The restraining assistant can then stop holding off the vein at the jugular furrow (<\/span><span class=\"s2\"><b>FIGURE\u00a05<\/b><\/span><span class=\"s1\">).<\/span><\/p>\n<div id=\"attachment_128053\" style=\"width: 360px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig5.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-128053\" class=\" wp-image-128053\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig5.png\" alt=\"\" width=\"350\" height=\"364\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig5.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig5-288x300.png 288w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig5-768x799.png 768w\" sizes=\"(max-width: 350px) 100vw, 350px\" \/><\/a><p id=\"caption-attachment-128053\" class=\"wp-caption-text\">FIGURE 5. Inserting the intravenous catheter during the modified Seldinger technique.<\/p><\/div>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 14:<\/b><\/span><span class=\"s1\"> Straighten out the J hook (<\/span><span class=\"s2\"><b>FIGURE 6<\/b><\/span><span class=\"s1\">) and plug the guidewire housing set into the catheter (<\/span><span class=\"s2\"><b>FIGURE 7<\/b><\/span><span class=\"s1\">). Advance the wire to the predetermined estimated mark (guidewires have single or double line marks to help notate desired insertion site).\u00a0To avoid inadvertently losing the wire inside the patient, do not advance more than two-thirds of the wire into the patient. Do not at any point let go of the guidewire (a case of a guidewire accidentally lost in a patient led to it being surgically retrieved<sup>6<\/sup>).<\/span><\/p>\n<div class=\"su-image-carousel  su-image-carousel-has-spacing su-image-carousel-crop su-image-carousel-crop-4-3 su-image-carousel-has-lightbox su-image-carousel-has-outline su-image-carousel-adaptive su-image-carousel-slides-style-default su-image-carousel-controls-style-dark su-image-carousel-align-center\" style=\"max-width:50%\" data-flickity-options='{\"groupCells\":true,\"cellSelector\":\".su-image-carousel-item\",\"adaptiveHeight\":false,\"cellAlign\":\"left\",\"prevNextButtons\":true,\"pageDots\":false,\"autoPlay\":5000,\"imagesLoaded\":true,\"contain\":true,\"selectedAttraction\":0.025,\"friction\":0.28}' id=\"su_image_carousel_69e88bcd47efd\"><div class=\"su-image-carousel-item\"><div class=\"su-image-carousel-item-content\"><a href=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig6A.png\" target=\"_blank\" rel=\"noopener noreferrer\" data-caption=\"FIGURE 6A. J hook outside of the housing. Courtesy Alli Butler, MILA International\"><img loading=\"lazy\" decoding=\"async\" width=\"864\" height=\"827\" src=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig6A.png\" class=\"\" alt=\"\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig6A.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig6A-300x287.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig6A-768x735.png 768w\" sizes=\"(max-width: 864px) 100vw, 864px\" \/><span>FIGURE 6A. J hook outside of the housing. Courtesy Alli Butler, MILA International<\/span><\/a><\/div><\/div><div class=\"su-image-carousel-item\"><div class=\"su-image-carousel-item-content\"><a href=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig6B.png\" target=\"_blank\" rel=\"noopener noreferrer\" data-caption=\"FIGURE 6B. J hook pulled back into the housing for the modified Seldinger technique. Courtesy Alli Butler, MILA International\"><img loading=\"lazy\" decoding=\"async\" width=\"864\" height=\"664\" src=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig6B.png\" class=\"\" alt=\"\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig6B.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig6B-300x231.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig6B-768x590.png 768w\" sizes=\"(max-width: 864px) 100vw, 864px\" \/><span>FIGURE 6B. J hook pulled back into the housing for the modified Seldinger technique. Courtesy Alli Butler, MILA International<\/span><\/a><\/div><\/div><div class=\"su-image-carousel-item\"><div class=\"su-image-carousel-item-content\"><a href=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig7.png\" target=\"_blank\" rel=\"noopener noreferrer\" data-caption=\"FIGURE 7. Connecting the guidewire housing to the intravenous catheter during the modified Seldinger technique.\"><img loading=\"lazy\" decoding=\"async\" width=\"864\" height=\"806\" src=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig7.png\" class=\"\" alt=\"\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig7.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig7-300x280.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig7-768x716.png 768w\" sizes=\"(max-width: 864px) 100vw, 864px\" \/><span>FIGURE 7. Connecting the guidewire housing to the intravenous catheter during the modified Seldinger technique.<\/span><\/a><\/div><\/div><\/div><script id=\"su_image_carousel_69e88bcd47efd_script\">if(window.SUImageCarousel){setTimeout(function() {window.SUImageCarousel.initGallery(document.getElementById(\"su_image_carousel_69e88bcd47efd\"))}, 0);}var su_image_carousel_69e88bcd47efd_script=document.getElementById(\"su_image_carousel_69e88bcd47efd_script\");if(su_image_carousel_69e88bcd47efd_script){su_image_carousel_69e88bcd47efd_script.parentNode.removeChild(su_image_carousel_69e88bcd47efd_script);}<\/script>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 15:<\/b><\/span><span class=\"s1\"> Remove the guidewire housing, leaving the guidewire in place (<\/span><span class=\"s2\"><b>FIGURE 8<\/b><\/span><span class=\"s1\">).\u00a0<b>Note: <\/b>Be cautious to keep the wire sterile and not let go of it.<sup>7<\/sup><\/span><\/p>\n<div id=\"attachment_128057\" style=\"width: 360px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig8.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-128057\" class=\" wp-image-128057\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig8.png\" alt=\"\" width=\"350\" height=\"325\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig8.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig8-300x278.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig8-768x713.png 768w\" sizes=\"(max-width: 350px) 100vw, 350px\" \/><\/a><p id=\"caption-attachment-128057\" class=\"wp-caption-text\">FIGURE 8. Removing the guidewire housing, leaving the guidewire in place, during the modified Seldinger technique. Courtesy Alli Butler, MILA International<\/p><\/div>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 16:<\/b><\/span><span class=\"s1\"> Remove the catheter, leaving only the guidewire in place (<\/span><span class=\"s2\"><b>FIGURE 9<\/b><\/span><span class=\"s1\">).<\/span><\/p>\n<div id=\"attachment_128058\" style=\"width: 360px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig9.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-128058\" class=\" wp-image-128058\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig9.png\" alt=\"\" width=\"350\" height=\"269\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig9.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig9-300x231.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig9-768x590.png 768w\" sizes=\"(max-width: 350px) 100vw, 350px\" \/><\/a><p id=\"caption-attachment-128058\" class=\"wp-caption-text\">FIGURE 9. Removing the intravenous catheter, leaving the guidewire in place, during the modified Seldinger technique. Courtesy Alli Butler, MILA International<\/p><\/div>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 17:<\/b><\/span><span class=\"s1\"> Fully feed the dilator into the vessel with a slight twisting motion, until the hub has reached the skin, and then remove the dilator (<\/span><span class=\"s2\"><b>FIGURE 10<\/b><\/span><span class=\"s1\">). It will take more force than you might expect. For ease of insertion, hold the dilator close to the skin.<\/span><\/p>\n<div class=\"su-image-carousel  su-image-carousel-has-spacing su-image-carousel-crop su-image-carousel-crop-4-3 su-image-carousel-has-lightbox su-image-carousel-has-outline su-image-carousel-adaptive su-image-carousel-slides-style-default su-image-carousel-controls-style-dark su-image-carousel-align-center\" style=\"max-width:50%\" data-flickity-options='{\"groupCells\":true,\"cellSelector\":\".su-image-carousel-item\",\"adaptiveHeight\":false,\"cellAlign\":\"left\",\"prevNextButtons\":true,\"pageDots\":false,\"autoPlay\":5000,\"imagesLoaded\":true,\"contain\":true,\"selectedAttraction\":0.025,\"friction\":0.28}' id=\"su_image_carousel_69e88bcd4851c\"><div class=\"su-image-carousel-item\"><div class=\"su-image-carousel-item-content\"><a href=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig10A.png\" target=\"_blank\" rel=\"noopener noreferrer\" data-caption=\"FIGURE 10A. Feeding the dilator over the guidewire.\"><img loading=\"lazy\" decoding=\"async\" width=\"792\" height=\"851\" src=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig10A.png\" class=\"\" alt=\"\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig10A.png 792w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig10A-279x300.png 279w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig10A-768x825.png 768w\" sizes=\"(max-width: 792px) 100vw, 792px\" \/><span>FIGURE 10A. Feeding the dilator over the guidewire.<\/span><\/a><\/div><\/div><div class=\"su-image-carousel-item\"><div class=\"su-image-carousel-item-content\"><a href=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig10B.png\" target=\"_blank\" rel=\"noopener noreferrer\" data-caption=\"FIGURE 10B. Feeding the dilator into the vessel. Courtesy Alli Butler, MILA International\"><img loading=\"lazy\" decoding=\"async\" width=\"864\" height=\"617\" src=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig10B.png\" class=\"\" alt=\"\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig10B.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig10B-300x214.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig10B-768x548.png 768w\" sizes=\"(max-width: 864px) 100vw, 864px\" \/><span>FIGURE 10B. Feeding the dilator into the vessel. Courtesy Alli Butler, MILA International<\/span><\/a><\/div><\/div><div class=\"su-image-carousel-item\"><div class=\"su-image-carousel-item-content\"><a href=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig10C.png\" target=\"_blank\" rel=\"noopener noreferrer\" data-caption=\"FIGURE 10C. Removing the dilator from the vessel during the modified Seldinger technique.\"><img loading=\"lazy\" decoding=\"async\" width=\"864\" height=\"914\" src=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig10C.png\" class=\"\" alt=\"\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig10C.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig10C-284x300.png 284w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig10C-768x812.png 768w\" sizes=\"(max-width: 864px) 100vw, 864px\" \/><span>FIGURE 10C. Removing the dilator from the vessel during the modified Seldinger technique.<\/span><\/a><\/div><\/div><\/div><script id=\"su_image_carousel_69e88bcd4851c_script\">if(window.SUImageCarousel){setTimeout(function() {window.SUImageCarousel.initGallery(document.getElementById(\"su_image_carousel_69e88bcd4851c\"))}, 0);}var su_image_carousel_69e88bcd4851c_script=document.getElementById(\"su_image_carousel_69e88bcd4851c_script\");if(su_image_carousel_69e88bcd4851c_script){su_image_carousel_69e88bcd4851c_script.parentNode.removeChild(su_image_carousel_69e88bcd4851c_script);}<\/script>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 18:<\/b><\/span><span class=\"s1\"> After removing the dilator, hold gauze over the site to stop bleeding.<span class=\"Apple-converted-space\">\u00a0 \u00a0<\/span><\/span><\/p>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 19:<\/b><\/span><span class=\"s1\"> Feed the central line over the wire to the desired location.\u00a0The wire will come out of the brown distal port.\u00a0The assistant should watch for the wire to unclamp it and reclamp it as soon as it has passed (<\/span><span class=\"s2\"><b>FIGURE 11<\/b><\/span><span class=\"s1\">).<\/span><\/p>\n<div id=\"attachment_128062\" style=\"width: 360px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig11.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-128062\" class=\" wp-image-128062\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig11.png\" alt=\"\" width=\"350\" height=\"368\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig11.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig11-285x300.png 285w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig11-768x807.png 768w\" sizes=\"(max-width: 350px) 100vw, 350px\" \/><\/a><p id=\"caption-attachment-128062\" class=\"wp-caption-text\">FIGURE 11. Feeding the central line over the wire during the modified Seldinger technique.<\/p><\/div>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 20:<\/b><\/span><span class=\"s1\"> To avoid air embolism, bleed each line, then flush with saline from the patient\u2019s dedicated bag (<\/span><span class=\"s2\"><b>FIGURE 12, VIDEO 2<\/b><\/span><span class=\"s1\">).\u00a0<b>Note:<\/b> Consider blood loss and the size of the patient.<\/span><\/p>\n<div id=\"attachment_128063\" style=\"width: 360px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig12.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-128063\" class=\" wp-image-128063\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig12.png\" alt=\"\" width=\"350\" height=\"247\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig12.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig12-300x211.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig12-768x541.png 768w\" sizes=\"(max-width: 350px) 100vw, 350px\" \/><\/a><p id=\"caption-attachment-128063\" class=\"wp-caption-text\">FIGURE 12. Bleeding each line during the modified Seldinger technique.<\/p><\/div>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 21:<\/b><\/span><span class=\"s1\"> Place 2 caps on each line, each of which should have a Luer lock port and a cap on top of it.<\/span><\/p>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 22:<\/b><\/span><span class=\"s1\"> Place a temporary securing bandage over the line and transport the patient to radiology. <b>Note:<\/b>\u00a0Placing central lines while in the radiology suite (instead of before) decreases the risk for inadvertent line removal.<\/span><\/p>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 23:<\/b><\/span><span class=\"s1\"> Take lateral (<\/span><span class=\"s2\"><b>FIGURE 13<\/b><\/span><span class=\"s1\">) and ventral\/dorsal views from the neck to the xiphoid process. Radiographs are recommended to confirm placement in front of the right atrium. If the line is too far in, back it out slowly, taking additional radiographs. Pull the line out in increments. Do not insert the line after it has been pulled out as it would no longer be sterile.<\/span><\/p>\n<div class=\"su-image-carousel  su-image-carousel-has-spacing su-image-carousel-crop su-image-carousel-crop-4-3 su-image-carousel-has-lightbox su-image-carousel-has-outline su-image-carousel-adaptive su-image-carousel-slides-style-default su-image-carousel-controls-style-dark su-image-carousel-align-center\" style=\"max-width:50%\" data-flickity-options='{\"groupCells\":true,\"cellSelector\":\".su-image-carousel-item\",\"adaptiveHeight\":false,\"cellAlign\":\"left\",\"prevNextButtons\":true,\"pageDots\":false,\"autoPlay\":5000,\"imagesLoaded\":true,\"contain\":true,\"selectedAttraction\":0.025,\"friction\":0.28}' id=\"su_image_carousel_69e88bcd48ab2\"><div class=\"su-image-carousel-item\"><div class=\"su-image-carousel-item-content\"><a href=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig13A.png\" target=\"_blank\" rel=\"noopener noreferrer\" data-caption=\"FIGURE 13A. Incorrect central line position during the modified Seldinger technique.\"><img loading=\"lazy\" decoding=\"async\" width=\"864\" height=\"625\" src=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig13A.png\" class=\"\" alt=\"\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig13A.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig13A-300x217.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig13A-768x556.png 768w\" sizes=\"(max-width: 864px) 100vw, 864px\" \/><span>FIGURE 13A. Incorrect central line position during the modified Seldinger technique.<\/span><\/a><\/div><\/div><div class=\"su-image-carousel-item\"><div class=\"su-image-carousel-item-content\"><a href=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig13B.png\" target=\"_blank\" rel=\"noopener noreferrer\" data-caption=\"FIGURE 13B. Correct central line position during the modified Seldinger technique.\"><img loading=\"lazy\" decoding=\"async\" width=\"864\" height=\"638\" src=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig13B.png\" class=\"\" alt=\"\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig13B.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig13B-300x222.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig13B-768x567.png 768w\" sizes=\"(max-width: 864px) 100vw, 864px\" \/><span>FIGURE 13B. Correct central line position during the modified Seldinger technique.<\/span><\/a><\/div><\/div><\/div><script id=\"su_image_carousel_69e88bcd48ab2_script\">if(window.SUImageCarousel){setTimeout(function() {window.SUImageCarousel.initGallery(document.getElementById(\"su_image_carousel_69e88bcd48ab2\"))}, 0);}var su_image_carousel_69e88bcd48ab2_script=document.getElementById(\"su_image_carousel_69e88bcd48ab2_script\");if(su_image_carousel_69e88bcd48ab2_script){su_image_carousel_69e88bcd48ab2_script.parentNode.removeChild(su_image_carousel_69e88bcd48ab2_script);}<\/script>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 24:<\/b><\/span><span class=\"s1\"> It is best to unwrap the bandage manually before suturing in place. If cutting the bandage, be careful not to cut any lines.<\/span><\/p>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 25:<\/b><\/span><span class=\"s1\"> After catheter positioning is correct, suture each butterfly wing in place with a single interrupted pattern and tightly around both indentations of the hub to secure the line in place (<\/span><span class=\"s2\"><b>FIGURE 14<\/b><\/span><span class=\"s1\">). <b>Note:\u00a0<\/b>Depending on the length, you may need to use butterfly extenders and secure 1 or both ports.<\/span><\/p>\n<div class=\"su-image-carousel  su-image-carousel-has-spacing su-image-carousel-crop su-image-carousel-crop-4-3 su-image-carousel-has-lightbox su-image-carousel-has-outline su-image-carousel-adaptive su-image-carousel-slides-style-default su-image-carousel-controls-style-dark su-image-carousel-align-center\" style=\"max-width:50%\" data-flickity-options='{\"groupCells\":true,\"cellSelector\":\".su-image-carousel-item\",\"adaptiveHeight\":false,\"cellAlign\":\"left\",\"prevNextButtons\":true,\"pageDots\":false,\"autoPlay\":5000,\"imagesLoaded\":true,\"contain\":true,\"selectedAttraction\":0.025,\"friction\":0.28}' id=\"su_image_carousel_69e88bcd49145\"><div class=\"su-image-carousel-item\"><div class=\"su-image-carousel-item-content\"><a href=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig14A.png\" target=\"_blank\" rel=\"noopener noreferrer\" data-caption=\"FIGURE 14. Suturing the central line after placement using the modified Seldinger technique.\"><img loading=\"lazy\" decoding=\"async\" width=\"864\" height=\"662\" src=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig14A.png\" class=\"\" alt=\"\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig14A.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig14A-300x230.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig14A-768x588.png 768w\" sizes=\"(max-width: 864px) 100vw, 864px\" \/><span>FIGURE 14. Suturing the central line after placement using the modified Seldinger technique.<\/span><\/a><\/div><\/div><div class=\"su-image-carousel-item\"><div class=\"su-image-carousel-item-content\"><a href=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig14B.png\" target=\"_blank\" rel=\"noopener noreferrer\" data-caption=\"FIGURE 14. Suturing the central line after placement using the modified Seldinger technique.\"><img loading=\"lazy\" decoding=\"async\" width=\"864\" height=\"855\" src=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig14B.png\" class=\"\" alt=\"\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig14B.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig14B-300x297.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig14B-768x760.png 768w\" sizes=\"(max-width: 864px) 100vw, 864px\" \/><span>FIGURE 14. Suturing the central line after placement using the modified Seldinger technique.<\/span><\/a><\/div><\/div><div class=\"su-image-carousel-item\"><div class=\"su-image-carousel-item-content\"><a href=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig14C.png\" target=\"_blank\" rel=\"noopener noreferrer\" data-caption=\"FIGURE 14. Suturing the central line after placement using the modified Seldinger technique.\"><img loading=\"lazy\" decoding=\"async\" width=\"792\" height=\"841\" src=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig14C.png\" class=\"\" alt=\"\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig14C.png 792w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig14C-283x300.png 283w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig14C-768x816.png 768w\" sizes=\"(max-width: 792px) 100vw, 792px\" \/><span>FIGURE 14. Suturing the central line after placement using the modified Seldinger technique.<\/span><\/a><\/div><\/div><div class=\"su-image-carousel-item\"><div class=\"su-image-carousel-item-content\"><a href=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig14D.png\" target=\"_blank\" rel=\"noopener noreferrer\" data-caption=\"FIGURE 14. Suturing the central line after placement using the modified Seldinger technique.\"><img loading=\"lazy\" decoding=\"async\" width=\"792\" height=\"874\" src=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig14D.png\" class=\"\" alt=\"\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig14D.png 792w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig14D-272x300.png 272w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig14D-768x848.png 768w\" sizes=\"(max-width: 792px) 100vw, 792px\" \/><span>FIGURE 14. Suturing the central line after placement using the modified Seldinger technique.<\/span><\/a><\/div><\/div><\/div><script id=\"su_image_carousel_69e88bcd49145_script\">if(window.SUImageCarousel){setTimeout(function() {window.SUImageCarousel.initGallery(document.getElementById(\"su_image_carousel_69e88bcd49145\"))}, 0);}var su_image_carousel_69e88bcd49145_script=document.getElementById(\"su_image_carousel_69e88bcd49145_script\");if(su_image_carousel_69e88bcd49145_script){su_image_carousel_69e88bcd49145_script.parentNode.removeChild(su_image_carousel_69e88bcd49145_script);}<\/script>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 26:<\/b><\/span><span class=\"s1\"> Place a Tegaderm dressing or Telfa pad over the insertion site and bandage with rolled cotton and elastic wrap. Leave the ports out and tape them to the elastic wrap to create a secondary source of tension (<\/span><span class=\"s2\"><b>FIGURE 15<\/b><\/span><span class=\"s1\">).<\/span><\/p>\n<div id=\"attachment_128070\" style=\"width: 360px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig15.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-128070\" class=\" wp-image-128070\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig15.png\" alt=\"\" width=\"350\" height=\"326\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig15.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig15-300x280.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig15-768x716.png 768w\" sizes=\"(max-width: 350px) 100vw, 350px\" \/><\/a><p id=\"caption-attachment-128070\" class=\"wp-caption-text\">Figure 15. Bandage over the central line site, leaving the ports out, after placement using the modified Seldinger technique.<\/p><\/div>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 27:<\/b><\/span><span class=\"s1\"> Label ports with tape (e.g., IVF [intravenous fluids], FLK [fentanyl, lidocaine, ketamine constant-rate infusion], insulin, sampling, alfaxalone).<\/span><\/p>\n<h3 class=\"p4\">Secondary Steps Specific to the Peel-Away Technique<\/h3>\n<p class=\"p2\"><span class=\"s1\">The peel-away technique is used for PICC line placement in a peripheral vein. Follow the first 7 steps under <\/span><span class=\"s2\"><b>Techniques<\/b><\/span><span class=\"s1\"> and then the steps below.<\/span><\/p>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 8:<\/b><\/span><span class=\"s1\"> Measure the PICC line (keeping it sterile) from the planned entry point to just past the femoral head (to the caudal vena cava). Visually note the cm mark on the PICC line or use the provided tape measure.<\/span><\/p>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 9:<\/b><\/span><span class=\"s1\"> Clamp each line to avoid air embolism. <\/span><\/p>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 10:<\/b><\/span><span class=\"s1\"> Remove the drape window, if needed, and place the drape on the patient, putting the desired entry point in the center of the fenestration <b>(<\/b><\/span><span class=\"s2\"><b>FIGURE\u00a016<\/b><\/span><span class=\"s1\"><b>)<\/b>.<\/span><\/p>\n<div id=\"attachment_128071\" style=\"width: 359px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig16.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-128071\" class=\" wp-image-128071\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig16.png\" alt=\"\" width=\"349\" height=\"353\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig16.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig16-297x300.png 297w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig16-768x777.png 768w\" sizes=\"(max-width: 349px) 100vw, 349px\" \/><\/a><p id=\"caption-attachment-128071\" class=\"wp-caption-text\">FIGURE 16. Drape placed over the lateral saphenous vein in a dog, preparing for the peel-away technique.<\/p><\/div>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 11:<\/b><\/span><span class=\"s1\"> Perform a stab incision over the desired entry point with the blade facing toward the ceiling (optional).<\/span><\/p>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 12:<\/b><\/span><span class=\"s1\"> Have the assistant, wearing examination gloves, hold off the vein above the stifle.<\/span><\/p>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 13:<\/b><\/span><span class=\"s1\"> Insert the catheter at the desired location; when blood appears, advance the catheter and remove the stylet (<\/span><span class=\"s2\"><b>FIGURE 17<\/b><\/span><span class=\"s1\">). The assistant then stops holding off above the stifle.<\/span><\/p>\n<div class=\"su-image-carousel  su-image-carousel-has-spacing su-image-carousel-crop su-image-carousel-crop-4-3 su-image-carousel-has-lightbox su-image-carousel-has-outline su-image-carousel-adaptive su-image-carousel-slides-style-default su-image-carousel-controls-style-dark su-image-carousel-align-center\" style=\"max-width:50%\" data-flickity-options='{\"groupCells\":true,\"cellSelector\":\".su-image-carousel-item\",\"adaptiveHeight\":false,\"cellAlign\":\"left\",\"prevNextButtons\":true,\"pageDots\":false,\"autoPlay\":5000,\"imagesLoaded\":true,\"contain\":true,\"selectedAttraction\":0.025,\"friction\":0.28}' id=\"su_image_carousel_69e88bcd496d1\"><div class=\"su-image-carousel-item\"><div class=\"su-image-carousel-item-content\"><a href=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig17A-scaled.png\" target=\"_blank\" rel=\"noopener noreferrer\" data-caption=\"FIGURE 17A. The introducer catheter is\u00a0placed during the peel-away technique.\"><img loading=\"lazy\" decoding=\"async\" width=\"896\" height=\"1024\" src=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig17A-896x1024.png\" class=\"\" alt=\"\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig17A-896x1024.png 896w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig17A-262x300.png 262w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig17A-768x878.png 768w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig17A-1343x1536.png 1343w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig17A-1791x2048.png 1791w\" sizes=\"(max-width: 896px) 100vw, 896px\" \/><span>FIGURE 17A. The introducer catheter is\u00a0placed during the peel-away technique.<\/span><\/a><\/div><\/div><div class=\"su-image-carousel-item\"><div class=\"su-image-carousel-item-content\"><a href=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig17B.png\" target=\"_blank\" rel=\"noopener noreferrer\" data-caption=\"FIGURE 17B. The stylet is removed during the peel-away technique.\"><img loading=\"lazy\" decoding=\"async\" width=\"792\" height=\"860\" src=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig17B.png\" class=\"\" alt=\"\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig17B.png 792w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig17B-276x300.png 276w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig17B-768x834.png 768w\" sizes=\"(max-width: 792px) 100vw, 792px\" \/><span>FIGURE 17B. The stylet is removed during the peel-away technique.<\/span><\/a><\/div><\/div><\/div><script id=\"su_image_carousel_69e88bcd496d1_script\">if(window.SUImageCarousel){setTimeout(function() {window.SUImageCarousel.initGallery(document.getElementById(\"su_image_carousel_69e88bcd496d1\"))}, 0);}var su_image_carousel_69e88bcd496d1_script=document.getElementById(\"su_image_carousel_69e88bcd496d1_script\");if(su_image_carousel_69e88bcd496d1_script){su_image_carousel_69e88bcd496d1_script.parentNode.removeChild(su_image_carousel_69e88bcd496d1_script);}<\/script>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 14:<\/b><\/span><span class=\"s1\"> Feed the PICC line into the catheter to the measured location (<\/span><span class=\"s2\"><b>FIGURE 18<\/b><\/span><span class=\"s1\">).<\/span><\/p>\n<div id=\"attachment_128074\" style=\"width: 360px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig18.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-128074\" class=\" wp-image-128074\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig18.png\" alt=\"\" width=\"350\" height=\"299\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig18.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig18-300x257.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig18-768x657.png 768w\" sizes=\"(max-width: 350px) 100vw, 350px\" \/><\/a><p id=\"caption-attachment-128074\" class=\"wp-caption-text\">FIGURE 18. Feeding the PICC (peripherally inserted central catheter) line into the introducer catheter during the peel-away technique.<\/p><\/div>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 15:<\/b><\/span><span class=\"s1\"> Place 2 caps on each line. Each line should have a Luer lock port and a cap on top of it.<\/span><\/p>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 16:<\/b><\/span><span class=\"s1\"> \u201cPeel away\u201d the catheter and remove it (<\/span><span class=\"s2\"><b>FIGURE\u00a019<\/b><\/span><span class=\"s1\">).<\/span><\/p>\n<div class=\"su-image-carousel  su-image-carousel-has-spacing su-image-carousel-crop su-image-carousel-crop-4-3 su-image-carousel-has-lightbox su-image-carousel-has-outline su-image-carousel-adaptive su-image-carousel-slides-style-default su-image-carousel-controls-style-dark su-image-carousel-align-center\" style=\"max-width:50%\" data-flickity-options='{\"groupCells\":true,\"cellSelector\":\".su-image-carousel-item\",\"adaptiveHeight\":false,\"cellAlign\":\"left\",\"prevNextButtons\":true,\"pageDots\":false,\"autoPlay\":5000,\"imagesLoaded\":true,\"contain\":true,\"selectedAttraction\":0.025,\"friction\":0.28}' id=\"su_image_carousel_69e88bcd49bee\"><div class=\"su-image-carousel-item\"><div class=\"su-image-carousel-item-content\"><a href=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig19A.png\" target=\"_blank\" rel=\"noopener noreferrer\" data-caption=\"FIGURE 19. Peeling away the introducer catheter during the peel-away technique.\"><img loading=\"lazy\" decoding=\"async\" width=\"864\" height=\"731\" src=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig19A.png\" class=\"\" alt=\"\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig19A.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig19A-300x254.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig19A-768x650.png 768w\" sizes=\"(max-width: 864px) 100vw, 864px\" \/><span>FIGURE 19. Peeling away the introducer catheter during the peel-away technique.<\/span><\/a><\/div><\/div><div class=\"su-image-carousel-item\"><div class=\"su-image-carousel-item-content\"><a href=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig19B.png\" target=\"_blank\" rel=\"noopener noreferrer\" data-caption=\"FIGURE 19. Peeling away the introducer catheter during the peel-away technique.\"><img loading=\"lazy\" decoding=\"async\" width=\"864\" height=\"630\" src=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig19B.png\" class=\"\" alt=\"\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig19B.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig19B-300x219.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig19B-768x560.png 768w\" sizes=\"(max-width: 864px) 100vw, 864px\" \/><span>FIGURE 19. Peeling away the introducer catheter during the peel-away technique.<\/span><\/a><\/div><\/div><\/div><script id=\"su_image_carousel_69e88bcd49bee_script\">if(window.SUImageCarousel){setTimeout(function() {window.SUImageCarousel.initGallery(document.getElementById(\"su_image_carousel_69e88bcd49bee\"))}, 0);}var su_image_carousel_69e88bcd49bee_script=document.getElementById(\"su_image_carousel_69e88bcd49bee_script\");if(su_image_carousel_69e88bcd49bee_script){su_image_carousel_69e88bcd49bee_script.parentNode.removeChild(su_image_carousel_69e88bcd49bee_script);}<\/script>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 17:<\/b><\/span><span class=\"s1\"> After the line is secured (with a single interrupted pattern, tightened around both indentations of the hub), place a Tegaderm dressing or Telfa pad over the insertion site and bandage with rolled cotton and elastic wrap. Leave the ports out and tape them to the elastic wrap to create a secondary source of tension (<\/span><span class=\"s2\"><b>FIGURE 20<\/b><\/span><span class=\"s1\">).<\/span><\/p>\n<div id=\"attachment_128077\" style=\"width: 260px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig20.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-128077\" class=\" wp-image-128077\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig20.png\" alt=\"\" width=\"250\" height=\"399\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig20.png 648w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig20-188x300.png 188w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2025\/09\/Waller_TVNFall25_CentralPICCLines_Fig20-642x1024.png 642w\" sizes=\"(max-width: 250px) 100vw, 250px\" \/><\/a><p id=\"caption-attachment-128077\" class=\"wp-caption-text\">FIGURE 20. Bandage, leaving the ports out, following the peel-away technique.<\/p><\/div>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 18:<\/b><\/span><span class=\"s1\"> Label ports with tape (e.g., IVF, FLK, insulin, alfaxalone, sampling).<\/span><\/p>\n<h2 class=\"p3\">Sampling From Central and PICC Lines<\/h2>\n<p class=\"p2\"><span class=\"s1\">Multilumen central lines ideally have a dedicated port for blood sampling. The distal (brown) port is ideal because it is the farthest from the insertion site and closest to the vena cava, but any port can be used. <\/span><\/p>\n<h3 class=\"p4\">Sample Collection<\/h3>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 1:<\/b><\/span><span class=\"s1\"> Stop any fluids running through any ports.<\/span><\/p>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 2:<\/b><\/span><span class=\"s1\"> Don gloves.<\/span><\/p>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 3:<\/b><\/span><span class=\"s1\"> Remove the cap, keeping it sterile.<\/span><\/p>\n<p class=\"p2\"><span class=\"s4\"><b>STEP 4:<\/b><\/span><span class=\"s1\"> Clean the port with alcohol for at least 5\u00a0seconds and let it air dry.<\/span><\/p>\n<p class=\"p5\"><span class=\"s4\"><b>STEP 5:<\/b><\/span><span class=\"s1\"> Use the push\/pull method.<\/span><\/p>\n<ul>\n<li class=\"p6\"><span class=\"s1\">Attach a 10-mL syringe with 1 mL of saline and flush the line.<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Pull 3 mL of blood and push it back into the line 3\u00a0times, then draw the sample.<\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Flush the line with saline, being mindful of the volume used, using a positive-pressure pulsating technique. Flushing with heparinized saline has not been demonstrated to be superior to saline, and excessive flushing with heparinized saline could lead to coagulation disorders, although this has not been proven.<sup>8,9<\/sup><\/span>\n<ul>\n<li class=\"p8\"><span class=\"s1\"><b>Troubleshooting:<\/b> Flushing with saline may help if you cannot get a sample. Adjusting the patient\u2019s head or leg position may help. If you still cannot get a sample, unwrap the bandage to verify that the line is still in place.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h2 class=\"p3\">Maintaining Central and PICC Lines<\/h2>\n<p class=\"p2\"><span class=\"s1\">To maintain catheter patency, the line should be routinely flushed, especially when a port is not in use. Flushing should be performed every 4 hours, with at least the priming volume of the central line (approximately 0.5 to 2 mL, depending on catheter size\/manufacturer).<sup>10<\/sup> Consider the size of the patient and concerns for fluid overload. When flushing, use a saline bag dedicated for that patient, wear gloves, maintain pulsating positive pressure as you flush, and clamp the line before disconnecting the syringe. <\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Bandages should be unwrapped by hand once daily and the insertion site inspected for erythema, swelling, or discharge. The insertion site should be gently cleaned with chlorhexidine scrub and dried, and all ports and the line should be wiped down for at least 5 seconds with alcohol and allowed to air dry. The bandage can then be replaced.<\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Note that when parenteral nutrition is to be administered, unnecessary disconnection of the central line port from parenteral nutrition administration lines should be avoided to prevent contamination. If disconnection is necessary, strict aseptic technique should be followed. <\/span><\/p>\n<h2 class=\"p3\">Summary<\/h2>\n<p class=\"p2\"><span class=\"s1\">Although central catheter placement requires advanced technical skills and comes with potential risks, being able to correctly place catheters is invaluable for management of critical-care patients. With training and practice, the skill can enhance patient care in emergency and intensive care settings. <\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Central venous catheters play a vital role in the management of critically ill veterinary patients.<\/p>\n","protected":false},"author":236,"featured_media":128078,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":0,"footnotes":""},"categories":[815],"tags":[145],"class_list":["post-128045","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-fall-2025","tag-peer-reviewed","column-skills-check","clinical_topics-emergency-medicine-critical-care"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.7 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ 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