Hickman Catheter Use for Long-Term Vascular Access in a Preclinical Swine Model

Summary

A reliable and reproducible approach for the insertion and maintenance of a tunneled Hickman catheter for long-term vascular access in swine is described. Placement of a central venous catheter allows for convenient daily sampling of whole blood from awake animals and intravenous administration of medication and fluids.

Abstract

Central venous catheters (CVCs) are invaluable devices in large animal research as they facilitate a wide range of medical applications, including blood monitoring and reliable intravenous fluid and drug administration. Specifically, the tunneled multi-lumen Hickman catheter (HC) is commonly used in swine models due to its lower extrication and complication rates. Despite fewer complications relative to other CVCs, HC-related morbidity presents a significant challenge, as it can significantly delay or otherwise negatively impact ongoing studies. The proper insertion and maintenance of HCs is paramount in preventing these complications, but there is no consensus on best practices. The purpose of this protocol is to comprehensively describe an approach for the insertion and maintenance of a tunneled HC in swine that mitigates HC-related complications and morbidity. The use of these techniques in >100 swine has resulted in complication-free patent lines up to 8 months and no catheter-related mortality or infection of the ventral surgical site. This protocol offers a method to optimize the lifespan of the HC and guidance for approaching issues during use.

Introduction

The indispensable role of central venous catheters (CVCs) in patient care is owed to their convenience, favorable safety profile, and versatility¹. Functions of a CVC include reliable access for total parenteral nutrition, hematopoietic stem cell transplantation, plasmapheresis/apheresis, and efficient fluid, blood, or co-drug administration². In veterinary medicine, CVCs also minimize animal discomfort via the rapid dilution of irritant drugs and blood sampling without repeated venipuncture³. Despite their broad applications, the use of CVCs in large animal research still presents severa....

Protocol

All animal procedures were conducted in accordance with an animal protocol approved by the Johns Hopkins University Institutional Animal Care and Use Committee (IACUC). Strains of male and female swine undergoing HC placement include miniature swine from the Massachusetts General Hospital (MGH) swine colony, Yucatan swine, and Yorkshire-crossed swine from an agricultural vendor (20-40 kg). Swine ranged from 3-10 months of age when the HC was placed. The HC may be placed anytime relative to the animal's experimental procedure. However, it is recommended to place it beforehand to permit the collection of baseline blood values. It is also recommended to give the swin....

Results

Over 100 swine have undergone successful HC insertion in our lab. The HC can be safely and correctly placed and secured in under 1 h with a surgeon, assistant, circulator, and anesthetist. The catheter pouch takes roughly 15-20 min to make. The technique is straightforward and easy to teach and has been performed by veterinarians, surgical residents, and medical students following supervised instructions.

HCs have remained in place without complications or revision for up to 8 months. In a rec.......

Discussion

While CVCs serve a spectrum of functions in large animal research, current literature lacks a consensus approach for safe and sustainable use in long-term trials over 30 days. This protocol's stepwise procedure for HC insertion, skin securement, and storage in a handmade pouch has undergone significant adjustments for quality improvement. As such, this protocol presents a technique for HC use that permits efficient and effective intravenous access while ensuring animal welfare and minimizing complications.

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
#10 blade	Medline	MDS15110
0.9% Sterile Sodium Chloride	Baxter	2F7123
0-0 Coated and Braided Nonabsorbable Suture	Covidien	S-196
0-0 Synthetic, Monofilament, Nonabsorbable Polypropylene Suture	Ethicon	8690H
1 inch Medical Tape	3M	1548S-1
10 USP units/mL Heparin flush	Becton, Dickinson and Company	306424
3-0 Braided Absorbable Suture	Covidien	SL-636 (cutting needle), GL-122 (taper needle)
3-0 Monofilament Absorbable Suture	Covidien	SM-922 (cutting needle), CM-882 (taper needle)
4-0 Coated and Braided Non-absorbable Suture Ties	Ethicon	A303H
70% Ethanol	Vedco	VINV-IPA7
Adson tissue forceps	MPM Medical Supply	132-508
Adson-Brown forceps	MPM Medical Supply	106-2572
Air warming blanket and pad	3M Bair Hugger	UPC 00608223595770
Backhaus towel clamp	MPM Medical Supply	117-5508
Brown needle holder	MPM Medical Supply	110-1513
Buprenorphine	PAR Pharmaceutical	3003408B
Cefazolin	Hikma Farmacuetica (Portugal)	PLB 133-WES/1
Chlorhexidine	Vet One	501027
Clave	Baxter	7N8399
Cotton Padding	Medline	NON6027
Debakey forceps	MPM Medical Supply	106-5015
Elastic Adhesive Bandage Tape	3M	XH002016489
Halstead mosquito forceps	MPM Medical Supply	115-4612
Hickman Catheter	Bard Access Systems	603710
Hickman Catheter Repair Kit, 7Fr, Red and White Connectors	Bard Access Systems	0601690 (red), 0601680 (white), 502017
Kelly hemostatic forceps	MPM Medical Supply	115-7014
Ketamine	Vet One	383010-03
Lactated Ringers	Baxter	2B2324X
Maropitant Citrate	Zoetis	106
Mayo scissors	MPM Medical Supply	103-5014
Metzenbaum scissors	MPM Medical Supply	132-711
Pantoprazole	JH Pharmacy	NDC 0143-9284-10
Scalpel blade handle	Medline	MDS10801
Vein Pick	SAI infusion technologies	VP-10
Veterinary Ophthalmic Ointment	Dechra	IS4398
Xylazine	Vet One	510004