Intubation, Central Venous Catheter, and Arterial Line Placement in Swine for Translational Research in Abdominal Transplantation Surgery

Published: February 03, 2023

doi:

Catherine Parmentier, Fei Gao, Samrat Ray, Masataka Kawamura, Emmanuel Noguiera, Sujani Ganesh, Markus Selzner, Trevor Reichman

¹Ajmera Transplant Program,University Health Network, Toronto General Hospital

Summary

To obtain the best possible results, surgeons performing translational research experiments should be proficient at intubation and vascular line placement. This paper describes the techniques used by the Toronto Organ Preservation Laboratory to perform these procedures.

Abstract

Translational surgical research models in swine are crucial for developing safe preclinical protocols. However, the success of the experimental surgeries does not solely rely on the research team’s surgical skills; perioperative care and management procedures, like intubation, central venous line, and arterial line placement, are necessary and of the utmost importance for favorable experiment results. As it is uncommon for research teams to have anesthesiologists or any other staff other than the surgical team, the surgical team involved in translational research must acquire and/or develop the skills to perform the perioperative care. The purpose of this paper is to show the techniques of intubation, central venous catheter, and arterial line placement used and perfected at the Toronto Organ Preservation Laboratory over the last 10 years, to be used as a reference for future researchers joining either this team or any other lab performing translational research protocols in swine and/or abdominal transplantation.

Introduction

Swine experimental models are often used in studying human diseases because of their similar anatomical and physiological properties. These models are crucial in the development of safe pre-clinical protocols, but they are also subject to legal and ethical restrictions¹. The use of swine for research must be done under the best possible conditions to avoid unnecessary loss of animals and suffering due to anesthesia complications unrelated to the research project.

Pre-operative techniques and skills such as intubation, central venous line placement, and arterial line placement are essential for achieving successful and reproducible results.

Every animal undergoing general anesthesia for a surgical procedure must be intubated to maintain an open airway, allowing assisted ventilation and avoiding broncho aspiration². The most common positions for intubation in swine are dorsal, lateral, and sternal recumbency³^,⁴. Sternal recumbency tends to be easier for personnel trained in human intubation³, which is the case at this research facility.

Good vascular access is essential for the administration of fluids, medications, and sampling during and after surgery. The use of vasopressors is common during abdominal transplant surgeries due to the hemodynamic instability resulting from the ischemia-reperfusion injury. Infusing vasopressors through a peripheral line can cause local tissue injury due to the vasoconstrictive effects⁵. A central venous line placement allows for infusing large amounts of fluids and vasoppresors. We prefer a guidewire-assisted percutaneous technique for central line placement since it minimizes damage to the soft tissue and vessels⁶.

Hemodynamic stability of the animal during surgery is required, and blood pressure is the parameter most typically monitored for this purpose⁷. An arterial line allows for a continuous blood pressure measurement, which is more accurate than traditional non-invasive measurement⁸ as non-invasive techniques underestimate values during hypertension and overestimate them during hypotension⁷^,⁸. An accurate reading of blood pressure during these experiments is fundamental to be able to control the amount of fluids and vasopressors that must be administered to the pig.

The Toronto Organ Preservation Laboratory has been using porcine models for more than 10 years and has standardized these procedures throughout the years with excellent outcomes. Although other approaches can be found in the literature for the same procedures, the goal of this paper is to present the techniques developed and perfected over the years at our facility.

Protocol

All animals used for this study received humane care in accordance with the "Principles of Laboratory Animal Care" formulated by the National Society for Medical Research and the "Guide for the Care of Laboratory Animals" published by the National Institutes of Health, Ontario, Canada. All studies were approved by the Animal Care Committee of the Toronto General Research Institute. In this study, 11-12-week-old male Yorkshire pigs weighing 30-40 kg were used. 1. Intubatio…

Representative Results

Pig monitoring during surgery is indispensable, and the normal parameters expected during surgery are shown in Table 13,14. The approximate duration needed to perform each procedure is shown in Table 2. As mentioned previously, this lab has been performing these procedures for the last 10 years. Over this period, 595 liver experiments, 277 kidney experiments, and 100 pancreas experiments have been carr…

Discussion

Every research center must create its own protocols and guidelines for translational research models; however, some basic rules are to be followed to guarantee successful results.

First, the pig must be submitted to a physical examination as soon as it arrives at the housing facility. A total of 5-7 days of conditioning is necessary before the procedure to reduce stress levels and allow the pig to recover the weight lost during transportation³. It is important to note t…

Disclosures

The authors have nothing to disclose.

Acknowledgements

None.

Materials

0.9% Sodium Chloride Irrigation, USP	Baxter	JF7124	Saline
Angiocath 16 GA 1.88 , 1.7 x 48 mm	BD	381157
Atropine sulfate (8 mg/20 mL – 0.4 mg/mL)	West-Ward	17733	20 mL vial
Cook TPN Single Lumen Cathether Set	Cook medical	G08132	with 10 Fr peel away introducer set
Hickman 9.6 F single-lumen CV cathether	Bard	600560
Laryngoscope	Heine
Midazolam (5 mg/mL)	Sandoz	46237968	10 mL vial
Miller blade 4	Heine		185 mm blade length
Narketan (Ketamine – 100 mg/mL)	Vetoquinal	8-00223	50 mL vial
Nasal tracheal tube cuffed 7.0 mm I.D.	Covidien	86450
Optixcare eye lube for dogs and cats	Aventix	5914304	20 g
Percutaneous Sheath introducer set with integral hemostasis valve/side port for use -7.5 Fr. Catheters	Arrow	SI-09880	8.5 Fr, 10 cm, 0.035 inch dia. Spring wire guide
Universal Electrosurgical Pad: Split with cord	3M	9165
Valleylab Rocker Switch Pencil Holster	Covidien	E2515H
Xylocaine 10% Spray	AstraZeneca	73050036	lidocaine (10 mg/metered dose)

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