Intravenous regional limb perfusion techniques in the anesthetized foal

To provide a video tutorial on how to perform IV regional limb perfusion (IVRLP) using the cephalic or saphenous vein in anesthetized foals.

Foals from neonatal to weaning age not amenable to standing, sedated procedures.

A pneumatic or wide-rubber tourniquet is applied around the proximal antebrachium or gaskin. The IVRLP dose of desired antimicrobial is diluted with physiologic saline to 30 mL of total volume. A 23-gauge winged infusion set or 22-gauge, 1-inch IV catheter is inserted into either the cephalic or saphenous vein distal to the tourniquet, and the entire perfusate volume is administered slowly by hand or with a syringe pump. The needle or catheter is removed, a pressure bandage applied over the venipuncture site, and the tourniquet left in place for a minimum of 20 minutes and up to 30 minutes. When IVRLP is administered in conjunction with systemic antimicrobial administration, the dose administered via IVRLP should be subtracted from the total systemic dose to avoid systemic toxicity.

When combined with systemic administration, cephalic or saphenous IVRLP in the anesthetized foal is considered an effective technique for achieving adequate systemic antimicrobial concentrations and supraphysiologic antimicrobial concentrations in the tissues and synovial compartments of the limbs.

While IVRLP in foals is commonly performed in equine practice, appropriate technique is essential to maximize the clinical effect. This tutorial video is intended to provide practitioners with basic instruction for proper technique of IVRLP using the cephalic or saphenous vein in the anesthetized foal.