Equine Reproductive Procedures. Группа авторов

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       Remove feces from the rectum.

       Place a tail wrap and tie the tail out of the way (see Chapter 4).

       Clean and dry the perineum of the mare (see Chapter 3).

       Don a sterile obstetrical sleeve.

       Place the end of an 80 cm uterine lavage catheter with a deflated 75 ml cuff into the palm of the hand.

       A 150–250 ml bag of 0.9% sodium chloride can be attached directly to the catheter and the catheter is filled prior to placement. This prevents air influx into the uterus and allows for better recovery of the lavage fluid. Alternatively, sterile, single‐line tubing can be used to connect the bag of saline to the lavage catheter (Figure 18.1).

       Place sterile lubricant on the back of the gloved hand, being careful not to get lubricant onto the palm. If the end of the lavage tubing becomes inundated with lubricant, the lubricant may get into the sample thus interfering with interpretation of the cells.

       Rub lubricant from the knuckles on to the vulva, straighten the fingers and insert through the vulva, being careful to not rub the clitoris as this structure has a significant natural bacterial flora.Figure 18.1 Low volume lavage supplies, including a uterine catheter, single‐line tubing, and 150 ml bag of sterile saline.

        Using a slight rotating motion, pass the hand into the vagina so that the mid‐forearm is to about the level of the vulva. This should enable palpation of the external cervical os.

       Gently insert the index finger into the external cervical os. Sometimes the os may be off‐center, located slightly downward, or to the left or right of center.

       Pass the index finger through the cervix to the last knuckle (metacarpo‐phalangeal joint). Usually there is a feeling of entering the uterine body lumen when the tip of the finger exits the internal cervical os.

       Pass the uterine lavage catheter past the inserted index finger, past the internal cervical os, and into the caudal uterine body. Sometimes, if the cervical canal is under the influence of progesterone and is toned, the index finger may need to be removed prior to passing the lavage catheter. Typically, the catheter would be pointed in a slightly downward direction when being passed through the cervix due to the dependent nature of the suspended uterus within the abdomen. The cuff on the uterine catheter should be inflated with approximately 75 ml of air to prevent reflux of fluid into the vagina. The cuff should be gently snugged against the internal cervical os.Figure 18.2 Infusion of sterile saline into the uterus by gravity flow for low volume lavage.

       The 150–250 ml bag of 0.9% sodium chloride or other sterile fluid is elevated to allow the fluid to flow by gravity into the uterus (Figure 18.2).

       The fluid is allowed to stay in the uterus for approximately 3 minutes to allow for distribution of fluid throughout the lumen.

       In addition, the uterus may be gently massaged per rectum to ensure distribution of the fluid. Care should be taken to not irritate the endometrium with the lavage catheter.

       The empty bag is subsequently lowered to allow a return of fluid via gravity flow (Figure 18.3). Gentle lifting of the uterus per rectum may increase return of fluid. If the fluid does not flow readily through the tubing, gentle aspiration with a catheter tipped 60 ml syringe may be used to initiate flow.

       A single 20 IU dose of oxytocin may be administered intravenously to stimulate uterine contractions and augment return of the uterine fluid.

       Once adequate fluid has been obtained, the clamp on the single‐line tubing is closed or the catheter is disconnected to make sure that there is no contamination of the recovered fluid with bacteria from the vaginal vault or caudal reproductive tract.Figure 18.3 Recovery СКАЧАТЬ