top of page

How to place a lavage system

When and where to place a lavage system

  • Consider early and whenever deep ulcer suspected.

  • Once basement membrane broached melting ulcer or stromal abscess may be <12 hours away.

  • Lavage systems can be managed by most owners in the stable although where very frequent medications required the hospital environment may be more appropriate.

  • Commercially available kits are very good and readily available although instructions for manufacturing kits can be found at www.ivis.org/proceedings/AAEP/1997/White.pdf

  • Ventromedial placement with sub palpebral lavage system preferred

    • Third eye lid protects.

    • More forgiving of imperfect placement than dorsal placement

    • More physiologically correct – medication placed directly into the lacrimal lake

1958.jpeg

​Sub-palbebral lavage systems in place: note the lavage system is fixed through the skin at two points, ventromedial to the eye avoiding the facial vein and in the facial midline at the level of the whorl.  The silicon lavage tubing is as well tolerated as nylon sutures are and better than dissolvable sutures

Technique

  • Forelock plait

    • Place single mane plait at level expect to secure the giving end of the SPL

    • Sedate

    • Auriculopalpebral block (facial n. stops blinking)

    • Frontal block (trigeminal, sensation, upper lid excluding lateral and medial canthi).

    • Topical local (proxymetacaine or tetracaine/amethocaine)

      • Single drop in to ventromedial fornix after prolapsing third eye lid

    • Wait for 15secs

      • Multiple applications. (6 drops, 10 seconds apart).

    • Topical local anaesthetic soaked sterile cotton bud tip placed at the site of Trochar pass (ventromedial or dorsomedial conjunctival fornix) – leave in place 15-30secs.

    • Inject 0.5-1ml subconjuntival local anaethetic at the site of trochar pass using an insulin syringe.

  • Local anaesthetic at site of trochar pass through lid - Local infiltration of 2-3mls local anaesthetic either as single bleb through single lid injection or as line block from medial canthus.

    • Local anaesthetic at SPL anchoring sites using 25 g needles, leave needles in place to mark injection sites.

      • Ventromedial to medial canthus (avoid the facial vein

      • Facial midline at level of whirl.

    • Infra-trochlear block placed 5minutes after the frontal block anaesthetises the medial canthal region and medial lower lid.

    • Directing the needle medially and then ventrally will additionally block further branches of the trigeminal nerve not readily palpated.

    • Surgically prepare the  lower lid skin, anchoring points for lavage kit and the ventral conjunctival fornix with dilute iodine prior to placement.

 

  • Palpate ventral orbital rim with a gloved finger.

 

  • Slip finger external to the orbital rim identifying the deepest part of the ventromedial fornix.

  • Place a trochar guide in to identified position or

  • Guide trochar alongside finger aiming to exit lower eye lid 1/3 of lid length from medial canthus.

  • Direct exit point medially aiming to exit ventral to the orbital rim.

    • NB a blunt metal instrument (eg closed scissors) can aid passing the trochar through the skin.

  • Secure to skin ventromedial to the eye and  to the mid-line nasal skin.

    • SPL can be secured safely and easily by passing the trochar through the skin or

    • Securing the SPL with tapes sutured to the skin – monofilament suture – or

    • Using supplied securing plates – NB these provide little tension on the tubing and allow free movement of the SPL tubing which can lead to movement of the foot plate especially when a dorsal placement is elected.

  • Pass lavage tubing through plaited forelock and rostral main.

  • Tape tongue depresser or similar to the mane plait to cre

  • Place blunt ended Canula or 21g angiocath into the giving end of the SPL prior to securing the Canula/angiocath to the SPL support

Tips

bottom of page