This page shows how to give subcutaneous fluids using a giving set (also
known as an IV administration set or a venoset), and includes
photographs.
Please be sure to read the
Tips on
Giving Subcutaneous
Fluids page as well, to help you prepare so that the process is as simple
as possible for both you and your cat.
Sub-Qs are not always appropriate
and in fact in certain circumstances can do more harm than good. Do NOT
give Subcutaneous fluids to your cat if:
Your cat is so severely dehydrated that your vet
considers
intravenous fluid therapy (IV) more appropriate. In certain circumstances
IV
is the only correct treatment. If your cat
has high bloodwork levels (creatinine over 7), s/he might benefit more
from IV fluids initially, with sub-Qs provided once s/he returns home
as needed.
Your cat has a heart condition. Fluid therapy may
still be possible but your vet must decide if it is appropriate for
your cat, and determine the amounts and frequencies to be
administered.
Your vet has refused to agree to the procedure on
other medical grounds.
fluids from the previous
session have not yet been absorbed.
your cat is over-hydrated. This may be obvious, or your cat may feel
"squishy", the way water in a plastic bag feels. Squishiness sometimes happens if a little air gets in with the fluids,
and is not normally a problem, but if it happens consistently, your cat may need less fluid. Other symptoms
of overhydration may include
sudden weight gain, coughing and nasal discharge. See
Symptoms
for more information. Overhydration
may be associated with a heart condition, but contrary to what some
vets claim it can still happen in a cat with a perfectly normal heart.
It is a good idea to
weigh
your cat regularly, to check for sudden or continuous weight gain which
may give early warning of a problem; or
Processing the extra fluids in itself places an additional workload on the kidneys which can make the
CKD
progress faster; plus it can flush out
certain nutrients, and giving fluids when they are not needed may
increase blood pressure; so it is best not to
begin fluids until the advantages are likely to outweigh the
disadvantages. Dr Katherine James of the
Veterinary Information Network believes
that most CKD cats will benefit from subcutaneous therapy once creatinine
levels are consistently over 300 -350 (US: 3.5-4). If your vet thinks your cat's
CKD is less advanced than this, then it is probably safer to hold off on
sub-Qs for the moment;
My vet agreed to us doing fluids in part because she
felt Thomas would not find them too distressing. You and your vet do
need to take your cat's personality into account in deciding whether to
go this route; but do not necessarily assume your cat cannot cope, many
cats who ordinarily hate medication of any kind tolerate sub-Qs because
they make them feel so much better. I would suggest trying them for a
few weeks at least.
Many cats
appear happier (more active and alert, with a better appetite) after
sub-Qs. However, some may become lethargic for an hour or so
afterwards. This is probably nothing to worry about, but if it happens
frequently it may be that your cat is not processing the fluid very
well, so I would ask your vet to check your cat for possible heart
problems or
fluid
retention.
This method, whereby the fluids
drip out of a bag rather like into human patients on an IV drip, is the most
common way of giving sub-Qs in the USA and Canada. It has the advantage of
being easier for one person to do alone, though may take longer than the
Syringe Method. It
can also be harder to tell how much fluid you are giving. I've heard of
one or two people using a
buretrol set to help them measure the
fluid. This is a device which allows you to
transfer a measured amount of fluid from the fluid bag into a chamber, then you give the fluid from the
chamber. The
Tips on Giving Subcutaneous
Fluids page has details of suppliers.
Thomas's friend,
Purr Box, who was diagnosed two months before Thomas in 1999, and who is also
a gorgeous black cat, models receiving fluids via a giving set below. These
photos were taken in October 2003: Purr Box's inspiring story can be found in
the Success
Stories section. As you can
see, Purr Box is not at all distressed. Some CKD cats like the fluids so much that
they come and remind their humans if they are a little late giving them!
Left
to right: the equipment you require is a Terumo needle, a venoset and Lactated
Ringers Solution.
The
first thing you will need to do is to insert the venoset into the bag of
fluid. Before you begin to do this, close the wheel valve on the venoset as
this prevents air from escaping from the bag. If air escapes, the bag will
have a collapsed appearance and the fluid level will be difficult to read.
Remove
the cap from the venoset spike.
Remove
the cap from the bag of Lactated Ringers. Some brands will have a white tab
that pulls off instead of the pictured clear plastic cap.
Force
the venoset spike into the receptacle in the bag. This can require a
considerable amount of force coupled with back and forth twisting.
Place
the bag in a hanging position and then squeeze and release the drip chamber
until the drip chamber is about half full. If it becomes too full, turn
the bag upside down and squeeze the bulb in order to push some of the fluids
back into the bag.
Remove
the cap from the needle end of the venoset. Note that some brands have a Luer
lock – a threaded collar that holds the needle onto the end of the line. If
you are using a brand with a Luer lock, unscrew the protective cap, push the
needle onto the Venoset and then thread the Luer lock onto the needle. If you
do not like using a Luer lock it can be taped out of the way.
Push
the needle securely onto the venoset. If you use a Luer lock, thread it onto
the needle.
Here
you can see the needle affixed with the Luer lock.
There
is no need to apply alcohol to the cat's skin first (Washington
State University explains why this isn't necessary unless the cat
has a poor immune system, e.g. also has cancer). Pinch
some of your cat's skin to form a tent or pouch. Hold the needle so the bottom
end is the longer end - the needle looked at sideways will look like
this: ___\ or this: l___. Holding the needle
parallel to your cat's back, insert the needle smoothly into the tent you
have formed.
It can be helpful not only to move the needle towards the
tent, but also to raise the skin slightly to meet the needle. Ensure you
have not pushed the needle through the other end of the tent - the
fluid will leak if so.
Once you are sure the needle has been inserted
correctly, open the crimp wheel to start the flow.
Your cat may flinch slightly when the fluids first start going in - this may
be because the fluids are too warm or too cold for the cat's liking, or the
sensation can be a little bit of a shock at first. Treats are often well
received when the fluids are running. In Purr Box's case, baby food makes for
a happy cat.
When
you have finished, remove the needle and pinch or massage the injection area for a
minute or so - this will minimise the possibility of fluids leaking.
Occasionally you will see a little blood when you withdraw the needle -
this just means that you have nicked a small blood vessel and is usually nothing
to worry about.
Put
the sub-Q fluid back in your storage area until the next session. Put the lids
back on the needles and do not use them again - you must be careful about
disposing of needles, which are clinical waste, so the safest thing is to keep them somewhere safe
away from children and your pets and ask your vet to dispose of them
permanently for you.
Please visit the
Tips on
Giving Subcutaneous
Fluids page for more tips on how to
give fluids and possible concerns that might arise during the process.
Dr Mike Ontiveros has a video which shows how
to prepare a venoset for sub-Q fluids.
Cornell University College of Veterinary Medicine
has a helpful video on how to give sub-Qs, including how to cope with it.
However, I would ignore the advice to use fluids at room temperature, most
cats prefer warmed fluids.
Left
to right: the equipment you require is a Terumo needle, a venoset and Lactated
Ringers Solution.
The
first thing you will need to do is to insert the venoset into the bag of
fluid. Before you begin to do this, close the wheel valve on the venoset as
this prevents air from escaping from the bag. If air escapes, the bag will
have a collapsed appearance and the fluid level will be difficult to read.
Remove
the cap from the venoset spike.
Remove
the cap from the bag of Lactated Ringers. Some brands will have a white tab
that pulls off instead of the pictured clear plastic cap.
Force
the venoset spike into the receptacle in the bag. This can require a
considerable amount of force coupled with back and forth twisting.
Place
the bag in a hanging position and then squeeze and release the drip chamber
until the drip chamber is about half full. If it becomes too full, turn
the bag upside down and squeeze the bulb in order to push some of the fluids
back into the bag.
Remove
the cap from the needle end of the venoset. Note that some brands have a Luer
lock – a threaded collar that holds the needle onto the end of the line. If
you are using a brand with a Luer lock, unscrew the protective cap, push the
needle onto the Venoset and then thread the Luer lock onto the needle. If you
do not like using a Luer lock it can be taped out of the way.
Push
the needle securely onto the venoset. If you use a Luer lock, thread it onto
the needle. 
Here
you can see the needle affixed with the Luer lock.
There
is no need to apply alcohol to the cat's skin first (
Your cat may flinch slightly when the fluids first start going in - this may
be because the fluids are too warm or too cold for the cat's liking, or the
sensation can be a little bit of a shock at first. Treats are often well
received when the fluids are running. In Purr Box's case, baby food makes for
a happy cat. 