This section shows how to give subcutaneous fluids using the syringe method.
Please be sure to read the
Tips on
Giving Subcutaneous
Fluids page as well, to help you prepare your needles, fluid and cat so that
the process is as simple as possible for both of you.
If you are in
the USA, you will probably be using the giving set method instead,
whereby the fluids drip out of a bag rather like into human patients on an
IV drip. Please visit the
How to Give Subcutaneous Fluids: Giving Set Method page for more
information.
When Not to Give Subcutaneous Fluids
Sub-Qs are not
always appropriate and in fact in certain circumstances can do more harm
than good. Do
NOT give sub-cutaneous 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
overhydrated. 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 continous weight gain which
may give early warning of a problem.
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 sub-cutaneous therapy once creatinine
levels are consistently over creatinine levels are consistently over
3.5-4.0 mg/dl (USA) or 300 -350 µmol/l (international). 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.
What You
Need
Essential Supplies
These are the
items you need:
Fluid bags
Most people
use a type of fluid called lactated ringers solution (LRS) but sometimes
other types of fluid are appropriate. See below for more on this.
Syringes
You use these
to measure out the fluid which you are going to inject into your cat.
Needles
You use these
to draw the fluid out of the fluid bag into the syringe, ready to give
to your cat.
Winged
infusion sets or extension sets
A winged
infusion set is a tube with a needle already attached and the needle is
used to inject the fluid into your cat. Some people prefer to use an
extension set (these are much cheaper), in which case you also need
separate needles which are attached to the end of the extension set and
injected into the cat.
Optional
Supplies When Using the Syringe Method
These are
optional but many people find them helpful:
Calming or
restraint method
Some cats do
better when these are used. See below for options.
Baby food
or other treats
Some people
use these to distract their cats during fluids, others use them as a
reward afterwards.
The Syringe Method
The syringe method has the advantages of speed plus precision regarding
the amount administered. This can be particularly important for a cat with
a concurrent heart condition where you need to be extremely cautious. The
main disadvantage of this method is that it can be difficult for one
person to do alone if the cat is the type to fidget.
If you are in the UK, if you are offered sub-Qs at all
(they are not routinely offered in the UK), you will probably be offered
this method of administration.
Some vets will ask you to give only 10ml of fluid in one
spot, then 10ml in another etc., sticking the cat anew each time. This is
not necessary. It is extra work and cost for you (since you should
inject each needle only once) and much more invasive and less comfortable
for your cat.
If your vet is recommending frequent sticks, see how we
did it below and ask about doing it this way.
International Cat Care states "Generally
around 10-20 ml/kg of fluid can be given at a single SQ injection site
(around 60-100 ml for an average sized cat)", so giving 100ml in one place
should not be a problem for a 10lb cat.
Below we show how we
gave Thomas his fluids. As you can
see, whilst it was not exactly the highlight of his day, it certainly did
not distress him in any way. Some CKD cats like the fluids so much that
they come and remind their humans if they are a little late giving them!
This
is a small needle used for drawing up fluids: we used a Terumo size 21.
This is
a syringe: we always used 20ml syringes because that is what we were
originally given by our vet and we got used to them; you might prefer to use larger ones, particularly
if you are giving fluids alone, though the bigger the syringe, the harder
they are to squeeze. Thomas received 100ml of fluid at each
session so we used five of these altogether.
Attach
the opposite end of the needle to the end of the syringe.
Take
the protective cover off the end of the Terumo needle so the needle is
exposed.
Take
the bag of fluids and find the entrance with the blue marker. Insert the
needle into the clear cellophane as far as it will go (you only need to
push gently).
Hold the
fluids upright and gently pull on the end of the syringe, gradually
drawing the fluids up into the syringe. Try not to pull up air - keeping
the fluids upright can minimise this.
When
the syringe is full, remove the needle and lay the syringe on its side on
a clean cloth, ensuring the end where the needle was attached is not
touching the cloth.
Continue
drawing up fluids in this way (it is fine to use the same Terumo needle
attached to each syringe) into syringes until you have as many syringes as
you require.
Lay all the syringes on a clean cloth where you can reach
them easily when you have your cat on your knee. Some people prefer to lay
the syringes on a heatpad to keep the fluid warm.
Put the bag of fluid to
one side until you are able to put it back where you store it - the valve on
the bag of fluids is one-way, so you do not need to worry about the fluids
spilling or leaking.
Next,
take another needle: this one is a
winged infusion set(also known as a butterfly needle), a needle with a
narrow tube attached. We used size 23, which is a very fine needle. Winged
infusion sets are more expensive than ordinary needles, so you might wish to
use a normal needle with an extension set instead.
Attach the end of the
needle to
the end of one of the syringes. Take the cap off the end of the butterfly
needle. Squeeze gently so the fluid begins to flow and clears the air out of
the needle.
Place
your cat comfortably on your knee. Pinch some of your cat's skin to form a
tent, or pouch. There is no need to apply alcohol to the cat's skin
first.
Critical Care DVM
says "It is not necessary to “sterilize” the skin with alcohol
prior to inserting the needle. In reality, wiping a little alcohol on the
skin does not sterilize it, and the odor and feel of alcohol may aggravate
your pet."
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.
Hold
your cat with one hand, and squeeze steadily on the syringe with the
other. There will be slight resistance as you squeeze on the syringe, and
if it seems to going in too easily, the chances are the needle is sticking
out the other side of the tent.
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 as my vet says,
the sensation can be a little bit of a shock to start with. Thomas never
flinched at the needle but occasionally did at the first squeeze of
the syringe. As you can see, he did not find sub-Qs distressing.
Steadily
squeeze all the fluid contents of the syringe into your cat. If there
is
some air at the end of the syringe, stop squeezing before you reach the
air so that you do not inject it into your 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. Replace the
syringes in their containers - it is safe to use them again as long as the
tips have not touched anything else apart from the needle that was attached
to them. You can re-use them until they no longer run smoothly. 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.
TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE
EXTREMELY DANGEROUS.
I have
tried very hard to ensure that the information provided in this website is
accurate, but I am NOT a vet, just an ordinary person who has lived
through CKD with three cats. This website is for educational purposes
only, and is not intended to be used to diagnose or treat any cat. Before
trying any of the treatments described herein, you MUST consult a
qualified veterinarian and obtain professional advice on the correct
regimen for your cat and his or her particular requirements; and you
should only use any treatments described here with the full knowledge and
approval of your vet. No responsibility can be accepted.
If your cat
appears to be in pain or distress, do not waste time on the internet,
contact your vet immediately.
This site was
created using Microsoft software, and therefore it is best viewed in
Internet Explorer. I know it doesn't always display too well in other
browsers, but I'm not an IT expert so I'm afraid I don't know how to
change that. I would love it to display perfectly everywhere, but my focus
is on making the information available. When I get time, I'll try to
improve how it displays in other browsers.
You may print
out one copy of each section of this site for your own information and/or
one copy to give to your vet, but this site may not otherwise be
reproduced or reprinted, on the internet or elsewhere, without the
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Contact Me
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This
is a small needle used for drawing up fluids: we used a Terumo size 21. 
This is
a syringe: we always used 20ml syringes because that is what we were
originally given by our vet and we got used to them; you might prefer to use larger ones, particularly
if you are giving fluids alone, though the bigger the syringe, the harder
they are to squeeze. Thomas received 100ml of fluid at each
session so we used five of these altogether.
Attach
the opposite end of the needle to the end of the syringe. 
Take
the protective cover off the end of the Terumo needle so the needle is
exposed. 
Take
the bag of fluids and find the entrance with the blue marker. Insert the
needle into the clear cellophane as far as it will go (you only need to
push gently).
Hold the
fluids upright and gently pull on the end of the syringe, gradually
drawing the fluids up into the syringe. Try not to pull up air - keeping
the fluids upright can minimise this.
When
the syringe is full, remove the needle and lay the syringe on its side on
a clean cloth, ensuring the end where the needle was attached is not
touching the cloth.
Continue
drawing up fluids in this way (it is fine to use the same Terumo needle
attached to each syringe) into syringes until you have as many syringes as
you require. 
Lay all the syringes on a clean cloth where you can reach
them easily when you have your cat on your knee. Some people prefer to lay
the syringes on a heatpad to keep the fluid warm.
Next,
take another needle: this one is a
winged infusion set(also known as a butterfly needle), a needle with a
narrow tube attached. We used size 23, which is a very fine needle. Winged
infusion sets are more expensive than ordinary needles, so you might wish to
use a normal needle with an extension set instead. 
Attach the end of the
needle to
the end of one of the syringes. Take the cap off the end of the butterfly
needle. Squeeze gently so the fluid begins to flow and clears the air out of
the needle.
Place
your cat comfortably on your knee. Pinch some of your cat's skin to form a
tent, or pouch. There is no need to apply alcohol to the cat's skin
first.
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. 
Hold
your cat with one hand, and squeeze steadily on the syringe with the
other. There will be slight resistance as you squeeze on the syringe, and
if it seems to going in too easily, the chances are the needle is sticking
out the other side of the tent. 
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 as my vet says,
the sensation can be a little bit of a shock to start with. Thomas never
flinched at the needle but occasionally did at the first squeeze of
the syringe. As you can see, he did not find sub-Qs distressing.
Steadily
squeeze all the fluid contents of the syringe into your cat. If there
is
some air at the end of the syringe, stop squeezing before you reach the
air so that you do not inject it into your cat.
Put
the sub-Q fluid back in your storage area until the next session. Replace the
syringes in their containers - it is safe to use them again as long as the
tips have not touched anything else apart from the needle that was attached
to them. You can re-use them until they no longer run smoothly. 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. 