Home administration of subcutaneous fluids


The following document is a guide for owners on the administration of fluids to chronic renal patients:

Your pet requires subcutaneous fluid administration. This requirement may be due to illness of the intestinal system or more likely disease of the kidneys. Chronic kidney disease is the most common reason clients are asked to give fluids to their pets at home. These fluids are necessary because your pet will not or cannot drink enough fluids to accomplish the goals of increasing the fluid flow through the kidneys. Increasing fluid (blood) flow though the kidneys causes more filtration and reduces the toxin build up that occurs. By administering these fluids to your pet you can greatly extend the life of your pet for months to years, beyond that of a pet not receiving these fluids.

This is a point by point guide designed to help you with the home administration of these fluids.

kidneys_6You will use needles inserted under the skin to gain access to the subcutaneous area. This area under the skin is ideal for fluid placement as it will stretch to accommodate the fluids and has adequate blood supply to absorb the fluids. Needles come in different sizes which follow a uniform color code system. The larger the needle the faster the fluids will flow, but the larger size may cause more discomfort. The smaller needles have less pain associated with the entry, yet substantially increases the time needed to deliver the required amount of fluids. Most cats tolerate a 20 gauge (pink) needle and most dogs can tolerate the 18 gauge (green) needle. Depending on your pet, the amount of fluids to give, and the amount of time you have to give them, may help you determine the best needle size for your pet and situation.

The needles are contained within plastic covers that snap off to prevent contamination of the needle. Do not touch the needle or lie the needle down without first placing the protective cap back on the needle. The needles are made to be used once and then discarded. This prevents infections in your pet. Please do not reuse a needle or use a needle in more than one pet.

Note: Disposal of medical products such as needles is coming under more and more regulation and it may be illegal to place these products (needles, fluid lines used bags of fluids) into the trash. Local pharmacies may have disposal recommendations for you. We will be happy to dispose of these products if you will bring them to us.

kidneys_7The fluid set or drip set is the tubing and apparatus that connects the bag of fluids to the needle. The fluid set comes sterile in a container or may already be attached to your pet’s bag of fluids. Fluid sets come in different flow rates indicated by the number of drips per ml. The most common drip set used for subcutaneous fluids is the one that is 10 drips per ml as compared to the ones that are 60 drips per ml. Fluids flow much faster from a 10 drip set than a 60 drip set and this is desirable for your pet.

kidneys_8There is a clamp on the tubing between the part that connects to the bag and the part that connects to the needle. This clamp has a roller valve that should be closed completely when the fluids are not being used or while the needle is being placed in the pet. The clamp is opened fully to release the flow of fluids into your pet.

kidneys_9The drip chamber is the portion of the drip set that is closely attached to the bag of fluids. The drip chamber can be compressed between your thumb and fingers to start the flow of fluids. Drips can be seen in the drip chamber and, in general, the faster the rate of fluid flow the better. Sometimes the drip chamber becomes filled. This can be fixed by inverting the bag of fluids with the drip chamber now on top and squeezing the drip chamber between your fingers. This will force the extra fluid back into the bag. When the setup is reverted to its normal state, the drip chamber should have less fluid in it and you should be able to see the drips.

kidneys_10The drip chamber is close to the spike which is used to tap the bag of fluids with a water tight seal allowing fluids to exit only through the line.

The bag of fluids will have a removable plug over the opening. This plug is pulled out and the cover over the spike (if there is one) is removed and the spike is pushed into the bag with a twisting motion. This allows fluids into the drip chamber.

Fluids

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There are several types of fluids used in a typical veterinary practice. They have names that may be confusing, but in general consist of electrolyte solutions that are balanced. This means they will not burn when administered under the skin. Examples are Lactated Ringers solution, 0.9% NaCl solution, 5% Dextrose solution. Fluids may come in bags or bottles and may be 250ml to 1000ml in size. Most are 1000ml or one liter in size. The bag or bottle will be marked on the side to determine how much has been administered.

Preparing for fluid therapy includes having the needle ready and attached to the end of the drip set in a sterile fashion. The needle has a cover to protect it until it will be used. The drip set is properly placed in the bag of fluids, the drip chamber is properly primed and the tubing of the drip set is primed with fluids as well. The bag is positioned above the patient. The higher the bag is placed above the patient the faster the fluids will run.

kidneys_13The patient is best positioned above the floor on a surface that is smooth. A towel can be used to create a cat burrito covering the feet in some unwilling patients. The fluids can be irritating if administered cold but should not be heated prior to their administration either. Once the pet is restrained, a tent of skin is picked up at the level of the attachment of the neck to the body between the shoulder blades. The needle is laid at the base of this tent of skin. The skin is pulled over the needle allowing the needle to advance and rest under the skin. If you pinch the skin when you do this it distracts the pet from the prick of the needle and the pet rarely feels it. Once the needle is in place and the skin has been allowed to return to the normal position, the fluids are started. The needle is held against the skin to prevent the force of the fluid flow from pushing the needle backwards out of the pet. The valve on the fluid line is opened completely to allow the fluids to flow. The bag of the fluids is watched to see that the drips in the drip chamber are dripping and the level of the fluid in the bag is dropping. The appropriate amount is administered. Then the valve is closed, the needle is removed and capped. This capped needle hub is protecting the end of the fluid line. If there is a sterile cover to the fluid line then the needle is discarded and the cover is placed if not leave the needle on the line until the next time to administer the fluids.

If during the administration, the drip rate in the chamber is slow, reposition the needle. If this does not work you will have to place the needle in a new spot. The fluids will accumulate under the skin, causing a large bulge. Over time this bulge will be absorbed and or gravitate (move to the bottom of the pet) to the area between the front legs. If these have not been absorbed before the next time fluids are to be given, it may mean that the pet has poor circulation, or that the pet does not need more fluids. Please notify us if this is happening.