|How it's done
|Click here for an illustrated step-by-step guide to administering subcutaneous fluids.
|Not sure you can do it?
|We weren't sure either. Recently, we have had to do the procedure ourselves for the first time. It wasn't as smooth as we hoped at the beginning, but it got much better over time. We describe our learning experience here.
Dr. Martin G. St.Germain of Practivet has developed an implantable Sub-Q administration tube called the Greta Implantable Fluid Tube (GIF-Tube). The nine inch silicon tube is inserted under the skin and a small skirt of material is sutured to the cat's skin, holding the tube firmly in place. An injection port is attached to the external end of the tube. Your vet will change the port monthly. The tube can remain in place for up to a year. A special needleless injector is used to administer fluids through the port.
If you cannot or will not use needles, or if your cat will not hold still for injections, the GIF-Tube provides an alternative.
Because the tube and ports remain in place for a long time, special care must be taken to prevent infection. Some cats have been known to scratch at the tube until they tear out their stiches and a few have actually removed the tubes, but most patients appear to adapt well to the tube.
Your vet will give you a full set of instructions for administering fluids through the GIF-Tube.
We have had no first-hand experience with the GIF-Tubes yet as they are relatively new.
There is a GIF-Tube user support mail list where caregivers share their experiences.
If you or your vet want more information on the GIF-Tube, visit the Practivet Web site at www.practivet.com
fluids (also known as sub-Q's or Lactated Ringer's solution) are fluids that are administered through a needle which is inserted under the
cat's skin. Each bag contains 1000 ml. (one liter) of solution
and must be prescribed by your veterinarian. While some cats
in CRF may never need them, most eventually do. Sub-Q fluids
are an essential and ongoing part of CRF management. As the
disease progresses, the cat may stop drinking, not drink adequate
amounts of water or vomit frequently and become dehydrated.
Sub-Q fluids help with rehydration. Without adequate hydration,
the blood flow through the kidneys is reduced which causes
even more rapid deterioration of the kidneys. Subcutaneous
fluid therapy will not repair the kidneys, but will help the
remaining kidney tissue function as effectively as possible.
fluids may be supplemented with potassium if your veterinarian
feels it is appropriate for your cat's particular situation.
CRF cats may be able to live for several additional years
with sub-Q fluids and the proper diet. The need is generally
determined by the creatinine and BUN numbers. Cats really
do seem to feel better after hydration so it is well worth
is perfect for all patients. While sub-Q fluids have extended
the lives of countless CRF cats, cats with heart conditions
can be put in extreme danger through the administration of sub-Q
fluids. Also, excessive fluids can put pressure on the pleural
cavity and temporarily collapse a lung.
amount of sub-Q's per injection is based on the cat's weight
and the severity of the disease. The frequency can also vary
depending on how much the disease has progressed. Never give
your cat a greater volume of sub-Q fluids than your vet has
specified. Some cats can do quite well on sub-Q fluids once
a week while others who are farther along in the disease can
benefit from daily injections. Some cats simply will not tolerate
sub-Q fluid injections and quality of life versus quantity
must be seriously considered. In later stages of CRF, your
cat may reach a point where it can no longer absorb the sub-Q
injection of sub-Q fluids may cause your cat to look somewhat
lumpy and off-balance for a short time. The cat may carry
the water pouch up to 24 hours until it's absorbed. It is
normal for fluid (sometimes slightly blood-tinged) to leak
from the injection site for a short time. After hydration,
the water pouch usually slips down to the bottom of the abdomen,
but occasionally it may slip down into one of the front legs.
The pouch is not as noticeable on a long-haired cat as it
is on a shorthair.
Administering Sub-Q's at Home
Administering sub-Q's can be done at home and your veterinarian or technician can train you. Practice at the veterinarian's office the first few times so you'll feel more competent doing it at home. Don't feel bad if you can't bring yourself to do it. Most vet's offices will give the fluids on a regular basis, but the cost will be quite a bit more than doing it yourself and the cat may be more stressed out by frequent trips to the veterinarian's office.
Lactated Ringer's, IV lines and needles may be purchased at lower prices through veterinary supply houses. A prescription from your veterinarian will usually be required.
Some Tips for Administering Sub-Q's at Home:
- Always check the fluid bag for holes and leaks before using. This is done by gently squeezing the bag. If there is a hole, the fluids have been contaminated. Dispose of it and start with a new bag.
- You may find it is easier as a two-person job, one to distract, pet, talk to and hold the cat firmly and one to administer the fluids.
- If possible, choose an area in your home that has a window for the cat to look through and be distracted. If you are a two-person team, have one person amuse the cat by dangling a toy in front of him. Try diverting the cat with the smell of tuna on your fingers.
- Warming the fluids will make the experience more comfortable for the cat. You can warm the fluid bag to just body temperature with warm water in the sink. ALWAYS test the temperature of fluids, just as you would test the temperature of a baby bottle, on the inside of your wrist, before administering fluids. The fluids should feel tepid to the touch.
Note: We do NOT recommend using a microwave to warm your cat's sub-Q fluids. Microwave temperatures vary and can heat unevenly. NEVER forget that overheated fluids can do great harm to a cat.
- Hang the bag from a planter hook or cupboard handle which will give height to increase the speed of the flow.
- Place the cat on a slick surface like a counter or tabletop so it will be harder for him to grab on to anything. Or you may find it helpful to confine the cat in a box, carrier, bathtub or sink and then stuff towels around him so that he'll be less likely to squirm around and jerk the needle out. You can also wrap a towel around the cat to confine him. The soft carriers with zippers at the top also can be used for confining the cat and administering the sub-Q fluids at the same time. Check with your veterinarian about using a restraint bag.
- An #18 gauge needle will make the procedure go faster, but may be more painful for the cat. A #20 gauge needle is smaller and is less painful, but fluid injection goes slower. It depends on what your cat will tolerate.
- Make note of each insertion site and alternate between sites each time you administer the fluids. Using the same insertion point over and over may cause scar tissue to build up and eventually cause difficulty when inserting the needle.
- The hardest part is getting the needle in far enough so that it doesn't easily pop out and not so far that it goes all the way through the 'tent' and out the other side. Also, you may hit muscle in which case the cat will feel it and react and the flow will stop. You have to move the needle around inside slightly sometimes to keep a good flow going.
- Never use the needle more than once. If you drop the needle or the cat jerks it out, ALWAYS start over with a new needle rather than risking contamination. The needles are extremely sharp, so be careful not to jab yourself.
- Don't get discouraged. If you or your cat becomes stressed out during the sub-Q, stop and try again later. There are times your cat may tolerate the fluids quite well and just won't at other times. Cats seem to pick up on our vibes, so stay calm and if it doesn't go well one day and you don't get the entire dose in, just do the balance later that day or the next. As time goes on, you'll begin to feel like a pro and wonder why you were so worried about this.
- After the sub-Qs are done, give your cat a treat or some favorite food. Cats may tolerate the sub-Qs better if they come to expect that something good will come immediately afterward.
- Ask your veterinarian about returning used needles and equipment for safe medical waste disposal. You may also purchase a Sharps container for storage (inquire at your pharmacy) or make your own container. Label a ziplock bag or closed container, such as a coffee can or plastic soda bottle, "used", and place the used needles in it to avoid using them again. Tape the lid when the container is full. Mark your homemade containers with a biohazard label. Store them in a safe place away from children and animals. For more information, see: How should I dispose of syringes, needles, lancets, and other ''sharps?'' .
- Although fluid bags are well sealed and the tubing is designed to prevent contamination, the safest way to store partially used bags is in the refrigerator. Warming the bag for the next session then becomes an absolute necessity.
For additional information on administering sub-Q fluids, please see our Links Page under the heading Subcutaneous Fluids and Page Three of our Caregiver Feedback section.
The Feline CRF Information Center assumes no liability for injury to you or your cat incurred by following the procedures described on this page.