ADMINISTRATION OF SUBCUTANEOUS FLUIDS AT HOME
There are numerous circumstances under which a patient may require fluid administration under the skin in the home setting. Chronic kidney disease is probably the most common as these patients need extra fluids beyond what they drink to wash dangerous renal toxins through their systems. Sometimes a sick patient will not reliably drink enough water and extra fluid administration is required, or perhaps an oral injury may preclude drinking and thus extra fluids are needed. In any case, if you are reading this, fluids under the skin have probably been recommended for your pet, you have received a demonstration on fluid administration, and this guide is meant as a handy "tip sheet" for when you are on your own at home with your pet.
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NEEDLES
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Needles are color coded according to the bore size of the needle. The higher the number, the smaller the needle bore. Most fluids are administered with 20 gauge (usually pink), 18 gauge (usually olive color), or 19 gauge (usually kelly green) needles. The smaller bore needles are less painful to your pet; however, the fluids flow will be slower. The larger bore needles produce a faster fluid administration but are sometimes more objectionable to the patient. Occasionally a patient is sensitive enough to require a 22 gauge (blue) needle or even a 25 gauge (red) needle. As you refill your needle prescription, you may wish to experiment with different sizes to see what seems to work best for you and your pet.
Needles come with a twist-off plastic seal to maintain sterility. The needle hub, which is clear plastic, usually slips onto the end of the drip set. Needles should be capped when not in use and each needle should be used only once.
To dispose of used needles, it is a good idea to have a special container made of thick plastic (an old liquid laundry detergent bottle is helpful). When this container is full, it can be closed and discarded in the trash. If you prefer, you may bring your needles in to us for disposal. Never put needles in the trash if they can uncap and puncture the trash bag thus injuring anyone handling the refuse.
DRIP SETS
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The drip set is the long plastic tubing that connects the fluid bag to the needle. Drip sets come in different sizes according to drop size. For efficient fluid administration, you want a size no smaller than 20 drops per cc. The larger the drop size, the faster the fluid administration will go. (The more drops per cc delivered by the drip set, the smaller the drop size; for example, a microdrip delivers 60 drops per cc).
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There will be a small clamp of some kind on the fluid line that will enable you to open and close the line. For subcutaneous fluid administration, the line will either be closed (when not in use) or all the way open (when fluids are given). Sometimes the tubing kinks slightly when it has been pinched closed for a while. You may use your fingers to re-open the line and move the clamp to a different area on the tubing so as not to keep pinching (and thus deforming) the same area of tubing.
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The drip set will have a small chamber towards the top where you
can see how fast the fluids are running. You will want the fluids to run
as fast as possible so as to finish the task quickly. If the chamber
completely fills with fluid, you will not be able to see the drip flow. To
remedy this problem, invert the set, squeeze the chamber slightly so as to
allow some air into the chamber, turn the set right side up and open the
flow so as to expel air from the fluid line.
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If the drip set is not connected to the bag of fluids when you purchase your set up, the drip set can easily be connected. The fluid bag will have a seal of some kind when is pulled off to open the bag and the sharp point on the end of the drip set is inserted here. Be sure to hold the fluid bag so that the open end is pointed up; otherwise the fluid will drain out of the hole and make a big mess. Also, be aware drip sets come out of their bag or box in an open position so as soon as they are connected to the bag and the bag is inverted, fluid will run out the end until you close the drip set clamp.
Discard your drip set with the empty fluid bag.
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FLUID BAGS
There are many types of fluids. They come in glass bottles as well as plastic bags. At our hospital, we mostly use one liter plastic bags which have demarcations printed on the side every 100cc. Be sure you know how much fluid to administer and where on the bag the desired level at the end of administration will be. If you like, ask the technician to mark the bag in pen.
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HOW IT'S DONE
We will begin assuming that the drip set, needle, and fluid bag are already connected and the patient has been placed on the work surface (floor, table, counter, back of sofa,etc.). The fluid set should be hanging from a location higher than the level of the patient. A second person can hold the fluids or a wall mounted towel or coat hanger can work. The bag can be set on its side at a level higher than the patient but you will not be able to see the drip flow if the bag is not hanging vertically and you will probably get lots of air in the line.
Pick up a handful of skin at the patient's scruff. This area has a sparse population of nerve endings and the needle is likely to hurt the least in this area. The farther toward the tail you go with the needle, the more the patient will feel the stick. Note that a "triangle" is formed in the skin.
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Uncap the needle and boldly stick it through the skin right in the center of the triangle. You should feel a slight punch as the thick skin is penetrated. You may relax your grip a bit depending on your confidence that your pet will continue to sit still.
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Open the drip set clamp and let the desired amount of fluid run in. A small bulge will appear under the patient's skin as fluid accumulates there.
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- If the needle has gone through the skin and out the other side, a
stream of fluid will be seen coming from the patient's skin. If this
occurs simply pull the needle slightly back toward you but not all the
way out so that the needle will again be positioned under the skin. If
this is too hard, simply close the drip set clamp and start
over.
- If the drip rate in the chamber seems slow, change the angle of the needle insertion slightly with your fingers until you get a better drip rate.
When the proper amount of fluid has been delivered,
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- After fluid administration, the bulge of fluids will tend to droop down around the front legs or chest. This is normal but if this bulge has not resolved by the time you are supposed to give fluids next, do not give the next fluid dose. This would mean that your pet's circulation is not good enough to absorb the fluids or that your pet simply does not need the extra fluids. In either case, report this to your veterinarian and your instructions will probably be revised.
If after the demonstration and instructions you still are not able to accomplish this procedure at home, we will allow you to bring your fluid set up and pet to Valley Animal Hospital for the administration of fluids by our staff for a small fee.
NEW EQUIPMENT FOR HOME USE:
THE ENDO-SOF SUBCUTANEOUS CATHETER
SET
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Many people shy away from giving subcutaneous fluids at home because they are not comfortable with needle use. To make the procedure more convenient, a subcutaneous catheter can be placed under the pet's skin, leaving a port outside the skin. The port connects directly to the drip set, and no needle is necessary.
Features:
- The catheter lasts for up to one year.
- Needles are not needed for fluid administration
- A short-acting anesthetic is needed to place the catheter, and
antibiotics are given for a few days after.
If this is something you might be interested in, ask any Valley Animal Hospital veterinarian for details.
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