Giving a Cat Fluids: An Illustrated Guide
83Your kitty needs help!
OK, your precious feline is getting up there in years and has developed kidney problems. Or maybe he or she is just recovering from an illness or surgery. Your vet tells you the pet will need subcutaneous fluids for a time -- perhaps, permanently. So you're faced with the choice of either learning how to give your pet the fluids or paying an animal hospital lots of money to do it. After having given fluids to our cat Babe every other day for the past five years or so, I recommend doing it yourself. Once you've got it down, it's quick and relatively easy. Your kitty will be spared the trauma of being constantly hauled off to the vet -- and you'll save money. And if you do it long term, your pet will come to appreciate your act of love.
Getting started
What are subcutaneous (or "sub-Q") fluids? Subcutaneous ("beneath the skin") fluids are sodium, potassium, calcium and other electrolytes that areinjected below a cat or dog's coat to rehydrate them -- just like Gatorade rehydrates an athlete. The fluids come in the same clear plastic bags as IV fluids given to humans, and with the same drip lines, but you only have to put these fluids under your kitty's coat, not in a vein (thank God!).
OK, you've decided to do it yourself and it's your first time. You need four things to start:
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- A 1000 ML bag of subcutaneous fluids (usually carrying the label "Lactated Ringers" or something similar and numbered from 1 to 9);
- An "administration set" - the drip line that carries the fluid out of the bag;
- A supply of small needles that you push onto the end of the drip line. The size - 18 x 1A - is written on the needle cap; and
- A coat hanger with the hook twisted so it can be hung on a door
At home vet care for cats
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Setting up the bag and line
Remove the bag of fluid from its wrapper. Warm up the bag of fluid by putting it in a large bowl - a salad bowl works well - of warm water (you should be able to keep your fingers in the water; otherwise, it's too hot). It takes 5 minutes at most to warm up. Remove the bag and pat it dry.
Remove the drip line from its plastic wrapping. You'll see a little flow-control box on the line that controls how fast the fluid comes out of the bag. Make sure the little wheel that adjusts the flow is pulled tightly to the narrow end of the box. This closes the line. You'll know you haven't closed it if it starts dripping out of the line -- it will, even if the line is capped -- once you hook it up to the bag!
How to do it:
- Take the bag of fluid in one hand. At the bottom of the bag is a tube-like protrusion that sticks out. On the bottom of this tube is a little rubber seal with a flap on it. REMOVE THIS SEAL WITH THE FLAP ON IT. It's just a cover that protects the sterile seal inside it. Now take the cap off the sharp plastic point on the end of the drip line, making sure IT DOESN'T TOUCH ANYTHING (to avoid contamination) and slowly but firmly push the point through the seal until most of it penetrates into the tube. You'll be able to see the point entering the bag. Make sure it's in all the way and that it doesn't puncture the bag. I've found that twisting it as you push helps. Once the point is in, bring the bag upright. Just below where you stuck the line in is a little see-through chamber where the fluid drips out. Gently squeeze this chamber until it's about a third full of liquid.
Next, take the other end of the drip line, remove the plastic cap from there also and press one of your little needles onto the end of the line, making sure again that the exposed line doesn't touch anything. Lastly, massage the bag to make sure any cold or hot spots dissipate, then test the temperature of the fluid by running some of it over your wrist, as you would with a baby bottle. It should be warm, but not hot. OK, your bag is ready to use.
Hanging the bag correctly
- You need a way to hang it though, and a wire coat hanger works great for this. Bend the hook of the hanger so it's perpendicular to the rest of the hanger, then slip the hanger's hook through the open slit at the top of the fluid bag and swing the bag around so the side with the numbers on it faces out (you'll need to see these numbers so you know when to stop the fluids).
Next you need somewhere elevated to hang the bag, so the fluid can drip down and into the cat. Some recommend buying an IV stand from a medical supply company. That's not really necessary. If your chair or couch is next to a closet, you can swing the closet door open and hang the bag there, numbers facing you. Or you can hang it from a nearby door-frame or a wall shelf and position the bag to face you. As long as the drip line reaches to the cat without being pulled tight, it will work; that's all I've ever used. You want to position it so the bag and your kitty can become one, and you can clearly see the bag and it's numbers as you administer the fluid.
Cat meets fluid bag
- Placing the cat on the couch or a large chair just below an armrest helps keeps them in place. The key is to place the kitty so he or she is parallel to the length of the couch or chair and facing the armrest -- creating a barrier to escape. Then squeeze yourself alongside the cat or just behind it. This gives the cat nowhere to go once the fluid starts. I learned this the hard way when I began giving Babe fluids and she'd get up and walk away, giving my couch and me a saline solution shower.
- TIP: How your cat responds to being given fluids depends a lot on its disposition and how sensitive it is. If it's his or her first time, you may need to wrap your kitty up in a towel or place it inside a cat carrier that opens from the top before you can administer the fluids.
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Making the stick
- OK, you've got your kitty in position, your bag armed and ready. Take the cap off the needle and twist the needle around so that the underside - the side with the hole exposed -- is facing up. This seems odd, but it lets the needle more easily penetrate the cat's coat. Keep the syringe cap nearby; you'll need it later. Pet your cat and talk reassuringly to him or her for a moment, then casually lift up the scruff of their coat between the shoulder blades with one hand - I used my thumb and index and middle fingers for this - and push the needle all the way in with the other. Try to stick it right in the middle of the loose scruff; too high, and it will poke out the other side; too low, and it might stick into the cat's underlying flesh. Your kitty won't like this.
- I've found that sticking the needle in is much easier if you pull up the cat's scruff with your left hand and push the needle in with your right. So you'll want to position the kitty so it's ON YOUR RIGHT when you're sitting next to her. Otherwise, doing the stick will be awkward and more difficult. Unless you're left-handed, which in that case you're fine.
- The first few sticks are the toughest. When I did them, I winced, certain I was hurting my cat. But it doesn't really hurt them; the scruff is loose and there's nothing inside. TIP: (courtesy of our readers) The syringes you typically get from the vet aren't the best quality; some call them "kitty harpoons." Make the procedure easier on your cat by requesting a higher-gauge syringe; the smaller needle size will be less intrusive and do less damage to the cat's coat long-term. Or order Terumo brand needles, which are more streamlined.
- SO ... you've got the needle in and, hopefully, your kitty hasn't scratched your face off. Now, start the fluid flowing by sliding the little wheel SLOWLY on the flow-control box forward toward the wide end. It's important to do it slowly because otherwise the water will shoot out in a jet, and that may startle your kitty. You've probably seen on TV or in the movies the slow drip-drip-drip of an IV: you can adjust the wheel to make it do that slow drip at first, then speed it up to a faster drip later on. I've gotten to the point where I can give Babe fluids in about 5 minutes.
- While the juice is flowing, keep your hand lightly on the needle to hold it in place. This will also lets you know if gets loose and starts leaking. A cat can somehow eject the needle by making a very slight move or squeeze of her coat. You'll know this happens when you suddenly see a stream of fluid running down the side of your kitty (in that case, just reinsert the needle and keep going). I try to keep my cat as boxed in as possible, with my hand lightly over the needle, to keep this from happening.
TIP: Make sure the fluid is completely shut off before you hang the administration set in the closet. And it's best to leave the needle end of the line facing upward, just in case it's not completely closed. Just thread it through the slit at the top of the bag and wrap it loosely around the top of the coat hanger facing up before you put it away.
Keep your eyes on the bag!
How much "juice" do you give your kitty? You should already have been told that by your veterinarian. I give our Babe 150 ML (milliliters) every other day. That's 1.5 numbers on the bag, which is on a scale of 10. 100 ML would be 1 number on the bag. Make sure the bag is oriented toward where you are sitting with the cat and there is enough light in the room so you can CLEARLY SEE the numbers.
Keep your eye on the bag as the fluid flows, and when you've reached the recommended amount, stop the fluid by pulling back the little wheel tightly. Then slip the needle out of your kitty and immediately press a few fingers over where the needle was. (Keep them there for about a minute -- this keeps "the juice" inside kitty.)
Put the cap back on the needle, then immediately replace the needle with a new one to prevent any contamination occuring as the needle sits for a day or two until your next session. You're done.
The Juice Creature
Don't be alarmed when you see a large bulge on your kitty's neck afterward - the fluid takes a little while to disperse. Sometimes it ends up down around one of their their legs, making your kitty look like one of those funky-looking camels. This makes for a great photo.
How to administer fluids, starring Babe
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Why you should keep your cat indoors? How to cat-proof your home Which plants, foods and household products are toxic to your kitty? Find all the answers here. - Low-Cost Veterinary Care
How to obtain good veterinary care without the bite -- it's easier than you think. - ASPCA Website
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Comments
Thanks Barbra! You absolutely can do it yourself. When I started giving fluids to Babe, it was intimidating. And she wasn't the kind of cat that would let you do it willingly, either. But she gradually became used to it, and now it's obvious she knows its good for her, because after I've got the needle in she settles down contentedly and purrs! If you have any specific questions, I'll be glad to try to answer them.
daniel
2 comments......
1, There's a far more comprehensive reference site here http://felinecrf.org/
2. Most people here http://pets.groups.yahoo.com/group/feline-crf-info (online practical support group of CRF caregivers) use and recommend #20 needles
3. Yes, fluids must be warmed...MORE IMPORTANT is HOW WARM? "5 minutes" may/may not do it....You MUST be sure of the temperature of the fluid, which should be 98-105F max....you don't want to SCALD your cat!
Nice to see this...every bit helps!
Outstanding hub...well written and informative without being too clinical. I think you hit just the right note with this one.
Very well done.
Thanks, Elizabeth! I've had pretty good feedback from cat people. I hope dehydrated cats out there somewhere will benefit too.
Very nice instruction site. The kitty in the images looks like my Siamese cat, Bandit. Fortunately he doesn't have CRF--yet. Pooky does and he hates the needles more than I do.
To "Dog gone": Your negative comments aren't welcome so why don't you go play in another sandbox. Many of us take this seriously. Your immaturity and ignorance is showing.
Nice little site, Daniel. BUT..... that white plastic cap on the "outlet tube" of the bag is supposed to come off the bag before you insert the spike. The spike is sterile (under its cap), but that plastic flap and the thick white plastic it's attached to (what you are calling the 'rubber seal') are NOT sterile. They are there to protect the inside, the *real* seal--which IS sterile; that seal is up at the end of outlet tube where it attaches to the bag; it is inaccessible except to the spike. If you leave that white plastic thing on the bag and stick the spike through it--instead of removing it first--you might as well just spit on the spike or drop it on the floor before you insert it. The little flap you have handled with your finger in that picture--and have contaminated by doing so--is actually put there in order for you to grab it and tear off the outer (white) seal. I'm surprised Babe has not gotten an infection from contaminated fluids!
A note on proper terminology: you talk about the "syringe" you're using here. There is no syringe being used. A syringe is a device composed of a hard plastic "tube" with a plunger. It may or may not have a needle on the end; one used for subq, IM, or IV injection WILL have a needle, but one used for feeding or giving oral meds to a cat will NOT have a needle. For this purpose--giving subq fluids to your cat--you are using a bag, a venoset (that's the tubing), and a needle. No syringe; it's just a needle, that's all.
And last--a note to/about "dog gone": what I want to say has four letters in it, beginning with an F, followed by the word "you." But I won't say that. Instead, I'll just figure your dog is gone because it ran away from the likes of you. Smart dog.
I agree. You have to pull that "plug" out first. I also think the coat hanger bit doesn't work too well. For one thing, it can easily fall off the door or wherever you hang it and it is too high to see the line on the bag where you should stop. I use the dresser because it has a knob on it that the bag fits nicely to. A hanger on the doorknob would suffice just as well especially since it is lower.
Heating the bag is a number one problem in my experience. The bag could be warm, but the fluids are always cold. Also, heating the bag causes unnecessary bubbles in the line. May not be harmful to kitty, but an irritation. I think heating is overrated.
Is that a Monoject needle (aka "Kitty harpoon")? If so, I would advise a switch to Terumo.
I use a coat hanger as well, but I hang it over the shower rod. I agree that it could fall over the door. I found that I needed the height to get the fluids to flow well.
Chris, Bill and Lori,
Ooh, I stand corrected. I've never been told that before about the flap. I'm going to add this information to the Hub immediately. And start removing it when I give fluids. THANK YOU!!!!! As far as the coat hanger goes, it's never fallen on me. Whatever works to keep the bag elevated. The shower sounds like a good idea, but I like to leave Babe in her comfort zone spot. And Lori, yes, it is a Monoeject needle (not syringe!) Are Terumo's better?
Thanks for such valuable feedback.
Daniel
p.s. and "Dog Gone" is .. gone.
Bill, I disagree strongly about warming the fluids. That's something we stress on the Feline-CRF-Support group. A cat who is sick, old, or thin needs to have warm fluids. Cold fluids rob needed calories from the cat--it takes "x" number of calories for the body to warm that fluid up to normal body temp (102º F). Kitty could (and should) be using those calories for something important. Also, cold fluids are uncomfortable, and chill the cat. To warm a bag of fluid, fill a container (sink, pitcher, pot, whatever) with hot tap water. Insert the bag so that none of the connections at its bottom are in the water. Let it sit. Periodically pick up the bag and "squish" it around in your hands to mix the fluid around inside, to speed up the warming. A full bag will take longer to warm up than will a mostly-empty bag. refill the container w/hot water again if necessary.
Tiny air bubbles are not a big deal at all. If they're in the bag, they will never make it into the tube; they'll migrate to the air-filled space at the top of the bag anyway. If they're in the tube, just run your fingers along the tube to purge it. Also, flicking sharply at the tube w/your fingers will dislodge the bubbles. Tiny bubbles like this are not uncomfortable for the cat; only large pockets of air cause discomfort--and that is only temporary at that, and very mild.
Lori is right about the Monoject needles. We call them "kitty harpoons' for a reason! Terumos are sharper, thinner, have better flow, and are a much higher-quality product than those awful Monojects. I've seen Monojects with no hole in them; I've seen them with "spurs" on the tip. And that's just the stuff you can *see*; makes you wonder what's going on "under the hood." Terumos cost the same as Monojects, so I see no reason not to use a better product on my kitties.
Oh--I forgot. Hangers: I just use those plastic ones w/the rotating metal hooks--like you see in clothing stores. They will hook over just about anything without slipping off.
I've been through three vets since I began giving Babe fluids and no one ever mentioned that a different kind of needle was available. Anything that will make things less stressful for the cat is good -- thanks again.
Daniel,Thank you for a wonderful resource. It's very well done and understandable. There are a couple of things I would add, though.One is the importance of bleeding any air out of the line before each fluid administration, esp. when using it on a new bag for the first time.Second is gently rocking the fluid bag back and forth a few times after warming to make sure the warmth is evenly distributed, then testing the fluid temp by allowing a bit of fluid to run across your wrist, just as you would test the temp of formula from a baby bottle. It's always safest to err of the side of a bit too cool rather than any too warm.Thank you for putting this page together. It'll help many folks who visit here.Laurie
Hi Laurief,
Someone else suggested bleeding the line, but my experience has been that I rarely see bubbles in the line, and if I do, they're small and aren't going to hurt the kitty. I have bled the line once or twice when I saw a stream of bubbles. As far as doublechecking the bag temp., several people have recommended that. I've always gauged the temp by handling the bag, but I think I'll take your suggestion so I know exactly how warm the fluid is before administering it.
Thanks!
Daniel
Hi Whbos,
Sorry - responding belatedly. Thanks for your nice message. I hope Pooky will be OK
Thanks!
Daniel
Daniel, bleeding the line is critical when starting a new bag of fluids. When you close the flow control to attach the venoset to the bag, all of the line below the flow control remains filled with air. It's important, after attaching the venoset to the bag and a needle to the venoset, to open the flow control long enough for the air to bleed out (until a steady stream of fluid comes out of the needle). THEN it's ready to begin fluid administration. Laurie
It's lookin' good, Daniel!
About Terumo needles: I have never heard of a vet who recommends them or uses them. Some have never heard of them. Go figure. Monoject must have some kind of choke-hold on the vet market--I don't know. But you can get them from medical suppliers, the same places you can order cases of fluids--Brico, Thriving Pets, etc. They're hard to get from local places like Costco or Walgreens, though. They're really worth chasing down. One member of the Feline-CRF-Support group said: "Compared to a Terumo, sticking my cat with a Monoject is like poking a knitting needle through leather."
Thanks, Chris. If I can get my wife to take yet another photo, I'll replace the one I removed with an updated correct one. I'd never heard the phrase "kitty harpoon" before or was told of Terumos; I'm looking for some now. This is the real value of Hubs, I guess -- that it's a two-way information exchange, and everyone benefits.
Excellent first hub..Congrats 2u.
Ps, i saw your profile about your liking for Lily Alan. I can see your attractiuon 2 her..i have a hub about her you will enjoy;)
I look forward to more of your hubs!
;)
hey thnx. yup, I love Lily Allen. i'm going to read that Hub!
Daniel
im just watching Lily now on tv uk, bbc3 10.30:)
just tried to access that, got "available in the UK only" msg. i'm jealous!
"The first few sticks are the hardest" never a truer word spoken. Your hub contains very supportive information. I appreciate your effrot.
Your fan.
Mon.
thanks Monitor. that's nice to hear.
Daniel
Doh!!;)
hi daniel and others!
i have been doing subQ on my kitty for almost three yrs now.
nice of you to take the time to do a step by step demo.
i have a couple things to add or expand on.
*first, after watching your video and looking at your photos,
you might want to try inserting the needle by making a tent
with the fur. can be done by placing the index finger and middle
finger at the bone area above the shoulder blades, below the neck
and using thumb pull up on skin to form a pouch like tent.
*another tip re insertion as it looked like you might have done a double poke,
its best if you don't succeed the first poke, change the needle because when its drawn out of the skin it gets bacteria on it and reinserting it can cause infection.
*re terumo needles and needles in general. DEFINITELY get the terumo ones.
they come in "ultra thin walled" which is the smoothest for insertion. also when the vet first have me needles they were #18!!! this is wayyyyyyyy too big for cats.
horrible that they even think this is ok. i am currently using #20 (the higher the number the smaller the barrel). this works the best i think for flow and size of poke, which is important because after a period of time there can be scare tissue developing which will make some insertion sites tougher to poke. i have recently started giving the subQ everyday and if i keep with that i will go even lower possibly to a 21/22/ or even 23. the flow will be slower with those, so if you choose to try them, know that you must have a very patient kity!
*re bleeding the lines. i am very freaky about the air bubble thing and check it before each treatment. its a quick glance and worth it. the place i commonly find the bubbles is in the elbow part of the line and near the needle base. with the cap on i just flick the elbow and the base with my finger and the bubbles usually loosen and move toward the tip so when you run a bit out before hand (i do whether theres bubbles or not) they will clear out.
*re heating the water. i let the bag sit (below the line insertion site. its important to not get anything near there and to keep it sterile) in hot water, not scolding but hot enough that its more than warm) let it sit for about 45 min. then i test it. i do think it helps but i don't think it ever gets that warm.
that's all i can think of right now,
hope those bits are useful
kim and meeper do!
Kim and Meeper Do,
This is valuable info. Thanks for taking the time to post it (i've been away and just got this). I generally do "make a tent" when I insert the needle. I don't always replace the needle if the first stick is unsuccessful. Thanks for pointing that out -- I'm going to start doing that. I'm planning to order Terumo needles when I run out of these Monojects, but just getting a higher gage is a good idea -- never thought of that.
hope meeper (your kitty?) is doing well!
hey daniel,
glad to be of some help.
meep ROCKS! he is fantastic.
he is currently circling like a shark
as he has veto'd the first three can offers
today lol! just had his treatment and purrs
thru the whole event. ... thankx for asking.
hope your kitty is doing well.
kim
working
Barbra Snyder says:
4 months ago
Great article, very helpful and easy to follow. I have a cat with the same problem & I'm going broke from the vet bills.After reading these step by step instructions I believe I can handle this myself.
Thanks Again,
Barbra Snyder