Giving Your Cat IV Subcutaneous Fluids at Home (With Photos)
Your 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.
What Are Subcutaneous Fluids?
What are subcutaneous (or "sub-Q") fluids? Subcutaneous means "beneath the skin," and subcutaneous fluids are sodium, potassium, calcium, and other electrolytes that are injected 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 fluid 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:
- A 1000 ml bag of subcutaneous fluids (usually carrying the label "Lactated Ringer's" or something similar and numbered from 1 to 9)
- An "administration set"—the flexible line that carries the fluid out of the bag
- A supply of small needles that you push onto the end of the fluid line. The size—18 x 1A, for example—is written on the needle cap
- A coat hanger with a hook that can be rotated, so you can hang it on top of a door, shower curtain rod, or other high place.
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 fluid 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. Slide that little box down the line until it's about 12 inches away from the needle end of the line so it's in reach when you want to adjust the flow. Make sure the little wheel that controls the flow is pulled tightly to the narrow end of the box so the line is closed. 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 fluid line, making sure it doesn't touch anything (to avoid contamination) and slowly but firmly push the point through the seal until it penetrates into the tube and can't go any farther in. 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. Hold the end of the fluid line over the sink and push the little flow control wheel back to open the line up and drain it of any air bubbles inside (you'll be able to see them in the line). This should take just a few seconds. Stop the flow. Remember to keep the exposed end of the line from touching anything.
Next, press one of your little needles onto the end of the exposed fluid line. 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. One kitty owner says she puts a towel in the bathroom sink, puts her cat there and gives it fluids from a bag hanging on the shower curtain rod. As long as the fluid line is at least two feet higher than the cat and reaches it without being pulled tight, it will work. You want to position it so the bag and your kitty can become one, and you can clearly see the bag and its 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 him or her 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, so that the armrest creates a barrier to escape (using the sink will also accomplish this). Then squeeze yourself alongside or just behind the cat. This gives him or her nowhere to go once the fluid starts. I learned this the hard way when I began giving Babe fluids and she'd jump up and walk away, giving my couch and me a saline solution shower.
Making the Stick
- OK, you've got your kitty in position and your bag armed and ready. Take the cap off the needle and twist it around so that the underside (the side with the hole exposed) is facing upward. 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 his or her coat between the shoulder blades with one hand—I used my thumb, 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 she or he is on your right when you're sitting. Otherwise, doing the stick will be awkward and more difficult. Unless you're left-handed, in which case, you're fine. If your kitty submits to the fluids without trying to escape, then positioning doesn't matter so much. I suggest wearing a glove—I use a leather garden glove—on the left hand until he or she gets used to being stuck. I always wear the glove just in case, so I don't have to worry about being bit.
- 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. They still don't like it, and may yell. If the needle doesn't go in, you just have to force it in. This is one of the most difficult things about giving a cat fluids. I've done this many times, and the most our cats have ever done is flinch. The experience was actually harder on me than it was on the cat. Then I got used to doing it, and it became routine. Now that I'm on my second cat with CRF, I've discovered something about doing the stick: Position the needle touching your kitty's coat and gently work the tip of the needle up and down (or back and forth) while pushing it in. If you do it right, the needle will slide right in with very little resistance and your kitty will barely notice the puncture.
How your cat responds to being given fluids depends a lot on his or her disposition and sensitivity levels. If it's his or her first time, you may need to wrap your kitty up in a towel or place him or her inside a cat carrier that opens from the top before you can administer the fluids.
- Now you've got the needle in, and, hopefully, your kitty hasn't scratched your face off. Next, start the fluid flowing by slowly sliding the little wheel 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 the slow drip-drip-drip of an IV on TV or in the movies. 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 five minutes. Keeping the kitty calm and still can be a challenge even when she's used to getting fluids. Stroking the kitty and massaging her ears while making soothing sounds helps.
- While the juice is flowing, keep your hand lightly on the needle to hold it in place. This will also let you know if it 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 either over the needle or on the line close to the needle, to keep this from happening.
- Note in the "positioning the line" photo below I am holding the line in position lightly with my fingers. If the fluid from the bag suddenly slows to a trickle or even stops, it likely is because the juice bulge surrounding the needle has pushed the needle to one side. Look up at the little drip chamber while you gently move the needle back into alignment. You should see the fluid start flowing again. If the line still isn't flowing, do the opposite and try moving the line gently from one side to the other, so the needle angles this way and that. Also make sure that neither you nor your kitty are resting on the line and that the line isn't crimped or twisted.
If you simply cannot get the fluid to flow, or if it only does a very slow drip, you may have a defective needle—one with a hole that is partly or mostly closed. Try replacing the needle and see if that makes a difference.
Positioning the line
Which Size of Needle to Use
The needles 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 higher the number, the smaller the hole). The smaller needle size will be less intrusive and do less damage to the cat's coat long-term. The downside? It will take longer to give your cat the fluids because the flow of liquid is slower. I use 20-gauge needles, and it takes me about four minutes to administer 75 ml of fluid, Stormy's daily dose. I've found this to be a good compromise between the 18-gauge "harpoons" and the slow-flow 21 gauges. Several commenters here have recommended Terumo needles, which are sharper and slide into your kitty's coat more easily.
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 (see update below). That's 1.5 numbers on the bag, which is on a scale of 10 ml. 100 ml would be one 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. Once your kitty is taken care of, remove the old needle from the end of the line, moisten a cotton ball or pad with some rubbing alcohol and swab the hole at the end of the line with it. Then immediately stick a new needle on the line. This will help prevent any bacterial contamination from a used needle while the fluid bag sits unused. I should note here that my cat sitter, a former longtime vet tech at a major animal hospital here in D.C., tells me there's no need to clean or sanitize the line afterward as long as you put a new needle on. I like to err on the side of safety, though.
Make sure the fluid is completely shut off before you put the administration set away (I leave it hanging in a closet) by pushing the fluid line into the notch of that little dangling piece of plastic on the line (yes, that's what it's for!). Just remember to free the line before you begin your next fluid session. I also always position the needle so that's it's facing up—just in case.
The Juice Creature
Don't be alarmed when you see a large bulge on your kitty's neck, back, or sides afterward—the fluid takes anywhere from six to eight hours to be completely absorbed. Don't worry, it will go away—and so will your darling little Quasimodo. Sometimes the fluid ends up down around one of the kitty's legs, making your kitty briefly look like a Bactrian camel. This makes for a great photo.
Costco's pharmacy sells a 12-bag box of subcutaneous fluids for $26.09—a little over $2 a bag. Vets typically charge $10 or more for a bag.
Update: Doctor Says Smaller Doses More Often Work Better
During our Stormy's recent heart exam, the kitty cardiologist asked me how often I give her fluids. "150 ml every other day," I told him—that was the amount the vet had prescribed. "Why not give her 75 ml every day?" the heart doc asked. Giving her 150 ml all at once is like when you gulp a large energy drink down after exercising, he noted: "You just pee a lot of it away" afterward. The cardiologist is a sharp guy. I thought about this, and it made sense to me. So I began giving Stormy 75 ml every day. She seems to have responded well to this new regimen; the last trip to the vet showed a slight improvement in her kidney values.
I would recommend this approach to anyone who isn't already giving their cat fluids on a daily basis, in consultation with your vet, of course. It means more sticks (I downsized the needle from an 18-gage to a 20-gage to minimize the puncture) and a cooperative cat, so it seems especially suited for a cat who's been getting fluids for a long time and submits to the procedure without resisting.
Any thoughts on this from fellow kitty owners?
Postscript: Please Do Your Cat's Blood Work
If you don't have a blood analysis done as part of your kitty's annual evaluation, please, please, please do so. Cats can develop chronic renal failure (CRF) without warning and at a younger age than you might expect. And they are experts at hiding the discomfort they feel from kidney problems until their condition becomes serious. I know this, unfortunately, from personal experience. While my wife and I were dealing with Babe during her last weeks and then her passing, we let her sister Stormy's annual evaluation slide. Stormy was always the intrepid hunter, full of energy, mischievous and constantly jumping on the table looking for a treat or to swipe a bit of food. We never even imagined her coming down with CRF. It wasn't until more than a year later, when Stormy began looking tired and down, that we took her in for blood work. I was shocked when the vet told us she'd lost 75 percent of her kidney function. A blood analysis of her creatinine and bunin would have flagged this much earlier. The vet pointed out that a middle-aged cat going two years without a blood analysis is like a person going eight to 10 years without one.
On the bright side, a regimen of fluids, a KD diet, and close monitoring has stabilized Stormy, and she lives a relatively normal, if more sedate, life now. But the thought that our precious kitty needlessly lost kidney function still haunts us. So get that blood work done at least once a year!
Support Group for Owners of Cats with CRF
The Yahoo support group http://pets.groups.yahoo.com/group/Feline-CRF-Support/ is an invaluable source on where to get the best-priced supplies and new medicines and which therapies work best. It also provides moral support for cat owners coping with a CRF diagnosis.