Sub-Qs are not always appropriate
and in fact in certain circumstances can do more harm than good. Do NOT
give Subcutaneous fluids to your cat if:
Your cat is so severely dehydrated that your vet
intravenous fluid therapy (IV) more appropriate. In certain circumstances
is the only correct treatment. If your cat
has high bloodwork levels (creatinine over 7 mg/dl or
627 µmol/L), s/he might benefit more
from IV fluids initially, with sub-Qs provided once s/he returns home
Your cat has a
heart condition. Fluid therapy may
still be possible but your vet must decide if it is appropriate for
your cat, and determine the amounts and frequencies to be
Your vet has refused to agree to the procedure on
other medical grounds.
from the previous session have not yet been absorbed.
your cat is overhydrated. This may be obvious, or your cat may feel
"squishy", the way water in a plastic bag feels. Squishiness sometimes happens if a little air gets in with the fluids,
and is not normally a problem, but if it happens consistently, your cat may need less fluid. Other symptoms
of overhydration may include
sudden weight gain, coughing and nasal discharge. See
for more information. Overhydration
may be associated with a heart condition, but contrary to what some
vets claim it can still happen in a cat with a perfectly normal heart.
It is a good idea to
weigh your cat regularly, to check for sudden or continuous weight
gain which may give early warning of a problem.
Processing the extra fluids in itself places an additional workload on the kidneys which can make the
progress faster; plus it can flush out
certain nutrients, and giving fluids when they are not needed may
increase blood pressure; so it is best not to
begin fluids until the advantages are likely to outweigh the
disadvantages. Dr Katherine James of the
Veterinary Information Network believes
that most CKD cats will benefit from subcutaneous therapy once creatinine
levels are consistently over 3.5-4.0 mg/dl (USA) or 300 -350 µmol/l (international). If
your vet thinks your cat's CKD is less advanced than this, then it is
probably safer to hold off on sub-Qs for the moment.
My vet agreed to us doing fluids in part because she
felt Thomas would not find them too distressing. You and your vet do
need to take your cat's personality into account in deciding whether to
go this route; but do not necessarily assume your cat cannot cope, many
cats who ordinarily hate medication of any kind tolerate sub-Qs because
they make them feel so much better. I would suggest trying them for a
few weeks at least.
appear happier (more active and alert, with a better appetite) after
sub-Qs. However, some may become lethargic for an hour or so
afterwards. This is probably nothing to worry about, but if it happens
frequently it may be that your cat is not processing the fluid very
well, so I would ask your vet to check your cat for possible heart
These are the
items you need:
use a type of fluid called lactated ringers solution (LRS) but sometimes
other types of fluid are appropriate. See below for more on this.
You have to
insert the needle into your cat to allow the fluids to flow into him or
her. Ideally you want Terumo ultra thin wall needles.
administration set (giving set or venoset)
you to attach the bag of fluid to the needle. The fluid flows from the
bag through the administration set and into the needle and then into
optional but many people find them helpful:
find these helpful to speed up the process.
These can be
helpful to measure how much fluid you are giving (100g = 100ml, about
are used by some people to measure accurately how much fluid they are
use these to distract their cats during fluids, others use them as a
The Giving Set Method
This method, whereby the fluids
drip out of a bag rather like into human patients on an IV drip, is the most
comon way of giving sub-Qs in the USA and Canada. It has the advantage of
being easier for one person to do alone, though may take longer than the
Syringe Method. It
can also be harder to tell how much fluid you are giving, though
Tips on Giving Subcutaneous
Fluids has some tips on how to do this.
Purr Box, who was diagnosed two months before Thomas, and who was also
a gorgeous black cat, models receiving fluids via a giving set below. These
photos were taken four years after her diagnosis: Purr Box's inspiring story can be found in
As you can see, Purr Box is not at all distressed. Some CKD cats like the
fluids so much that they come and remind their humans if they are a little
late giving them!
to right: the equipment you require is a Terumo needle, a venoset and Lactated
first thing you will need to do is to insert the venoset into the bag of
fluid. Before you begin to do this, close the wheel valve on the venoset as
this prevents air from escaping from the bag. If air escapes, the bag will
have a collapsed appearance and the fluid level will be difficult to read.
the cap from the venoset spike.
the cap from the bag of Lactated Ringers. Some brands will have a white tab
that pulls off instead of the pictured clear plastic cap.
the venoset spike into the receptacle in the bag. This can require a
considerable amount of force coupled with back and forth twisting.
the bag in a hanging position and then squeeze and release the drip chamber
until the drip chamber is about half full. If it becomes too full, turn
the bag upside down and squeeze the bulb in order to push some of the fluids
back into the bag.
the cap from the needle end of the venoset. Note that some brands have a Luer
lock – a threaded collar that holds the needle onto the end of the line. If
you are using a brand with a Luer lock, unscrew the protective cap, push the
needle onto the Venoset and then thread the Luer lock onto the needle. If you
do not like using a Luer lock it can be taped out of the way.
the needle securely onto the venoset. If you use a Luer lock, thread it onto
you can see the needle affixed with the Luer lock.
is no need to apply alcohol to the cat's skin first.
Critical Care DVM
says "It is not necessary to “sterilize” the skin with alcohol prior to
inserting the needle. In reality, wiping a little alcohol on the skin does not
sterilize it, and the odor and feel of alcohol may aggravate your pet."
some of your cat's skin to form a tent or pouch. Hold the needle so the bottom
end is the longer end - the needle looked at sideways will look like
this: ___\ or this: l___. Holding the needle
parallel to your cat's back, insert the needle smoothly into the tent you
It can be helpful not only to move the needle towards the
tent, but also to raise the skin slightly to meet the needle. Ensure you
have not pushed the needle through the other end of the tent - the
fluid will leak if so.
Once you are sure the needle has been inserted
correctly, open the crimp wheel to start the flow.
Your cat may flinch slightly when the fluids first start going in.
be because the fluids are too warm or too cold for the cat's liking, or the
sensation can be a little bit of a shock at first. Treats are often well
received when the fluids are running. In Purr Box's case, baby food makes for
a happy cat.
you have finished, remove the needle and pinch or massage the injection area for a
minute or so - this will minimise the possibility of fluids leaking.
Occasionally you will see a little blood when you withdraw the needle -
this just means that you have nicked a small blood vessel and is usually nothing
to worry about.
the sub-Q fluid back in your storage area until the next session. Put the lids
back on the needles and do not use them again because, apart from the
sterility issue, they will no longer be sharp and could hurt your cat. You
must be careful about disposing of needles, which are clinical waste, so
the safest thing is to keep them somewhere safe away from children and
your pets and ask your vet to dispose of them permanently for you, or to
purchase a sharps box.
Photos of Purr Box Copyright Radford Hunt 2003, and
used with grateful thanks.
TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE
tried very hard to ensure that the information provided in this website is
accurate, but I am NOT a vet, just an ordinary person who has lived
through CKD with three cats. This website is for educational purposes
only, and is not intended to be used to diagnose or treat any cat. Before
trying any of the treatments described herein, you MUST consult a
qualified veterinarian and obtain professional advice on the correct
regimen for your cat and his or her particular requirements; and you
should only use any treatments described here with the full knowledge and
approval of your vet. No responsibility can be accepted.
If your cat
appears to be in pain or distress, do not waste time on the internet,
contact your vet immediately.
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