? Advice on giving sub-q fluids

Bama’s renal values are starting to be a concern for kidney failure. Most notably BUN which was at 64 when I brought him to the vet 10 days ago. I am starting at home subq fluid administration and would really like some advice including what you wish you had known when you started subq and also how soon must I use up the fluid once the bag has been punctured? My vet said it was good for about a week. Bama gets 200 mls per day so I know I have 5 days worth. I was hoping to stretch it for up to 2 weeks and administer 2 or 3 times per week. Bama is really feeling crummy; struggling to eat, and perhaps feeling pain due to arthritis. I have Gabapentin for pain and Ondansatron for nausea. Getting pills down him is a major struggle. Thanks for your help. @JanetNJ

 

Hi
I do believe that sub-Q fluids do not last an entire week. I was refrigerating Yogi's, and then warming up the bag, and even then much was wasted. (He only got 100 mls.)
I really needed 4 hands to administer it. He would struggle as soon as he felt the cool fluid. I eventually learned that I was letting the stream hit much too suddenly and that going slower was best.
I also decided it was worth a 20 minute drive to the vet to allow a vet tech to do it for me for $10 (they kept lactated ringers there with his name on them).
With my next cat, Monkeydo, I learned to attach the bag to a coat hanger and hang it from my bed canopy. It worked out so much better. The fluid flowed well, and I was able to control Monkeydo on my bed by just calmly sitting beside him. (I did Yogi's fluids in the bathroom and the yellow fluid went all over the walls. A bad idea.)
Hugs,
Oh and I almost forgot. Monkeydo gets transdermal Gaba so it is one less thing to put inside his mouth. :=) I have difficulty with pilling him.

 

200 mls per day sounds like a lot, I was giving Tyler's brother who had kidney disease 100 mls per day. You can get 2 different size needles , one flows faster than another.
I would put Perry on my kitchen table on a towel and put one of Command hooks on the wall and hang the fluids from that . I would warm up the bag in a pot so it was luke warm. He never gave me a problem
Have they checked his heart and blood pressure
Tagging
@Marje and Gracie

@tiffmaxee

@Sienne and Gabby (GA)

Thank you ladies

 

If you're administering sub-q fluids daily or every other day, they will last several weeks. I'll use a bag up to a month and the same venoset for 2 bags. Changing out the needle after each use will prevent contamination. There's no need to refrigerate fluids - just keep them out of the heat and sun. Always warm them in the sink or a bowl of hot water (keep the needle out of the water). The best fluids for maintenance is Lactated Ringers. NaCl (sodium chloride) has it's place but it's not good for maintenance and can cause hypertension.

I do my cats on a towel on the kitchen counter and hang the bag from the top of the cabinet with a big S hook, actually a plant hanger from a garden center. Some cats like a little snack while getting their fluids. I keep my hand on the cat, petting around the head/ neck, ready to restrain if necessary.

Don't insert the needle in the scruff where there's muscle and can be painful, causing the cat to resist or fight the whole process. I go further down, in the saddle area, alternating sides and avoiding the spine. It's better to move around to prevent the formation of scar tissue. Good info here, with pictures:
http://www.weirdstuffwemake.com/weird/stuff/pets/cats/sophia/catjuice.html

Get good needles. Terumo needles are smaller, sharper and the thin walls make the fluids flow faster so it's more comfortable for the cat. The 1-inch length makes it less likely you'll go right through the skin and out the other side. You can get needles and infusion lines from Thriving Pets without a prescription. Fluids do require a script. I get fluids from my vet at their cost and you'll probably save some money if your vet will do that.

https://www.thrivingpets.com/terumo-needles-ultra-thin-wall-20-gauge-1-inch-box-of-103.html
https://www.thrivingpets.com/iv-admin-set-bbraun-v1402.html
https://www.thrivingpets.com/lactated-ringers-inj-usp-1-liter-bags.html

200 ml/ day seems like a lot to me and it's certainly too much to administer at one time. Too much can cause overhydration and pleural effusion which is life threatening. I'd start with 100 ml/ day. Fluids will flush out the toxins and help him feel better. Weekly B-12 injections can help improve appetite. Some cats eat better if their food is 'seasoned' with Forti-Flora.

 

I am not sure if you have seen this excellent site of CKD : www.felinecrf.org. They also have a support group.

And here's the section on fluid therapy:
https://www.felinecrf.org/fluid_therapy.htm

How to Give Subcutaneous Fluids (Video)

 

I always used
sub q bags about 3 weeks, but be sure to remove the needle after each use. What is his creatinine? At 17 lbs he should get about 170 ml.

 

Thanks for these links. Lots of good info here. I have tried Forti-Flora with mixed results. Best topper I've found are Delectable Squeeze Ups. He really goes for those.

 

Janet, his labs showed BUN/Creatinine at 30. His weight is down to 15.2 lbs. I've updated my signature to reflect that. I'm having a hard time determining whether his lack of appetite is due to nausea or pain from his arthritis or other sources. He had an abdominal ultrasound in April that showed some thickening of his small intestine, likely early renal failure of both kidneys and debris--likely tubular casts from the kidneys--in his bladder. He frequently moves as though his back hips are painful thus the script for Gabapentin. Thanks for weighing in.

 

do they think the pain is arthritis? My cat took adequan shots for arthritis and it helped tremendously.
What is the creatnine number alone, not the ratio?

 

Please do not refrigerate the fluids. Keep at room temperature. A bag should last about 2 weeks.

 

Wow, so much variance in the "advice".
I do not recall who told me to refrigerate Yogi's fluids; perhaps the vet tech who handed them to me.
His fluids were bright yellow (vitamin added).
On when to toss them, I remember reviewing the US Davis office of research (procedure IACUC-48) on line. I wrote it down. (Discard 7 days after first use if the bag is attached to an administration set.)
Sounded o.k. to me.

 

I’ve always been told not to refrigerate. As for 7 days my vet said 14 is fine and many go 21 days.

https://vcahospitals.com/know-your-pet/subcutaneous-fluid-administration-in-cats

This says store in a cool place away from direct sunlight .

 

Great to know it lasts longer for the future.
I wonder if Yogi's needed refrigeration because of the Vitamin B.

 

I guess it’s possible. Did you warm tge fluids before administering?

 

Yep. Wanted to make it as comfortable as possible.

 

The labs don’t show it or I couldn’t find it on the report.

 

He was x-rayed last March and they said it was arthritis. I worry that he may have a soft tissue tumor or something that didn’t show on X-ray. There are so many things he has stopped doing, it seems. He no longer rolls over on his back, doesn’t stretch his back legs out when he gets up, and doesn’t massage me or his bed.

 

It might be labled as Cre or Crea and would be in the list near bun

 

Creatinine is listed @ 2.1 mg/dl.

 

Ahhh. Ok so it's stage 2. In that case I'm not sure why they are telling you to give daily sub q's. Maybe a little boost of 100 ml every 2-3 days of you want to keep him hydrated. Most people don't start giving fluids until the creatnine is 2.8-3.5. There is a good ckd group on Facebook called Cats with Chronic Renal Failure.

 

My cat had severe arthritis caused by acromegaly.... Adequan shots were life changing and gave her several more quality years! Plus its easy on the kidneys. Ask your dr about it.

 

Janet - where did you give the adequan shots on the cat's body? Did the location of the injections matter? Also, do you give SQ or IM? My script says SQ but I am wondering if IM might be better. My vet knows I can do IM so I think she would have said to give IM if it was better, IDK. I haven't been able to ask her, she is hard to catch.

 

I gave the shots between the shoulders/scruff. Same as insulin. I always did sub q.

Since my cat had severe arthritis i started with a maintainance dose of every 3 weeks, and eventually did it every week. It gave her a lot more quality of life.

 

Did you notice it affecting her bgs? I have noticed an increase in her bg after the shots. Like tonight she was at 119 at AMPS+6 and then at PMPS it was 217! I hope that doesn't mean anything but it is unsettling. I am going to ask the vet about it.

Edit: I found this old thread with the same question so maybe it is not very common for this to happen. She is only on her 3rd shot. How soon should one expect to see an improvement if it is going to help?
https://www.felinediabetes.com/FDMB...-and-gabapentin-raising-blood-glucose.130872/

 

No it didn't effect her bg. I wouldn't worry at all about a 217.

 

Jumps like this are not typical for Kierra which made me wonder since the adequan was the only thing that had changed in her routine.