Mar Vista Animal Medical Center

3850 Grand View Blvd.
Los Angeles, CA 90066

(310)391-6741

marvistavet.com

SUBCUTANEOUS FLUID ADMINISTRATION AT HOME

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.

   
The fluid set up consists of a bag of fluids, a drip set, and a needle. These may have been pre-connected before purchase.
If they are separate, you will need to connect them yourself. Instructions on how to do this in video below.

(original graphic by marvistavet.com)

 

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 fluid 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.


(original graphic by marvistavet.com)

 

Needles come with a twist-off plastic seal in a paper and plastic envelope which can be peeled back. Needles are sealed in one of these ways to maintain sterility. The needle hub, which is clear plastic or metal, slips or twists onto the end of the drip set. At the end of the fluid administration, the needle should be removed for disposal and a fresh capped needle should be attached to prevent exposure of the line from bacteria. Needles should be used only once and then discarded appropriately. For needle disposal instructions see the last section presented.


(original graphic by marvistavet.com)

DRIP SETS

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. The larger the number on the drip set, the smaller the drops).

 

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. If you are connecting a fresh drip set, be aware that drip sets come out of the package in an "open" position. This means as soon as you hook up the new line, fluids will run out. To avoid making a mess, you may want to close the clamp before hooking up the line to the bag (or just be quick to close the clamp after).


(original graphic by marvistavet.com)

 


(original graphic by marvistavet.com)

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.

 

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.

You may discard your drip set with the empty fluid bag in the regular trash as long as the needle has been removed from the end for separate disposal as described below.


(original graphic by marvistavet.com)

 

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.


(original graphic by marvistavet.com)

 


(original graphic by marvistavet.com)

Fluid bags may be given to you already connected to the drip set or they may be purchased separately. When purchased separately, they are often enclosed within another plastic bag to ensure sterility. A small amount of moisture between the two bags is normal and does not indicate a leak in the fluid bag.

 

VIDEO - For a video presentation on how to assemble the equipment reviewed above
and a recap of the above information, please click the PLAY arrow below:
 


(original video by marvistavet.com)

 

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.

 


(original graphic by marvistavet.com)

Lifting up the scruff (above)

“Triangle” of skin (right) (point of triangle in fingers)


(original graphic by marvistavet.com)

 

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. 


(original graphic by marvistavet.com)


(original graphic by marvistavet.com)


(original graphic by marvistavet.com)

 

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.


(original graphic by marvistavet.com)

  • 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, close the clamp and withdraw the needle and recap it or dispose of it and replace it with a fresh capped needle. If a relatively large amount of fluid is to be delivered, you may have been instructed to administer fluids in two locations. If so, repeat the procedure for the second area.

  • 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.


(original graphic by marvistavet.com)

 

VIDEOFor a video description reviewing fluid administration, click the PLAY arrow below: 


(original video by marvistavet.com)

If after the demonstration and instructions you still are not able to accomplish this procedure at home, your veterinarian should allow you to bring your fluid set up and pet to their hospital for the administration of fluids by their staff for a small fee.

 

OTHER METHODS FOR HOME HYDRATION

To assist people who find period needle sticks objectionable for their pets there are a couple of products which may be able to make subcutaneous fluid administration possible. The first is the GIF tube made by Practivet. The product is a soft tube that is implanted under the pet’s skin in a minor anesthetic procedure. An injection port protrudes from behind the pet’s neck and the fluid port can be inserted here without the pet feeling it. The disadvantage is that the pet will have a plastic disc on the base of his neck (an area where petting is traditional and thus somewhat disrupted). Also, general anesthesia (though brief) is required for implantation.

The second product is the SkinButton by Norfolk Vet Products. This is a small implant is placed with local anesthetic and provides a small port for fluid administration. It employs a special blunt needle inserted into the button port rather than conventional sharp needles.

For more information on the GIF tube (in PDF Format), visit:


GIF tube in place
(Photocredit: Practivet. Used with permission.)

http://www.practivet.com/downloads/gifclientbrochure.pdf


The SkinButton in place.

For more details, visit Norfolk Vet Products at www.norfolkvetproducts.com/skinbutton.html

The disadvantage of these products is that they can become infected or clogged after several months. Veterinarians report a mixed bag of experiences: some good, some frustrating. If this is something you are interested in, discuss the pros and cons with your veterinarian.

An alternative form of fluid administration is the Esophagostomy tube. Here, a tube is placed through a small hole in the esophagus (the tube connecting the mouth and stomach). Fluids can be administered through this tube and into the stomach thus avoiding the needle stick. The tube can stay comfortably in place for months but the hole will require regular cleaning and bandaging at home. A cat with an Esophagostomy tube should not be allowed outside in case the tube or wraps become entangled in bushes, fences etc. General anesthesia is required for placement of this tube.


(original graphic by marvistavet.com)

 

DISPOSAL OF OLD NEEDLES

NEEDLE REMOVAL

The first step in disposing of used needles is removing the needle from the drip set. This may sound simple as the needle twists off easily but it is important to review technique as it is possible to stick yourself badly if you are not careful. The needle should be removed from the drip set and discarded uncapped. This may seem counterintuitive but it turns out that most needle injuries occur trying to recap needles. Twist off the needle from the drip set and deposit it in a puncture-proof plastic or metal container as soon as you are finished with fluid administration. Keep this container covered so as to avoid spills. If you feel better recapping the needle before disposing of it, this is best done with a one-handed technique as shown here:

Do not leave the end of the drip set uncovered. As soon as the old needle is removed, replace it with a fresh capped needle so as not to leave the line open to environmental contamination.

NEEDLE DISPOSAL

In the past, disposal of used needles and syringes was simple. One could simply place used syringes, lancets, and other sharps in a thick plastic container (such as the type liquid laundry detergent comes in) and discard the entire container in the regular trash when it was full. This is still probably fine in most areas, but as of September 1, 2008 the State of California law precludes the disposal of any home-generated medical sharps in the regular trash. Instead, special disposal is required to see that these sharps go to a special medical waste landfill. The rules for what is allowed varies with county. To see a list of options for California, click here or, if you wish, you may bring your used needles to our hospital for disposal. Outside of California or in areas without specific disposal requirements, the puncture proof container can simply be closed and discarded in the regular trash. Never throw away a needle without a container as the needle can injure the people responsible for handling and processing refuse.

 

Last updated: 3/25/2018