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.
Needles
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 fluids 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.
Needles come with a twist-off plastic seal
to maintain sterility. The needle hub, which is clear plastic, usually
slips onto the end of the drip set. Needles should be capped when not in
use and each needle should be used only once.
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, specific disposal is required to
see that sharps go to a medical waste landfill.
Your veterinary
clinic might have an appropriate disposal company contracted to remove
medical waste; if so, ask the clinic if you can return the syringes
there.
Use a "mail-back" system. This means you buy a container
for your sharps and when it is full, simply use a prepaid mailing label
to send it to the disposal company it came from. See a list of companies
that participate in this mail-back program.
Bring your home-generated sharps to a sharps consolidation center. Below are two lists of centers in California:
http://ladpw.org/epd/hhw/sharps/sites.cfm or
www.cdph.ca.gov/certlic/medicalwaste/Documents/MedicalWaste/HomeGenShConsolPtaug08.pdf
You
can probably also bring them to your local pharmacy, as many pharmacies
perform this service. Check first to see if your local pharmacy will
take care of this.
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).
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.
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. Also, be aware
drip sets come out of their bag or box in an open position so as soon as
they are connected to the bag and the bag is inverted, fluid will run
out the end until you close the drip set clamp.
Discard your drip set with the empty fluid bag.
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.
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.
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:
Veterinary Partner's video player requires Flash 7 or higher. Click below to get Flash.
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How It's Done
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| Lifting up the scruff | |
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.
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| "Triangle" of skin (point of triangle in fingers) | |
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.
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| Inserting the needle | |
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.
- 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 re-cap it. 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.
Veterinary Partner's video player requires Flash 7 or higher. Click below to get Flash.
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For another description of this procedure please view:
http://members.aol.com/aquila111/subq/webinstruct.html
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.
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