How to Administer Subcutaneous Fluids To A Cat

Subcutaneous fluids (also known as sub-Q fluids) are an essential part of managing your cat's CRF. Although the idea of sticking a needle into your pet may sound daunting, administering fluids at home is fairly simple and painless, and can extend your cat's quality of life for anywhere from months to years. The key is to do it consistently.

A subcutaneous fluid setup consists of the following:

1. 1000-ml bag of Ringer's Lactate
2. IV set
3. Needles

• Before administering fluid for the first time, always check for leaks and holes by gently squeezing the bag. If you do find a leak or a hole, don't use the bag - it's no longer sterile.
• Your bag will have two ports at the bottom: an administration port for the IV set, and an injection port for medications.  You will not need to use this, unless instructed otherwise.  Some vets recommend adding supplemental potassium to the bag, since cats who get sub-Q fluids tend to pee a lot, and electrolytes get flushed out of their body very quickly.
• Pull off the rubber cap from the administration port.  Find the white spiked end of the IV set (it sits on top of a plastic drip chamber) and take off the plastic cap. Insert the spike into the inner tube of the IV port. You'll probably have to work it back and forth a little as you push it in. Be careful not to tear the plastic.

• Take the plastic cap off the other end of the IV set and attach the needle by gently twisting it clockwise. A pink 18 gauge needle will help the procedure go faster, but it may be more painful for the cat. A green 20 gauge needle is smaller and less painful, but the fluid injection will go faster. It all depends on what your cat will tolerate. Terumo needles are thin-walled, and many cat owners say their cats don't feel the "poke" as much with Terumos.
• Once the needle is attached, flush the line by rolling up the clamp wheel and allowing fluid to flow down the line. This gets rid of air bubbles. When the fluid reaches the needle, close off the clamp wheel again.
• Hang the bag from the highest location you can find. This will speed up the flow. If you don't have a high planter hook handy, thread a coat hanger through the hole, then hook the coat hanger onto a door or sturdy curtain rod. You can also buy an inexpensive rolling IV pole. This may be a good investment if you anticipate administering fluids on a regular basis for the long term.

• Now, it's time to gather up the star attraction: your cat. It may take some experimentation to find the most comfortable position for your cat to receive the fluids. You may want to wrap him loosely in a towel, put him inside a box or carrier, or place him on a slick surface such as a countertop where he won't have anything to grab on to. Some cats do well on your lap, in an easy chair or on a bed, where you can cuddle him with your left arm and administer the fluids with your right.
• If you imagine putting a saddle onto the back of a cat, the best spot to insert the needle is anywhere that the saddle would touch. This is where your cat's skin is loosest. Pick a spot, pinch the skin lightly between your thumb and middle finger, and pull it up to form a little tent. The needle will go into the end, or "doorflap", of the tent. Poke lightly with your index finger to make a nice flat triangular space.

• Gently insert the needle, parallel to the cat's spine. Don't poke too hard, or the needle will come out the other side of the tent.
• Once the needle is in, roll the clamp wheel all the way up with your thumb (slowly) and check the drip chamber to see if fluid is coming out. You can regulate the speed of the drip by rolling the clamp up or down. Start your cat off slowly at first, and then gradually increase the drip rate. You don't want to startle your cat with a sudden influx of Ringer's Lactate. (By the way, remember that old TV show Emergency, where the prescription for every ailment was 100cc of Ringer's Lactate? I used to wonder what that meant. Now I know.)
• Make sure that fluid isn't leaking out. If fluid is dribbling down the outside of your cat, it means the needle either didn't go in all the way, or it pulled out. If that happens, clamp the IV tubing shut again and change to a fresh needle. Never reuse needles.
• If you don't see fluid dripping in the IV chamber, try gently wiggling or rotating the needle (keeping the tip inside your cat, of course). Sometimes the skin collapses around the needle and plugs up the hole. Moving to a slightly different position is usually enough to get the flow going.
• Many owners like to warm up the fluid before administering it. The fluid will be room temperature and feel quite cool to your cat, and many CRF cats don't have a lot of extra padding to begin with. Don't put the bag in the microwave, because it can heat unevenly and you risk burning your cat. A safer method is to warm the bag inside a bowl of hot water (or even run the tubing through a bowl of hot water set on the floor). I've also found that gripping the end of the tubing with my right hand, close to the cat's body, helps to warm the fluids.

• Stay calm and relaxed. Continue stroking and reassuring your kitty. Most cats will tolerate fluids pretty well. Some cats don't like the liquid potassium supplement - apparently it stings like the dickens. I can personally attest to that, having accidentally spilled some on a cut on my finger once. If potassium has been added to your bag and your cat seems excessively uncomfortable or agitated, ask your vet if you can switch to oral potassium supplements instead.
• Once the dose has been administered, clamp off the tubing, slip the needle out, and dispose of it safely in a Sharps medical container. If you don't have one, an empty plastic orange juice container will do (make sure it's the hard #2 type of plastic, and clearly label it as used). Check with your vet to see if they will accept your used needles.
• Subcutaneous fluids have a fairly long shelf life, and it doesn't take long to go through a bag, but if your cat is only getting them occasionally, consider storing the bag in the refrigerator. Remember to take the bag out and let it warm to room temperature before administering the fluids.
• Buying from your vet can get expensive quickly if your cat, like mine, requires daily fluids. For example, at my vet, a single 1000 ml bag of Ringer's Lactate with IV set and supplemental potassium costs $25. You can order a dozen bags and IV sets from online suppliers such as Thriving Pets or Walgreens for about $50. Your vet will have to phone or fax the prescription to the vendor, but this is the best way to save money in the long run.

Coping with feline CRF can be overwhelming, but regular sub-Q fluid administration is one of the best therapies available for your cat.  It's only five minutes out of your cat's day, but it helps him feel better for the other 23 hours and 55 minutes.  The key is to be patient and consistent.  Over time, many cats do improve and stabilize on a daily fluid regime, and there's no question that it improves quality of life.  It can also be a bonding opportunity as well - many cats enjoy the "snuggle time", even if they're not wild about the needle.