I V Lesson 101, Please

[Sorcha]

My vet instructed me on how to administer IV fluids using a veterinary clinic cat (who was a star "patient"). Totally different scenario when I gave it a go at home on the actual patient, Maxie the Llewellyn setter. First time I tried was a complete failure, Maxie was freaked out from the moment the needle went into her skin, she started trembling in fear and that made me upset so I stopped before barely a dozen drips made it in. I mixed up a bowl on Ensure instead and she drank it up. I called the vet and talked through it but waited 24 hours before trying again. Attempt #2 I bribed her with pieces of dog biscuit. She flinched when the needle went in, but was too busy munching on biscuits to really care so no trembling. The biscuits ran out and she starts getting upset. Soothing words are of no comfort, and I can't leave her to go get more biscuits. At the same time I noticed the IV stopped dripping, after 100 ml of fluid. She's supposed to get 1.5 to 2 (edited to add: meaning 150 - 200 ml). She was getting upset at this point so I stopped it.

 

Why did it stop dripping fluid out? What am I doing wrong?

Edited December 20, 2011 by Sorcha

[macoduck]

Are you putting it into a blood vessel or under the skin?

[Guest Energy11]

Hi there!

 

Unless you are trained, this isn't easy, so try not to stress. You will be just fine!

 

You need to pull the skin up as much as possible, and insert the needle just UNDER the skin, making sure not to go deep.

 

NONE of the animals I used to do it for really enjoyed it. Some were better than others. I like the idea of the treats. How about a large spoonfull of peanut butter? That is the ONLY way I can get four out of my five's nails cut! They lick the spoon, which takes a while, while I trim!

 

It is normal for SOME of the IV fluid to leak out. AND, it is also normal for a bump to appear under the skin. This will absorb.

 

The more you do it, the easier it will get, and easier for your Maxine as well.

 

Sending hugs your way!

 

To me, having worked in human and veterinary medicine, I'd much rather do sub q fluids on a dog or cat, than IVs on humans

[Guest buttonwillow]

Hey ... subq veteran here. I'm thinking you are giving subcutaneous fluids, not an IV. Ignore this if I'm wrong.

I am 90pct sure the doggie is picking up on your anxiety. You are stressed to be doing this new thing. Relax It's ok, you won't screw up and kill the dog, you're doing him a favor. Thank you for doing this for him.

If the fluid stopped moving, likely the needle needed to be adjusted a bit or there was a kink in the line. Don't worry about moving things around while the needle's in.

Are you really only giving 1mL? We were giving our cat 100ml...

Tips: warm up the fluid before giving it, not too hot. it won't be such a surprise going in then.

Giving treats or yummy food at the same time is a nice distraction. After a while it'll be second nature to both of you.

[Sorcha]

Are you putting it into a blood vessel or under the skin?

 

Under the skin. I was also worried because it pillowed up the first time, but vet said it's supposed to and will absorb.

[Guest Energy11]

Are you putting it into a blood vessel or under the skin?

 

Under the skin. I was also worried because it pillowed up the first time, but vet said it's supposed to and will absorb.

Yes, the fluid will absorb. That is the idea ... getting much needed fluids into her. The lumps look ugly, but they don't hurt the animal, and will absorb.

[Sorcha]

Hey ... subq veteran here. I'm thinking you are giving subcutaneous fluids, not an IV. Ignore this if I'm wrong.

I am 90pct sure the doggie is picking up on your anxiety. You are stressed to be doing this new thing. Relax It's ok, you won't screw up and kill the dog, you're doing him a favor. Thank you for doing this for him.

If the fluid stopped moving, likely the needle needed to be adjusted a bit or there was a kink in the line. Don't worry about moving things around while the needle's in.

Are you really only giving 1mL? We were giving our cat 100ml...

Tips: warm up the fluid before giving it, not too hot. it won't be such a surprise going in then.

Giving treats or yummy food at the same time is a nice distraction. After a while it'll be second nature to both of you.

 

Sub-Q yes, in an IV bag thing. It's Normosol-R.

 

Sorry, meant to say I only got 100 ml in. Should have been 150 - 200 ml. (My brain was thinking the numbers on the bag, 1 = 100 ml, etc.) I did try moving the line, and adjusting the needle without removing it but still could not get anymore fluid to go in.

 

How can I warm it up? I can't imagine it can go in the microwave?

 

Thanks.

 

At $22 a bag through the vet I don't want to mess this up! Yes, I know, I need to look into getting the vet to write me a RX to get them for less from the pharmacy.

Edited December 20, 2011 by Sorcha

[Guest Energy11]

Hey ... subq veteran here. I'm thinking you are giving subcutaneous fluids, not an IV. Ignore this if I'm wrong.

I am 90pct sure the doggie is picking up on your anxiety. You are stressed to be doing this new thing. Relax It's ok, you won't screw up and kill the dog, you're doing him a favor. Thank you for doing this for him.

If the fluid stopped moving, likely the needle needed to be adjusted a bit or there was a kink in the line. Don't worry about moving things around while the needle's in.

Are you really only giving 1mL? We were giving our cat 100ml...

Tips: warm up the fluid before giving it, not too hot. it won't be such a surprise going in then.

Giving treats or yummy food at the same time is a nice distraction. After a while it'll be second nature to both of you.

 

Sub-Q yes, in an IV bag thing. It's Normosol-R.

 

Sorry, meant to say I only got 100 ml in. Should have been 150 - 200 ml. (My brain was thinking the numbers on the bag, 1 = 100 ml, etc.)

 

How can I warm it up? I can't imagine it can go in the microwave?

 

Thanks.

 

Microwave warming can be risky. I'd prefer filling up a sink full of hot water, and floating the bag. Be sure to drip some on yourself ... should be warm NOT hot. They have warmers in the ER for blankets, and we used to put the bags of fluid in them. They kept them at wonderfully warm temps. I would not use the microwave though. Again, good luck!

[Sorcha]

 

 

Microwave warming can be risky. I'd prefer filling up a sink full of hot water, and floating the bag. Be sure to drip some on yourself ... should be warm NOT hot. They have warmers in the ER for blankets, and we used to put the bags of fluid in them. They kept them at wonderfully warm temps. I would not use the microwave though. Again, good luck!

 

That makes sense, thanks - I will give it a try next time. It's okay to warm up the whole bag, only use 150 - 200 ml, put it aside, them warm up again next time and etc.?

[Guest Energy11]

 

 

Microwave warming can be risky. I'd prefer filling up a sink full of hot water, and floating the bag. Be sure to drip some on yourself ... should be warm NOT hot. They have warmers in the ER for blankets, and we used to put the bags of fluid in them. They kept them at wonderfully warm temps. I would not use the microwave though. Again, good luck!

 

That makes sense, thanks - I will give it a try next time. It's okay to warm up the whole bag, only use 150 - 200 ml, put it aside, them warm up again next time and etc.?

Yep! You can warm the bag as many times as you need. I'd try the peanut butter distraction or anything that takes a while to eat. Keep us posted!

[GeorgeofNE]

Deep breath, relax!

 

It's just a needle, and it won't hurt her. If you can be calm, it should be no big deal at all.

 

Remember, you're doing it to make her (him?) feel better, and it WON'T HURT!

 

 

You can do it!

[Sorcha]

Deep breath, relax!

 

It's just a needle, and it won't hurt her. If you can be calm, it should be no big deal at all.

 

Remember, you're doing it to make her (him?) feel better, and it WON'T HURT!

 

 

You can do it!

 

Breathing! Thanks. Maxie is an 18 year old female in kidney failure. Still otherwise happy, getting around, etc. so just keeping her as comfortable as possible.

[MaryJane]

Sorry to interject here but, you probably want to check with the vet whether the IV liquid can be rewarmed after it has already been rewarmed once. I would think there is an issue of fluid integrity because of the salt in it and also warming up the plastic bag itself can change the chemical structure of the plastic and leech materials into the fluid.

 

Can you get smaller bags so you don't have to keep on rewarming the same bag?

[tbhounds]

You can warm water bath the fluid bag multiple times. Just make sure that you don't immerse the entire bag under the water- keep the part were you punctured the bag to place the line above the water.

If the dip stops during the process slowly move your needle-- you may even have to draw the needle out slightly.

[Trihounds]

Feline (not canine) sub q expert here, though I would expect it to be easier on a dog.

- rewarming of the bag is not a problem.- I'd use hot water in the sink and let it cool to body temperature, or slightly warmer, as measured by a thermometer (you don't need to be precise). - I also never liked the full IV needle and bag, preferring to pre-load 3 large syringes and use butterfly needles that connected to the syringe via 2' flexible tubing. It was easy to swap out a new loaded syringe without removing the needle from under the skin. - once you get into a routine, things will be easier for both of you- this is generally an easy and effective way to extend the quality of life of kidney patients, but unfortunately, it is not a cure. I'm sorry you are having to go through it.

[Guest Greytluv]

I have to give Doni Rae fluids 2x a week. I'm going to start warming it.

 

At first it was a struggle to do it. Now she just jumps up on the couch to do it. Then everyone gets a treat

[kudzu]

Well join the Sub-Q anxiety club. Most of us go through it at least to some extent. BF could tell tales of my meltdowns a few times. "She gonna die if I don't get this done," or at least it seemed like that then. It does get better, believe me. If I can do this for an 18 yo cat who loathed being restrained then you can do this for your sweet but worried girl. You'll get better & more reliable, plus will also get a feel for which spots work the best on your dog. For my cat, right between & just behind the shoulder blades worked best but for my dogs it was better a little off to one side. Practice, getting a good routine & finding the best equipment will help you both settle into & learned not to stress so much over fluid session.

 

You've already gotten good info. I always warmed the fluids by letting the bag sit in a sink of warm water. Some folks wrapped a heating pad around the bag but I never tried that personally. Sometimes if fluids are not flowing well you just need to move the needles slightly. It's either in a little too far, not quite far enough or is turned so that some tissue is impeding the flow. Since needles are beveled sometimes just rotating the needle a few degrees is all that's needed. I found that if I gently pinched the skin at the spot where I pulled out the needle & held it for 10-30 seconds it kept prevented or greatly limited the fluids from weeping out of that spot. Only had to do this with my Greyhound not my cat or other dog.

 

Also wondering what brand & gauge needles you are using. We never had good luck with Monoject but BD & Terumo were very good. They slid in so easily & painlessly where as I actually felt resistance from their skin when using the Monoject my vet originally provided. Terumos were my favorite though because their UTW (ultra thin walled) needles gave an equivalent flow of fluids as needles one gauge larger in Monoject or BD. So if your vet gave you something like Monoject 20g needles its possible Terumo 20g UTW could really help.

 

Hugs to you for being willing to tackle this problem. Though stressful in the beginning, it can actually for some become almost a bonding experience, a set amount of time for one on one attention.

[Sorcha]

Thanks everyone. I have no idea what type of needles they are. He just gave me some in a plastic baggie. There is resistance when putting it into her skin and I hate that. You can't just go out and buy needles somewhere without a RX can you? I am dreading asking him for a RX for the fluid because I know he expects I will continue to get them from him but I can't afford that especially knowing I can get them for less elsewhere. Can I just keep re-using the line, or should I buy a new one with each bag?

[kudzu]

Some people reused the line but I used a different one for each bag when only using a few hundred milliliters each session. For my big guy who at one point was getting 1 liter a day (no kidding!) I would reuse the line once as it cut the cost of lines from $70/mo to $35. Honestly I think you would be best not to reuse them but that may just be because I am a klutz & have trouble juggling all that equipment for a change in bags & so likely to drop the line or knock the tip against things.

 

You are using a different needle each time, right? I get the impression you are but just making sure.

[Sorcha]

Yes, using new needle each time. Vet supplied me with a half dozen, so going to need more.

[kudzu]

Just PM'd you.

[JAJ2010]

Is the liquid cold? When the vet gave Sunshine some she was shivering like she had flies on her skin cause it felt funny to her. It was colder than her body temp and her skin was stretching obviously. We just got it done as quick as possible for her.

 

If you can get her to drink water do you need to IV? If you put a few cups of water mixed in with her food does she slurp it all up? Luckily my girls will.

[Guest budsmom]

Cat veteran here, too. My vet showed me to make a little tent like with the skin, pull some up like you would if you were testing for dehydration and then kind of push one end in making a little dent. Then put the needle in there. It does go in a little hard getting through the skin, but just use gentle, consistent pressure and it will go in. I reused the line, and the vet told me I could use the needle 2 to 3X. If the treats are working, grab the whole container so you have it with you and can then just keep giving them to her until you're done. I absolutely hate needles and didn't think I'd be able to do this, either, but when you love these guys you can do anything if it helps them!

[kudzu]

Sterile practices aside, a good reason to use a new needle each time is because the needles get duller each time you use them, even after one use. This may not bother some dogs but it will definitely make a difference for others. Since I can actually feel more resistance & dogs tend to be stoic I would prefer to always use a new needle. Besides, needles are pennies apiece. JMHO

[Batmom]

Use new tubing and a new needle. You don't want an already-debilitated dog getting an infection because you didn't.