Hi everyone. I was wondering if someone can give me a few hints about the needle part of giving the sub-cutaneous fluids?
Basically I have had a one-off tutorial with my vet and she made it look so easy. We tried it alone last night and I think I managed to get maybe 50ml into my baby who took it so well, but I must have shed about 3 litres of tears over the whole thing. I had a huge argument with my husband over it and havent' spoken to him since last night - we have been traumatised by the whole experience even though she handled it well. Both our blood pressures must have been off the scale but the needle recipient didnt mind it at all. Honestyly, if I could choose I would rather have the cat giving me the injection rather than the other way around. I would put up with anything for her but can't bear the thought of inflicting the slightest chance of discomfort on her.
She was such a sweet little kitten about it all - which made me feel even worse given how badly we were behaving. She didn't show any sign of being upset at aqll , she was great but I let her down by being too anxious. The needle came out twice and I gave up after the third attempt because I was too freaked abbout how hard I had to push the needle to get it through her skin and in far enough. I was worried I would push it into muscle or body cavity. A little "camel hump" welled up so that means it was sub-cutaneous, right?
A few q's
1. If the needle went into muscle wouldn't that have hurt, and she reacted? She didn't say a thing, just sweetly and patiently waited, but her skin/fur flickered and twitched near the injetion site.
2.The other problem was that I am having trouble reading the IV bag and determining how much fluid has been administered. Even though the "swelling" part of the bag is meant to indicate the ml level, there is a lot of fluid that rises above the swollen part. I'm just anxious and confused and I don't really know how much she got. Can I weigh it and translate ml to grams? She needs 300ml twice a week so if it weighs 300gm less is that an ok way to measure it?
3. PUSHING THE NEEDLE IN This is my major problem - it feels really tough and I have to push it fairly firmly to get it in. She is old (17) - is geriatric skin tougher? I'm freaked about pushing it in too far and hurting her. Is it meant to feel sofirm/tough? Is there any way I can hurt her by pushing too hard/far in that I should be aware of?
4. The vet showed me a method by which I make a "tent" of fur by piching and then slide the needle into the tent area. The vet said she "pinches" the area hard to help the cat notice the pinch over the injection *beep*. I understood the injection to be made in the tent under the pinch. I'm wondering now whether she meant it to be between the pinch , i.e between the thumb and forefinger into the pinched skin? Am I doing it wrong by injecting into the tented skin underneath the pinched skin? I'm injectiong about 1-2cm below th pinch.
5. Am I getting the spot right? She said above the shoulderbldes, but I'm scared of hitting the blades so I injected lower downin the "dip" of the spine below the shoulderblade hump.
6. If I'm doing it wrong it should hurt , right? She's not really reacting and tolerating it well - I'm the one who's a mess. Can I assume it is going alright and I'm not doing any harm if she's OK about it all? Is there anything I should look out for - warning or danger signs?
7. Is it OK if I trim/shave the fur away from the spot where I will be injecting because I think part of the problem (the needle falling out) is because the fur (shorthair siamese) covers up the needle and I cant see how far I've pushed it in which scares me.
8 Is it OK to stretch the skin quite high into a tent to avoid any possibility of hitting muscle/bone? Or would stretching it make it more painful.
Ifound a site that showed some pictures of how to do it but the kitty was long haired and it was difficult to see exactly how the injection was done.
I'm just so scared I will hurt my little purrbaby. The vet told me at the end of the "lesson" that a lot of owners found they couldn't cope with it and not to feel bad if we found we couldn't do it.
That's just not an option for me.
I have to do this for her but I'm really struggling with it and desperate for some words of wisdom. She needs this to stave off kidney failure and lengthen her life and make it comfortable. She's been a little trooper, she's got through soooo much- hyperT and associated heart condition and now she's looking great and is perky and happyand naughty as ever - I just have to get some courage and get over my needle phobia for her sake and keep her this way for as long as possible.
Any advice would be greatly appreciated. thanks guys.
Lara & Bella
xxx
Some advice re administering sub-Q Fluids for needle-shy?
Your last paragraph is your answer. You need to relax. Or, you need to go back to your vet and ask if you can do it yourself as she instructs you. I always ask my clients to perform this procedure at least once or twice before leaving the clinic so that they know they are doing it right and are comfortable with it at home.
First, it sounds as though you did it correctly, but if you are uncomfortable, chances are you are likely to panic and make a mistake. First times can be difficult for owners so that would be reasonable, but after the first or second try, you should begin to be comfortable about it.
The following are tips I give to clients, I hope they help.
Preparation tips:
Slightly warm the fluids by running them under warm water for a few moments, or let the bag sit in the sink with warm water for about 5-10 minutes. Don't refrigerate them. Keep them at room temperature at all times. If they are slightly warm, this is a better feeling for kitty during administration (as opposed to cold fluids)
Make sure the fluid bag is hanging higher than the kitty, the higher the bag, the faster the flow of fluids. Use a coat hanger or such and let the fluid bag hang, don't manipulate it in any way. This allows you to know where the fluids are as they flow and reach each ml amount.
Before starting, always make sure the line is clear of air, and that there are no kinks in the line. To do this, again, make sure the bag is hung high above, turn the clip on, let the fluids flow until they are coming out of the needle, then turn off the clip. If you have air in the line (if you see bubbles), these can be alittle uncomfortable for kitty as it enters under the skin, and can also cause a slow flow of fluids.
Make sure the resevoir is at least 1/4 full before injecting fluids. If you are starting with a fresh line and bag, simply sqeeze the resevoir once or twice and it will fill. Don't let it completely fill, only need 1/4 to keep fluids flowing smoothly.
Injection tips:
Always start with a fresh needle, never ever reuse needles, this is a sure way to introduce infection. You can use one needle for each time you give fluids, and if you miss or can't get the needle positioned correctly, you can use that same needle, but all needles must be discarded after the procedure and when the fluid amounts have been given for each time.
The higher the gauge of the needle, the smaller it is (in diameter). I use an 18-gauge needle for sub-q fluids, I find them more convenient for faster fluid flow. You can use a higher gauge (smaller needle) if you want, it depends on kitty's comfort level to the needle. You might want to start with a 20 or 22-gauge first, and if you find the fluid flow too slow, then ask your vet for another size.
When making the 'tent', choose an area on kitty's body that has more skin to work with. Near the shoulder blades are ideal because the skin is more flacid in this area. However, some cats seem to prefer sub-q fluids slightly over to the right or left of the area, and even lower down, as you have tried. I always start at the right side of the shoulder, slightly below the shoulder blades. If a large amount of fluids is to be given (i.e., 100-200 ml), then I split the fluids in two places.
It doesn't matter really where the needle is injected 'in the tent', as long as it does not pass through the skin to the other side or into your finger. Don't hold the needle vertically, instead hold it rather horizontally and just slightly downward, using GENTLE pressure but with a quick insertion to guide the needle into the skin. If you hit the sublayers of the skin or hit muscle, blood will be drawn into the needle, and fluids will automatically run out of the skin and you will see blood. In that event, withdraw the needle, gently massage the injection for a moment, and then try again on the opposite side of the body.
To answer your question about shaving the skin, no, don't do that.
After correctly inserting the needle, pull it back slightly, this allows the needle to form to the skin and will usually stay in place during the procedure. Don't pull back far, it only takes a fraction. If you pull back too far, you'll have the needle out and fluids running everywhere.
Each bag of fluids contains 1 liter of fluids, this is equal to 1000 ml. Each line on the bag represents 100 ml. You will see the numbers 1-9 noted on the bag. For example, if you are giving 50 mls each day, start at number 1 and stop the flow halfway between the line 1 and 2 (if you continue the fluids to line 2, you will have given 100 mls) . So, each time you give fluids, you want to watch the lines and when it reaches a half-way point between them, you've given 50 mls, or when you've started at one line and stop the flow at the next line, that is 100 mls given.
Your vet has instructed you to give 300 mls twice a week, is that correct? I would suggest calling her and confirming for certain. If kitty has a heart condition (i.e., congestive heart failure), you have to be careful about giving too many fluids. Please confirm with your vet before proceeding. If indeed the amount is correct, then I would suggest the following:
Give 100 or 150 mls per day, half in the morning, the other half in the evening. You could maybe give 200 mls a day, but I would not suggest more than that. Your vet needs to tell you how much to give per day so that you are not giving too much per day.
Watch the top of the fluids against the bag as you are giving them. The top of the fluids in the bag are your gauge to how much is flowing as it reaches each line. Remember, don't manipulate the bag, let it hang loosely, and make sure it is straight, you will know it's straight when the top of the fluids are even with the lines. Remember, when you released the air from the line and let the fluids flow through before injection, the bag shouldn't have any air in it, the top of the fluids should rest against the bag nicely. (there will be an indentation at the top of the bag, and the lower part of the bag will be full)
At the end of each procedure, use the stop clamp on the line, gently pull out the needle, and gently drape the line over the bag or coat hanger, once. Don't twist it or curl it in any way. The looser it remains, the less likely it will kink or twist. Because your vet has instructed to give a fairly high amount of fluids weekly, you will want to change the line each week with a new one after you've used a full bag of fluids. Ask your vet for a good supply of needles to have on hand and always try to have an extra line set available in the event of an unmanageable kink or hole in the line.
You will know that the fluids administration was succesful when:
There is a soft lump under the skin, and it will recede or 'move' to a lower position than the actual injection site. This means it is distributing. If you've given too many fluids in one spot, the skin will leak the fluids. In that event, don't do anything, don't manipulate the skin or agitate kitty. It will eventually stop leaking and will begin to distribute.
Kitty will probably feel really good shortly after fluids administration, the fluids combat dehydration associated with renal failure, and it will help perk her up considerably. This is one reason why I suggest dividing the fluids into two administrations per day, to keep her well hydrated.
Once you've done this successfully a few times, you'll begin to feel more confident. Sometimes however, in times of stress or illness, your kitty may fight you, so if that occurs, leave her alone and try again later.
Again, if you are terribly uncomfortable with this, do ask your vet to show you again, and try to do it in her presense so that you feel you are confident. There is probably always a patient at the clinic your vet can use as a training example, so you don't necessarily have to take your own kitty in just for a training experience. Even the techs would probably be happy to take the time to help and show you.
Hope this helps....
First, it sounds as though you did it correctly, but if you are uncomfortable, chances are you are likely to panic and make a mistake. First times can be difficult for owners so that would be reasonable, but after the first or second try, you should begin to be comfortable about it.
The following are tips I give to clients, I hope they help.
Preparation tips:
Slightly warm the fluids by running them under warm water for a few moments, or let the bag sit in the sink with warm water for about 5-10 minutes. Don't refrigerate them. Keep them at room temperature at all times. If they are slightly warm, this is a better feeling for kitty during administration (as opposed to cold fluids)
Make sure the fluid bag is hanging higher than the kitty, the higher the bag, the faster the flow of fluids. Use a coat hanger or such and let the fluid bag hang, don't manipulate it in any way. This allows you to know where the fluids are as they flow and reach each ml amount.
Before starting, always make sure the line is clear of air, and that there are no kinks in the line. To do this, again, make sure the bag is hung high above, turn the clip on, let the fluids flow until they are coming out of the needle, then turn off the clip. If you have air in the line (if you see bubbles), these can be alittle uncomfortable for kitty as it enters under the skin, and can also cause a slow flow of fluids.
Make sure the resevoir is at least 1/4 full before injecting fluids. If you are starting with a fresh line and bag, simply sqeeze the resevoir once or twice and it will fill. Don't let it completely fill, only need 1/4 to keep fluids flowing smoothly.
Injection tips:
Always start with a fresh needle, never ever reuse needles, this is a sure way to introduce infection. You can use one needle for each time you give fluids, and if you miss or can't get the needle positioned correctly, you can use that same needle, but all needles must be discarded after the procedure and when the fluid amounts have been given for each time.
The higher the gauge of the needle, the smaller it is (in diameter). I use an 18-gauge needle for sub-q fluids, I find them more convenient for faster fluid flow. You can use a higher gauge (smaller needle) if you want, it depends on kitty's comfort level to the needle. You might want to start with a 20 or 22-gauge first, and if you find the fluid flow too slow, then ask your vet for another size.
When making the 'tent', choose an area on kitty's body that has more skin to work with. Near the shoulder blades are ideal because the skin is more flacid in this area. However, some cats seem to prefer sub-q fluids slightly over to the right or left of the area, and even lower down, as you have tried. I always start at the right side of the shoulder, slightly below the shoulder blades. If a large amount of fluids is to be given (i.e., 100-200 ml), then I split the fluids in two places.
It doesn't matter really where the needle is injected 'in the tent', as long as it does not pass through the skin to the other side or into your finger. Don't hold the needle vertically, instead hold it rather horizontally and just slightly downward, using GENTLE pressure but with a quick insertion to guide the needle into the skin. If you hit the sublayers of the skin or hit muscle, blood will be drawn into the needle, and fluids will automatically run out of the skin and you will see blood. In that event, withdraw the needle, gently massage the injection for a moment, and then try again on the opposite side of the body.
To answer your question about shaving the skin, no, don't do that.
After correctly inserting the needle, pull it back slightly, this allows the needle to form to the skin and will usually stay in place during the procedure. Don't pull back far, it only takes a fraction. If you pull back too far, you'll have the needle out and fluids running everywhere.
Each bag of fluids contains 1 liter of fluids, this is equal to 1000 ml. Each line on the bag represents 100 ml. You will see the numbers 1-9 noted on the bag. For example, if you are giving 50 mls each day, start at number 1 and stop the flow halfway between the line 1 and 2 (if you continue the fluids to line 2, you will have given 100 mls) . So, each time you give fluids, you want to watch the lines and when it reaches a half-way point between them, you've given 50 mls, or when you've started at one line and stop the flow at the next line, that is 100 mls given.
Your vet has instructed you to give 300 mls twice a week, is that correct? I would suggest calling her and confirming for certain. If kitty has a heart condition (i.e., congestive heart failure), you have to be careful about giving too many fluids. Please confirm with your vet before proceeding. If indeed the amount is correct, then I would suggest the following:
Give 100 or 150 mls per day, half in the morning, the other half in the evening. You could maybe give 200 mls a day, but I would not suggest more than that. Your vet needs to tell you how much to give per day so that you are not giving too much per day.
Watch the top of the fluids against the bag as you are giving them. The top of the fluids in the bag are your gauge to how much is flowing as it reaches each line. Remember, don't manipulate the bag, let it hang loosely, and make sure it is straight, you will know it's straight when the top of the fluids are even with the lines. Remember, when you released the air from the line and let the fluids flow through before injection, the bag shouldn't have any air in it, the top of the fluids should rest against the bag nicely. (there will be an indentation at the top of the bag, and the lower part of the bag will be full)
At the end of each procedure, use the stop clamp on the line, gently pull out the needle, and gently drape the line over the bag or coat hanger, once. Don't twist it or curl it in any way. The looser it remains, the less likely it will kink or twist. Because your vet has instructed to give a fairly high amount of fluids weekly, you will want to change the line each week with a new one after you've used a full bag of fluids. Ask your vet for a good supply of needles to have on hand and always try to have an extra line set available in the event of an unmanageable kink or hole in the line.
You will know that the fluids administration was succesful when:
There is a soft lump under the skin, and it will recede or 'move' to a lower position than the actual injection site. This means it is distributing. If you've given too many fluids in one spot, the skin will leak the fluids. In that event, don't do anything, don't manipulate the skin or agitate kitty. It will eventually stop leaking and will begin to distribute.
Kitty will probably feel really good shortly after fluids administration, the fluids combat dehydration associated with renal failure, and it will help perk her up considerably. This is one reason why I suggest dividing the fluids into two administrations per day, to keep her well hydrated.
Once you've done this successfully a few times, you'll begin to feel more confident. Sometimes however, in times of stress or illness, your kitty may fight you, so if that occurs, leave her alone and try again later.
Again, if you are terribly uncomfortable with this, do ask your vet to show you again, and try to do it in her presense so that you feel you are confident. There is probably always a patient at the clinic your vet can use as a training example, so you don't necessarily have to take your own kitty in just for a training experience. Even the techs would probably be happy to take the time to help and show you.
Hope this helps....
..........Traci
Thankyou sweet Traci!
Traci, you are just wonderful! Thankyou so much for all that advice. We had another go after reading all that as well as a few hours researching the net and things went much better all 'round. All your advice helped so much, I can't thank you enough.
Also, you might be interested, there was a little tip that I found that also made a big difference with my needle phobic approach. I found a tip that suggested keeping the needle stationary and pulling the tent of skin into/onto the needle rather than pushing the needle into the skin and it made the world of difference! I can't believe how much easier it was to do it that way rather than the other way round. There was no toughness, it just slid straight in so quick and easy that I was a little stunned but delighted.
I utilised all your advice and everything went really well, the only persisting problem is that I still can't read that darn bag. I know she had received a fair bit of fluid judging by the "camel hump" under her skin, but I just couldn't see the difference in the bag! I feel so stupid! I tried weighing the bag before and after and the bag weighed 102 grams less when it was over. The reason I stopped at that stage was only because the needle slid out after a while and we had done so well that I didn't want to stick her again so I decided it was better to cut our losses and run. I will give her some more tonight but I felt it was better for both our sanity (hubby and I) to leave it on a good note and try again another day.
Yes, our Vet (who is actually a Specialist at the University Hospital we were referred to by my usual vet) has indeed prescribed 300ml twice a week. I will confirm that with her as you suggested, and I also note from all the other web sites that I checked out that most cats seem to have far smaller amounts administered, particularly in the event of a heart condition. In addition Bella is only a small kitty - 3.2kg. Despite this, I really trust this vet, she kind of "saved" Bella from the last vet and what I suspect was an overly enthiusiastic prescription of some medications that led to Bella's crash. She took her from death's door and I am convinced Baby B wouldn't be here today if it hadn't been for this lady. She is costing us a small fortune but she is worth every cent. She did blood tests before the first 300ml admiistration of fluids and 24 hours after and Bella was coping great and her blood tests showed an improvement, so she told us to continue. We haven't been successful in getting the whole 300 into her since the first time with the Vet, but things are still looking good. In a week or so we will check her blood levels again and hopefully her creatinine (300) and BUN (29.5) will be lower.
Wait and see.
Anyway, thankyou again Traci, you have been such a help to me and I feel so much better about it all now. I'm even talking to poor long suffering Hubby again!:lol:
I'm so glad it helped, Lara.
But, as for the needle tip, be verrrrrry careful about that, you don't want to manipulate the skin and needle together too much and do take note of Bella's reaction when you do that.
As for gauging the amount of fluids: Think of it as a clear glass of water with gauges written on it (like a baby bottle for formula). Imagine putting a straw in it, sucking on the straw and drawing out the water, you watch the water line recede as the water is drawn out through the straw. Same thing with the fluid bag. Instead of a straw, the fluids are drawn out through the line and into the needle and into the skin. Watch the top of the bag like the glass of water, and watch the fluid line recede as the fluids run through. As you give the fluids, keep your eye on the numbers on the bag, they are to the right of the bag in black or blue print. If by some weird anomaly there are no printed numbers and lines on the bag, then call your vet promptly and request a bag that does!
Then, refer to the rest of my previous post to gauge amounts given. Remember, between each numbered line represents 100 ml.
Typically, the time it takes to give 100 ml should not take any longer than 4-5 minutes, but this also depends on the height of the bag (always have it well above Bella), and the gauge of needle used. The smaller the gauge, the faster the fluids will flow.
Does this help?
But, as for the needle tip, be verrrrrry careful about that, you don't want to manipulate the skin and needle together too much and do take note of Bella's reaction when you do that.
As for gauging the amount of fluids: Think of it as a clear glass of water with gauges written on it (like a baby bottle for formula). Imagine putting a straw in it, sucking on the straw and drawing out the water, you watch the water line recede as the water is drawn out through the straw. Same thing with the fluid bag. Instead of a straw, the fluids are drawn out through the line and into the needle and into the skin. Watch the top of the bag like the glass of water, and watch the fluid line recede as the fluids run through. As you give the fluids, keep your eye on the numbers on the bag, they are to the right of the bag in black or blue print. If by some weird anomaly there are no printed numbers and lines on the bag, then call your vet promptly and request a bag that does!
Then, refer to the rest of my previous post to gauge amounts given. Remember, between each numbered line represents 100 ml.
Typically, the time it takes to give 100 ml should not take any longer than 4-5 minutes, but this also depends on the height of the bag (always have it well above Bella), and the gauge of needle used. The smaller the gauge, the faster the fluids will flow.
Does this help?
..........Traci
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Susan and the girls
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Dear Lara -
I just wanted you to know that you're definitely not alone in your fears of doing all this!
When I had to give fluids to Lily, it stressed me out WAY more than it stressed her. She was a lot like Bella - patient and calm, while I cried and panicked when I didn't get it right. Like you and Bella, though, I had to do it, and since it was the only way to help her, managed to learn how. In time, it became just "another thing" in our routine.
Traci's advice was excellent. Traci - can you put that somewhere as a link for "how-to" on this site? I know you don't want to have to type it out each time someone has a question, and it's a marvelous instructional.
You're going to make it through this, and I'm sure Bella appreciates your willingness to help her. Like Bella, Lily didn't act like it hurt or anything, and Lily's skin seemed kinda "tough," too. (She was only 3.) I agree with Traci - 300 ml seems kinda high for an administration.... I did about 100 ml each day for a few days (I think....it's been so long I can't remember exactly), and that leaves quite a big hump in itself!
Good luck and hang in there. Give Bella a hug from me and the girls!
When I had to give fluids to Lily, it stressed me out WAY more than it stressed her. She was a lot like Bella - patient and calm, while I cried and panicked when I didn't get it right. Like you and Bella, though, I had to do it, and since it was the only way to help her, managed to learn how. In time, it became just "another thing" in our routine.
Traci's advice was excellent. Traci - can you put that somewhere as a link for "how-to" on this site? I know you don't want to have to type it out each time someone has a question, and it's a marvelous instructional.
You're going to make it through this, and I'm sure Bella appreciates your willingness to help her. Like Bella, Lily didn't act like it hurt or anything, and Lily's skin seemed kinda "tough," too. (She was only 3.) I agree with Traci - 300 ml seems kinda high for an administration.... I did about 100 ml each day for a few days (I think....it's been so long I can't remember exactly), and that leaves quite a big hump in itself!
Good luck and hang in there. Give Bella a hug from me and the girls!
>^.,.^< Susan >^.,.^<
Proud mommy of ALEX, ANNA CLAIRE, & ALYSSA KATE
and a bunch of incredible cats
(Scarlett, Daisy, and Princess and Duke)
RIP Belle 4/24/97 - 9/12/11 Heaven's newest angel
RIP Lily
RIP SweetPea
RIP Adolf
Proud mommy of ALEX, ANNA CLAIRE, & ALYSSA KATE
and a bunch of incredible cats
(Scarlett, Daisy, and Princess and Duke)
RIP Belle 4/24/97 - 9/12/11 Heaven's newest angel
RIP Lily
RIP SweetPea
RIP Adolf
Re: Some advice re administering sub-Q Fluids for needle-shy
Thanks Susan and purrbabys. We are going to make it though this - I just wish it was her giving ME the injections instead ! Bella sends back kittykisses to you and yours.
La
xxx
! Bella sends back kittykisses to you and yours. La
xxx