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.
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.
VIDEO - For a video presentation on how to assemble the equipment reviewed above
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.
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.
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.
VIDEO - For a video description reviewing fluid administration, click the PLAY arrow below:
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:
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.
DISPOSAL OF OLD NEEDLES
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.
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