(SQ) fluid administration is providing fluids into the space
under the skin from where it can be slowly absorbed into the
blood and body. This is a very useful way of providing additional
fluids to cats and helping to manage and prevent dehydration.
With chronic renal failure, cats usually lose more fluids
than usual through their kidneys, and as the disease progresses
they often become dehydrated as they do not drink sufficiently
to compensate for this fluid loss. This has several detrimental
effects, including potentially worsening the kidney failure
– regular SQ fluid administration in the home environment
can therefore be an extremely valuable part of the management
regime for these cats.
Subcutaneous fluids may be given as often as is needed, but for most cats
that require fluid supplementation, SQ fluids are most often
provided between once a week and once a day (with 2-3 times
weekly being most common).
do I use?
veterinarian will provide you with the fluid to give your
cat, will give you instructions on how much to administer
and how frequently. Also, your vet will supply you with additional
material needed to administer the fluids (needles, tubing,
etc). The most common fluid type given to cats is a balanced
electrolyte solution known as ‘Hartmann's' or 'Lactated Ringer's'
solution, although others are also available.
is the fluid given?
are several different ways to administer SQ fluids, but the
way that is best tolerated is usually by using a ‘drip bag'
(ie, the bag containing the sterile fluid for administration
– this is actually most commonly given by intravenous drip,
hence the name) and a length of 'drip tubing' attached to
a needle which is placed under the skin.
this sounds potentially uncomfortable, the vast majority of
cats tolerate being given SQ fluids tremendously well. The
drip bag is suspended above the level of the cat so that the
fluid can run into the space under the skin under the influence
of gravity. It usually takes several minutes to administer
the fluid, and it is often helpful to cuddle, stroke or pet
your cat during this period, and many people find it helpful
to feed the cat at the same time, providing them with a distraction.
much fluid is given?
veterinarian will tell you how much fluid to administer, whether
to use a single site or more than one site, and how often
to give the fluids. Generally around 10-20 ml/kg of fluid can
be given at a single SQ injection site (approximately 60-100 ml
in total for most ‘average' sized cats).
lump will develop under the skin at the site where the fluid
has been given. This should be neither hot nor painful for
the cat, and the fluid is gradually absorbed over several
hours (it may take up to 8 hours for all the fluid to be absorbed).
The fluids are usually given under the skin high up on the
chest, but gravity will often cause the fluids to accumulate
lower down on the chest or tummy. If there is still fluid
under the skin from previous SQ administration when your cat
is next due for fluids, no further fluids should be given
and you should check with your veterinarian.
instructions on fluid administration
veterinary surgeon will supply you with the fluids and equipment
necessary to administer the fluids along with specific instructions for your cat. This is designed as a general guide to help you.
for administering sub-cutaneous fluids:
the equipment is sterile and therefore supplied in
sealed wrappers – these should not be opened until
they are to be used
bag and giving set
is helpful to warm the bag of fluids first by immersing it
in a bowl of warm water for 5-15 minutes. Pre-warming the fluids
(to make them lukewarm) helps to reduce irritation and make
the procedure more comfortable for the cat. Most intravenous
fluid bags contain either 500 ml of fluids or 1litre. For cats,
it is most common to use 500 ml bags for subcutaneous administration.
Do not use the fluids if they appear cloudy or discoloured.
unopened bag of fluid can be warmed by immersing it fully in a bowl of warm water
part-used bag of fluids can be warmed by immersing
the fluid bag in a bowl of warm water, but keeping
the giving port and attached drip set out of the water
bag of intravenous fluids usually comes sealed within an outer
bag/wrapper, which needs to be removed first. At one end of
the fluid bag there will be two 'ports'. One of these is an
injection port for adding solutions/drugs to the intravenous
fluids – unless instructed otherwise by your vet, you will
not need to do anything with this port. The other is the administration
port or 'spike port' and this usually has a blue plastic cover
on it that will need to be pulled off (it is usually attached
quite firmly so you will have to pull hard!).
bag removed from its wrapper
administration port is on the left and has a blue
plastic seal; the port on the right is an injection
port for adding solutions to the fluids (unless instructed
otherwise, you will not need to use this)
administration port is opened by twisting the blue
plastic cover to break it and expose the port.
giving set (drip set) is a long length of plastic tubing that
will also need to be removed from its plastic wrapping. At
one end of the giving set there is a plastic 'drip' chamber
and a white spike sits on top of this (shielded by a removable
cover). The other end is also protected by a cover and this
is the end to which a needle is attached (later). There will
also be a plastic roller clamp that serves to regulate the
flow of fluids. This should be rolled down initially so that
the tubing is tightly clamped to prevent fluids flowing through
the tubing. There may also be a 'pinch clamp' that can be
used to pinch the tube and stop any fluid flowing.
set in its wrapper (to keep it sterile) and out of
'pinch' clamp – in the open position (left) and closed
'wheel clamp' – in the open position (left) and closed
the clamps have been applied to the tubing, the cover over
the white spike can be removed. The spike is then introduced
into the giving port of the bag of intravenous fluids. You
should avoid touching the white spike at all to prevent it
being contaminated, and you may need to apply a twisting motion
as you push the spike through to help it engage fully in the
giving port. Care should be taken not to push it in at an
angle as this could lead to puncturing the fluid bag.
plastic cover is removed from the spike on the giving
set (take care not to touch the spike)
spike is pushed fully into the administration port
of the fluid bag using a twisting motion
the giving set has been attached to the fluid bag, the bag
should be suspended – it can be hung on any suitable hook
using the plastic tab at the end of the bag opposite the giving
and administration ports.
the bag is suspended, the drip chamber should be 'primed'
– this chamber needs to be half filled
with fluid and this is achieved by gently squeezing and releasing
the sides of the chamber while the fluid bag is suspended.
(NB: Make sure the clamps on the drip line are closed while
this is being done.) This process can be repeated until the
chamber has sufficient fluid present.
fluid bag can be suspended from
a convenient location above the height
of the cat
drip chamber is 'primed' by gently squeezing it one
or more times (with the pinch and roller valves closed)
until the chamber is just over half full of fluid
the drip chamber is primed, the tubing also needs to be primed
(filled with fluids) to remove air from the giving set. With
the fluid bag still suspended, the pinch clamp is first released,
and then the roller clamp is gradually released to allow a
slow flow of the fluids through the tubing – you will see
a steady flow of drips in the drip chamber, and you will see
the fluids gradually filling the tubing. Run fluid through
the tubing until all the air and air bubbles are removed and
fluid is emerging from the end. When this is done, use the
roller clamp to seal off the tubing again and prevent any
further flow of fluids.
gauge needles are colour-coded green and 20 gauge
needle can be opened by peeling apart the enclosing
are now ready to place the needle on the giving set. The needle
should be removed from its protective cover, but the removable
hard plastic cover over the needle itself should be left in
place. Most commonly a 19, 20 or 21 gauge needle is used (this
is the thickness of the needle) 1 inch in
cover should be removed from the end of the giving set, and then
the hub of the needle (the coloured plastic part) can be gently
twisted on making a secure attachment. Neither the hub of
the needle (especially the inner part) or the protected end
of the giving set should be touched during this process to
make sure they do not get contaminated.
cover is removed from the end of the giving set, but
it is important that the exposed is not
hub of the needle is attached to the end of the giving
set. This is secured in place by screwing it onto
the giving set in a clockwise direction. The plastic
guard should be kept over the needle until it is used
giving set is now ready for you to give fluids to your cat.
Usually the skin at the site where the needle is going to
be inserted is not cleaned or prepared in any special
way (this is not usually necessary, although your veterinarian
will let you know if the skin should be cleaned/prepared for
your particular cat).
fluid bag should be suspended at a height above where your
cat will be sitting. Having a hook (eg, coat-hanger wire bent
into an S-shape) over the top of a door or over a door handle
can be useful, attaching the bag to this hook.
It is also important to have the cat in a comfortable position
for the fluid administration – being cuddled on your lap,
or sitting beside you on the couch would be
ideal. Additionally, to make the procedure as stress-free
as possible, feeding your cat or offering your cat special
treats during the procedure can be very valuable.
plastic cap should be removed from the needle (by pulling
the two apart, but be careful not to stab yourself with the
needle!). One hand should hold the needle at the hub (the
base of the needle - avoid touching the needle itself which
would contaminate it) and with the other hand, the scruff
(skin between the shoulder blades) should be lifted to form
a 'tent'. The needle should be inserted quickly and smoothly
into the tent that has been formed (avoid 'stabbing' motions)
keeping the needle parallel with the back of the cat, so that
the tip of the needle is lying in the subcutaneous space.
It may be easier to place the tip of the needle next to the
skin and then 'pull the skin over the needle' rather than
‘push the needle through the skin'. Once the needle is in
place, the skin can be released, but you may need to hold
the end of the drip set to keep the needle securely under
the skin. It may help to insert the needle to one side of
the mid-line slightly so that the fluid accumulates on the
left or right side – this is especially useful if quite large
volumes of fluid need to be given, as the needle can be repositioned
(removed and re-inserted if necessary) to give half the fluids
on each side (your veterinarian will tell you if this is needed).
'tent' of skin is held up in the scruff behind the
plastic cap is taken off the needle and the needle
is inserted into the tissue under the skin where the
tent has been formed (or the skin is slid back over
two clamps on the giving set now need be opened to allow fluids
to flow, and the roller clamp should be fully opened to allow
the fluids to flow as quickly as possible. If the fluids are
not flowing at a steady, fast rate (continuous flow seen in
the drip chamber) you may need to either try slightly repositioning
or tilting the needle and/or raise the bag of fluids to a
higher level. If the needle has been put straight through
the skin (this is quite easy to do and a common mistake!)
the cat's fur will become wet immediately you open the clamps
and it will be obvious the fluid is not going into the sub-cutaneous
space. If this occurs, simply remove the needle from the skin,
replace it with a new one, and repeat the procedure.
veterinarian will tell you how much fluid to administer to
your cat – there may be gradations on the side of the fluid
bag to give you an indication of the amount of fluid that
has been administered, and if you have a small set of weighing
scales, these can also be used to measure the volume of fluid
(each 100 ml of fluid weighs 100 g). If the rate of flow of
the fluid slows during the administration period, again repositioning
of the needle and/or raising of the bag of fluids should be
the required amount of fluids has been administered, the
clamps on the giving set should be turned off and the needle
gently but firmly pulled from the skin (in one quick movement).
When fluid administration is finished your cat can be treated
as normal, and the fluids will usually be absorbed during
the next few hours.
needle is gently held in place and the valve(s) are
opened to allow the fluid to flow into the space under
some food at the same time as the fluids helps to
make the experience more positive for your cat.
your cat sitting on your lap or sitting next to you
on a chair is often the easiest way to administer
may be a small amount of fluid oozing out from the site where
the needle went through the skin – this is quite normal, and
there may be quite a large lump where the fluid has accumulated
under the skin. This can be massaged gently to help disperse
the fluid and stop further fluid leaking from the injection
between each episode of fluid administration, the part-used
fluid bag, giving line and needle (all still attached) are
best stored in the fridge, but this should be in a clean,
new plastic bag that is replaced each time to ensure the fluids
are kept protected. The whole system should be allowed to
warm to room temperature for at least 1-2 hours before each
use, and the fluids can be warmed by placing the fluid bag
in warm water (as before), but suspending the bag 'upside down'
in the water, and ensuring that the administration port does
not become immersed. Again, fluids should not be used if they
appear cloudy or discoloured.
time a new fluid bag is used, a new giving set should be attached,
but generally only one giving set needs to be used for each
fluid bag (ie, these can be left attached until the fluid
bag is finished). Old needles should not be thrown away with
household rubbish. It is best to put these in a plastic screw-top
bottle, and important to return these periodically to your
vet (along with old fluid bags and giving-sets) for safe disposal.
of fluid administration
associated with subcutaneous administration of fluids are
actually very uncommon, but if there is anything you are concerned
about at any stage, seek advice from your veterinary surgeon
without delay. If
your cat develops a persistent swelling at the site of injection,
and especially if this becomes hard, warm and painful, this
could indicate some local infection (abscess) that will require
Updated November 2008