subcutaneous fluid administration presented by maj patti glen

SUBCUTANEOUS SUBCUTANEOUS FLUID FLUID

ADMINISTRATIOADMINISTRATIONNPRESENTED BY MAJ PATTI PRESENTED BY MAJ PATTI

GLENGLEN

INTRODUCTIONINTRODUCTION-Fluid given under the skin, subcutaneously (SQ), is absorbed into the blood stream and can be used to correct or prevent dehydration.

-The most frequent disease for which fluids are given is chronic kidney failure. Dogs with chronic kidney failure pass large amounts of urine and may not feel well enough to drink enough to prevent dehydration.

-Subcutaneous fluids may be given a few times a week to supplement the water the dog is drinking in order to prevent dehydration and help flush waste products through the kidneys. -The most common fluid type given to dogs with chronic kidney failure is Lactated Ringers Solution (LRS).

SUBCUTANEOUS FLUID SUBCUTANEOUS FLUID ADMINISTRATION ADMINISTRATION

INDICATIONSINDICATIONS

Slightly ill and mildly dehydrated animalSlightly ill and mildly dehydrated animal

Slightly prolonged skin tent or capillary Slightly prolonged skin tent or capillary

refill timerefill time

Mild diarrhea or vomiting of short durationMild diarrhea or vomiting of short duration

SUBCUTANEOUS FLUID SUBCUTANEOUS FLUID ADMINISTRATION ADMINISTRATION

TECHNIQUETECHNIQUEThree general techniques used to give SQ Three general techniques used to give SQ

fluidsfluids

With a syringe and needle With a syringe and needle

With a syringe, needle and flexible tubing With a syringe, needle and flexible tubing

called an extension set called an extension set

From a vinyl bag using a solution drip set From a vinyl bag using a solution drip set

GUIDELINESGUIDELINES Subcutaneous fluids are tolerated by most dogsSubcutaneous fluids are tolerated by most dogs

10-20 ml per kg of body weight (5 -10 ml per pound) 10-20 ml per kg of body weight (5 -10 ml per pound) can be given in one spot (e.g. 50 ml for a 10 pound can be given in one spot (e.g. 50 ml for a 10 pound dog) before moving to another location dog) before moving to another location

It usually takes 6 to 8 hours for all the fluids to be It usually takes 6 to 8 hours for all the fluids to be absorbed absorbed

Check to see if the previously administered fluids Check to see if the previously administered fluids have been absorbed before giving more fluids have been absorbed before giving more fluids

Even though the fluids are given on the back, gravity Even though the fluids are given on the back, gravity will cause the fluids to accumulate on the belly, so will cause the fluids to accumulate on the belly, so check for residual fluids on the belly before giving check for residual fluids on the belly before giving more more

PREPARATIONPREPARATION

The skin is usually The skin is usually notnot cleansed before inserting the cleansed before inserting the needle (if the dog has a normal immune system, the few needle (if the dog has a normal immune system, the few bacteria that are pushed under the skin with the needle bacteria that are pushed under the skin with the needle will be killed by the dog's immune system)will be killed by the dog's immune system)

Alcohol on a cotton ball can be used to make the hair Alcohol on a cotton ball can be used to make the hair lay flat so it is easier to see where the hair ends and the lay flat so it is easier to see where the hair ends and the skin starts. Alcohol takes about 30 minutes before skin starts. Alcohol takes about 30 minutes before bacteria are killed, so just swiping the hair with alcohol bacteria are killed, so just swiping the hair with alcohol is not an effective way to kill bacteria.is not an effective way to kill bacteria.

If dog has an abnormal immune system several patches If dog has an abnormal immune system several patches of hair may be shaved and the injection sites scrubbed of hair may be shaved and the injection sites scrubbed with an antiseptic solution such as Novalsan® or with an antiseptic solution such as Novalsan® or Betadine® before placing the needle to prevent Betadine® before placing the needle to prevent pushing bacteria under the skin pushing bacteria under the skin

NEEDLE SELECTIONNEEDLE SELECTION The thickness of a needle is measured by gauge (g), the The thickness of a needle is measured by gauge (g), the

smaller the number, the thicker the needle. An 18 gauge smaller the number, the thicker the needle. An 18 gauge needle is thicker than a 20 gauge needle. needle is thicker than a 20 gauge needle.

Needles may also be different lengths, one-inch and one Needles may also be different lengths, one-inch and one and one-half-inch are most commonly used. and one-half-inch are most commonly used.

The plastic hub is the wide part of the needle that attaches The plastic hub is the wide part of the needle that attaches to the syringe.to the syringe.

20g needles are most commonly used to give SQ fluids 20g needles are most commonly used to give SQ fluids

although larger needles (18g) may be used in large dogs although larger needles (18g) may be used in large dogs and may be used to draw fluid from the container of fluids. and may be used to draw fluid from the container of fluids.

Smaller needles (22g) may be recommended for Smaller needles (22g) may be recommended for small dogs. small dogs.

NEEDLE DISPOSALNEEDLE DISPOSAL Needles are packaged in rigid plastic cover and wrapped Needles are packaged in rigid plastic cover and wrapped

in paper or plastic to keep them sterilein paper or plastic to keep them sterile

Keep needles in original package until use Keep needles in original package until use

Do not dispose of needles or syringes in the trash. Do not dispose of needles or syringes in the trash.

Keep used needles and syringes in a puncture-proof Keep used needles and syringes in a puncture-proof container such as a biohazard container container such as a biohazard container

Don't use the same needle that was placed under the skin Don't use the same needle that was placed under the skin to draw more fluids from the container of fluids or bacteria to draw more fluids from the container of fluids or bacteria will be introduced into will be introduced into

the container of sterile fluidsthe container of sterile fluids

SYRINGE SELECTIONSYRINGE SELECTION

Usually a large (60 ml) syringe is Usually a large (60 ml) syringe is used for fluid deliveryused for fluid delivery

The syringe is often packaged in a The syringe is often packaged in a plastic case plastic case

Keep the container if the syringe is Keep the container if the syringe is to be used more than onceto be used more than once

SYRINGE DESCRIPTIONSYRINGE DESCRIPTION

The syringe is marked in milliliters (ml) and The syringe is marked in milliliters (ml) and ouncesounces

The syringe is marked at 5 ml increments (5 The syringe is marked at 5 ml increments (5 ml, 10 ml, 15 ml, etc.)ml, 10 ml, 15 ml, etc.)

Each line between the numbers is 1 mlEach line between the numbers is 1 ml This syringe contains 26 ml of fluid.This syringe contains 26 ml of fluid. There is a small air bubble in this syringe. It There is a small air bubble in this syringe. It

is not necessary to remove tiny air bubbles is not necessary to remove tiny air bubbles such as this one when you are giving fluids such as this one when you are giving fluids

SQ. SQ.

FLUIDSFLUIDS Fluids are in plastic bags or glass bottles Fluids are in plastic bags or glass bottles Bags of fluids come packaged in plastic wrapperBags of fluids come packaged in plastic wrapper Remove the wrapper from the plastic bag just Remove the wrapper from the plastic bag just

before usingbefore using The fluid type most often given SQ is Lactated The fluid type most often given SQ is Lactated

Ringers Solution (LRS)Ringers Solution (LRS) Fluids do not contain a preservative, ideally they Fluids do not contain a preservative, ideally they

should only be used only once and then any should only be used only once and then any remainder should be discardedremainder should be discarded

Most veterinarians stock fluids in 1,000 ml bags, Most veterinarians stock fluids in 1,000 ml bags, a much larger volume than is usually given to a a much larger volume than is usually given to a dog at one timedog at one time

PREPARING INJECTION PREPARING INJECTION PORTPORT

The neck of the bag of fluids has 2 ports; the injection port The neck of the bag of fluids has 2 ports; the injection port that is covered with a rubber stopper and a port covered by that is covered with a rubber stopper and a port covered by plastic (blue) in which the spike of a solution set is inserted plastic (blue) in which the spike of a solution set is inserted

Clean the rubber stopper of the injection port with an Clean the rubber stopper of the injection port with an antiseptic solution such as Novalsan® (chlorhexadine) or antiseptic solution such as Novalsan® (chlorhexadine) or Betadine® (povidone iodine) before inserting the needle, if Betadine® (povidone iodine) before inserting the needle, if more than one puncture will be made through the stopper.more than one puncture will be made through the stopper.

Alcohol takes about 30 minutes of contact before bacteria Alcohol takes about 30 minutes of contact before bacteria are killed, so it is not a good solution to use.are killed, so it is not a good solution to use.

Always use a sterile needle to draw fluids from the sterile Always use a sterile needle to draw fluids from the sterile container container

Do not use the same needle to give the fluids to the dog, Do not use the same needle to give the fluids to the dog, and then place that needle back into the fluid container as and then place that needle back into the fluid container as it will become contaminated with bacteria from the skin. it will become contaminated with bacteria from the skin.

NEEDLE PLACEMENT INTO NEEDLE PLACEMENT INTO FLUID BAGFLUID BAG

Remove plastic cap from needle Remove plastic cap from needle Place tip of needle into injection portPlace tip of needle into injection port Needle must be inserted into the Needle must be inserted into the

center of the rubber stoppercenter of the rubber stopper The injection port itself is held so The injection port itself is held so

the needle is inserted the needle is inserted straightstraight into into the injection port. the injection port.

INCORRECT NEEDLE INCORRECT NEEDLE PLACEMENTPLACEMENT

This needle is placed off-center and This needle is placed off-center and is puncturing the injection portis puncturing the injection port

DRAWING FLUID INTO DRAWING FLUID INTO SYRINGESYRINGE

Draw back on the syringe plunger while Draw back on the syringe plunger while holding the syringe barrel steady so the holding the syringe barrel steady so the needle does not pull out of the fluid bagneedle does not pull out of the fluid bag

Fill the syringe to the volume desiredFill the syringe to the volume desired Do not fill a 60 ml syringe past 50 ml as Do not fill a 60 ml syringe past 50 ml as

the plunger may accidentally be pulled the plunger may accidentally be pulled out of the barrel of the syringe and spill out of the barrel of the syringe and spill the fluidthe fluid

RE-DRAWINGRE-DRAWING Replace the 18 g needle with a 20g needleReplace the 18 g needle with a 20g needle When you have given the first syringe full of When you have given the first syringe full of

fluids, change back to the 18g needle to fluids, change back to the 18g needle to draw another syringe full and change back draw another syringe full and change back to the 20g needle to inject the dogto the 20g needle to inject the dog

Keep the plastic caps on the needles as you Keep the plastic caps on the needles as you exchange them. Use one new 18g and one exchange them. Use one new 18g and one new 20g needle each time you give fluids to new 20g needle each time you give fluids to the dog; alternating needles between syringe the dog; alternating needles between syringe

fulls of fluids. fulls of fluids.

ADMINISTERING THE ADMINISTERING THE FLUIDFLUID

Pinch up a fold of skin anywhere along the Pinch up a fold of skin anywhere along the neck or back using your left hand if you neck or back using your left hand if you are right-handedare right-handed

Use your right hand to place the needle Use your right hand to place the needle that is attached to a 60 ml syringe, into that is attached to a 60 ml syringe, into the skin fold along the long axis of the foldthe skin fold along the long axis of the fold

If you place the needle in the opposite If you place the needle in the opposite direction, across the skin fold, it is more direction, across the skin fold, it is more likely that the needle will go through one likely that the needle will go through one fold of skin and out the other fold of skin fold of skin and out the other fold of skin


Before injecting the fluid, pull back on the Before injecting the fluid, pull back on the plunger of the syringe. plunger of the syringe.

If air bubbles appear in the syringe, the If air bubbles appear in the syringe, the needle has gone through both folds of skin needle has gone through both folds of skin and you are sucking room air into the and you are sucking room air into the syringe. syringe.

Remove the needle from the skin and try Remove the needle from the skin and try again.again.

If you get blood, the tip of the needle is in If you get blood, the tip of the needle is in a blood vessel. a blood vessel.

Remove the needle and try again. Remove the needle and try again.


Once the needle is correctly placed Once the needle is correctly placed let go of the skin fold and push the let go of the skin fold and push the plunger to inject the fluidsplunger to inject the fluids

The plunger can be pushed using The plunger can be pushed using one hand by holding the syringe one hand by holding the syringe between your fingers and pushing between your fingers and pushing the plunger with the thumb of the the plunger with the thumb of the same hand same hand

The other hand can be used to The other hand can be used to steady the syringe or comfort the petsteady the syringe or comfort the pet


Alternatively, hold the syringe in one Alternatively, hold the syringe in one hand and push the plunger with the hand and push the plunger with the otherother

The fluids can be injected as fast as The fluids can be injected as fast as the plunger can be pushed the plunger can be pushed


If the needle is not directly attached to the If the needle is not directly attached to the syringe, but is attached to a flexible piece of syringe, but is attached to a flexible piece of tubing (an extension set) first, the dog can move tubing (an extension set) first, the dog can move around a bit while the fluids are being injected. around a bit while the fluids are being injected.

The extension set will be packaged in a The extension set will be packaged in a plastic/paper wrapper. Remove from wrapper, plastic/paper wrapper. Remove from wrapper, remove the white plastic cap from one end and remove the white plastic cap from one end and firmly place on the tip of the syringe. Remove the firmly place on the tip of the syringe. Remove the cap on the other end and place into the hub of cap on the other end and place into the hub of the needle.the needle.

The two ends are different, the female end The two ends are different, the female end fits over the tip of the syringe. The male fits over the tip of the syringe. The male end fits into the hub of the needle. end fits into the hub of the needle.


The needle attached to the extension The needle attached to the extension set is inserted into the injection portset is inserted into the injection port

Draw the prescribed amount of fluid Draw the prescribed amount of fluid into the syringeinto the syringe

Replace the 18g needle with a 20g Replace the 18g needle with a 20g needle and recap the 18g needle with needle and recap the 18g needle with the plastic needle cap the plastic needle cap

Push some of the fluid through the Push some of the fluid through the tubing to evacuate air from the tube, tubing to evacuate air from the tube, a procedure called priming. a procedure called priming.

ADMINISTERING THE ADMINISTERING THE FLUIDFLUID The syringe containing the fluids is laid on the The syringe containing the fluids is laid on the

table. table. Pinch up a fold of skin anywhere along the neck Pinch up a fold of skin anywhere along the neck

and back using your left hand if you are right-and back using your left hand if you are right-handed. handed.

Use your right hand to place the needle into the Use your right hand to place the needle into the skin fold along the long axis of the fold.skin fold along the long axis of the fold.

Pull back on the plunger of the syringe. If air Pull back on the plunger of the syringe. If air bubbles appear in the syringe, the needle has bubbles appear in the syringe, the needle has gone through both folds of skin and you are gone through both folds of skin and you are sucking room air into the syringe. Remove the sucking room air into the syringe. Remove the needle from the skin and try again.needle from the skin and try again.

If you get blood, the tip of the needle is in a If you get blood, the tip of the needle is in a blood vessel. Remove the needle and try againblood vessel. Remove the needle and try again


Once you have checked that the Once you have checked that the needle is correctly placed, let go of needle is correctly placed, let go of the skin fold and push the plunger to the skin fold and push the plunger to inject the fluidsinject the fluids

The plunger can be pushed using The plunger can be pushed using one hand by holding the syringe one hand by holding the syringe between the index finger and middle between the index finger and middle finger and pushing the plunger with finger and pushing the plunger with the thumb of the same hand the thumb of the same hand


If this is difficult, hold the syringe in If this is difficult, hold the syringe in one hand and push the plunger with one hand and push the plunger with the other.the other.

The yellow X marks the site the The yellow X marks the site the needle is entering the skin. needle is entering the skin.


The third method to give SQ fluids is to The third method to give SQ fluids is to attach a solution drip set to a bag of fluidsattach a solution drip set to a bag of fluids

Remove the solution set from the Remove the solution set from the plastic/paper wrapper plastic/paper wrapper

Both ends are covered with plastic caps. Both ends are covered with plastic caps. After removing the cap, the male end fits After removing the cap, the male end fits into the hub of the needleinto the hub of the needle

The white spike is punctured into the The white spike is punctured into the spike port of the bag of fluids after spike port of the bag of fluids after removing the plastic tube that covers the removing the plastic tube that covers the spikespike


The spike port on the bag of fluids is The spike port on the bag of fluids is covered by a blue plastic covercovered by a blue plastic cover

This cover is pulled off This cover is pulled off The cover is tightly covering the The cover is tightly covering the

spike port and you have to pull spike port and you have to pull firmly to remove it firmly to remove it


The white The white spikespike on the solution set is on the solution set is pushed into the spike port. Hold the pushed into the spike port. Hold the spike port in your left hand to guide spike port in your left hand to guide the spike straight into the port. If the spike straight into the port. If you push the spike in at an angle, it you push the spike in at an angle, it may puncture the bag of fluids.may puncture the bag of fluids.


Attach a needle to the other end of Attach a needle to the other end of the solution setthe solution set


The plastic tubing has 2 clamps that must be opened to The plastic tubing has 2 clamps that must be opened to allow fluid to flow allow fluid to flow

The dark blue pinch clamp has a tapered slot, the tubing is The dark blue pinch clamp has a tapered slot, the tubing is pushed to the widest part of the slot to open and pushed to pushed to the widest part of the slot to open and pushed to the narrowest part of the slot to stop fluid flow the narrowest part of the slot to stop fluid flow

The light blue clamp is a roller clamp. Use your thumb to The light blue clamp is a roller clamp. Use your thumb to roll the white disk up, toward the solution chamber to open roll the white disk up, toward the solution chamber to open and in the opposite direction to close and in the opposite direction to close

The fastest flow of fluids occurs with both clamps fully The fastest flow of fluids occurs with both clamps fully openopen

Before placing the needle in the SQ, open the clamps and Before placing the needle in the SQ, open the clamps and let fluid flow until the air is evacuated from the tubinglet fluid flow until the air is evacuated from the tubing

You will see drops of fluid drop in the drip chamber when You will see drops of fluid drop in the drip chamber when the clamps are open. If the drip chamber fills with fluid so the clamps are open. If the drip chamber fills with fluid so that you cannot see the drops forming, turn the drip that you cannot see the drops forming, turn the drip chamber upside down and squeeze some of the fluids back chamber upside down and squeeze some of the fluids back into the bag into the bag


The skin is tented and the needle The skin is tented and the needle inserted along the long axis of the inserted along the long axis of the fold. fold.

You cannot suck back to check for You cannot suck back to check for air so watch the site at which the air so watch the site at which the fluids are entering the skin fold to fluids are entering the skin fold to make sure the hair isn't getting wet make sure the hair isn't getting wet suggesting the needle is incorrectly suggesting the needle is incorrectly placed placed


The fluids can be dripped into the The fluids can be dripped into the SQ space as fast as the drip will go SQ space as fast as the drip will go

The higher you hand the bag, the The higher you hand the bag, the faster the fluids will flowfaster the fluids will flow


The bag can also be rolled up and The bag can also be rolled up and the fluids squeezed out of the bag the fluids squeezed out of the bag for faster delivery for faster delivery

If instructed to use the same fluids If instructed to use the same fluids and solution set for more fluids later, and solution set for more fluids later, place a clean needle covered by its place a clean needle covered by its plastic cover on the end of the plastic cover on the end of the solution set solution set

REFERENCEREFERENCE

http://www.vetmed.wsu.eduhttp://www.vetmed.wsu.edu – giving – giving subcutaneous fluids to a dogsubcutaneous fluids to a dog

subcutaneous fluid administration presented by maj patti glen

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