Hi David, that is a really high creatinine, but perhaps you can bring it down. I had to put my cat to sleep a few weeks ago, but here is my old thread with a lot of information about treating kidney failure and how to do the sub-q fluids:

http://ths.gardenweb.com/forums/load/pets/msg1123035630866.html?19

The Terumo needles, and pre-warming the fluids, was super helpful. My cat also soon made the connection between fluids and feeling better.

I feel like I real gave ZIggy my all. If you think your cat has life in him--go for it, do all that you can do to make the brief time he has left good. You won't regret it. I knew the time had come when Ziggy wouldn't even take food from the syringe, and then one day he went outside and didn't come back in right away like he usually does when it rains. I found him just sitting in the rain. He would NEVER do that--I knew it was time.

Maybe try a thinner needle.

Only you can say when it's "time." One family member insisted on keeping kitty beyond her time. In the end she bit that person deeply on the arm, something she had never done to anyone in her life. It's a horrible memory.

Please know I'm not encouraging you to have her put down. Just sharing our experience. We loved our kitty as you love yours, and it truly was a tough time for us.

Think about her quality of life. Are there things she continues to enjoy like sitting in the sun, being petted, keeping you company? Is she eating a bit? Or does she just lay in her bed?

Thanks for your 2-cents.
I know it differs for all, but can someone tell me: 1) How long you personally gave IV's to your cat; and 2) It must be almost impossible not to re-stick, at times, the same hole - true? Thanks again!

David

I have given subQ fluids to several of the same cats for years (I have never administered an IV, but I assume you meant to ask about subQ's and not IV's). If the needle slips out, or you are unable to get the needle seated properly so that fluids flow freely, change the location of the second stick (even if just slightly). Don't keep sticking the exact same spot, or you'll make the cat tender and sore in that spot.

Laurie

I have also given sub-Q fluids to 3 cats, including my current kitty, and my two older dogs. I started giving the fluids on the advice of my vet in the pets' older years for the remainder of their lives, to counteract dehydration and decreasing kidney function. As Laurie said, try to pick a different spot each time to stick the needle. I suppose previous needle holes heal over fairly quickly, as the diameter of the hole is so small.

I'm sorry that you're having a hard time with your cat. As others recommended, a smaller diameter needle might be more comfortable for your cat. I use a size 20 gage. I agree with Socks that if your cat is enjoying parts of his life, then he probably is not ready to give up. I wish you luck.

I have been doing this daily for 4 1/2 years with no regrets. Kitty is doing real well. Terumo needles (either 18's or 20's) are a must! My cat decided on the 18's since they are faster. You can order them online at thriving pets. Aldo you can save quite a bit of money by buying fluids from a regular pharmacy.. Maybe a couple of treats after fluids might entice kitty to behave.

1. Does it matter so much if the fluid ends up on mostly one side of the body because you don't have the needle dead-center?
2. How far up (towards the head) or back (towards the tail) can one go (I know shoulder area is the target)?
3. My vet adds vitamin B-12 to the pouch? How important is that? If important, can a pharmacist do that too? Does one get the needles also there. Is there savings on just a pouch or 2 at a time, or our we talking a case?

1) No, it doesn't matter at all. In fact, I typically aim the needle tip so that the fluids run down over one shoulder or the other. They seem to flow more readily when aimed downward. The only consideration here is that you don't want to admin more than 100 ml in one spot during one admin (it's a rare circumstance that would necessitate more than 100ml to be administered during a single session, anyway). If the fluid pocket becomes too large, the cat will become uncomfortable and likely uncooperative.

I have also, on occasion, placed a needle in a spot that is clearly uncomfortable for the cat. When that happens, I just remove the needle, reposition it slightly, and try again. It's important to note that a needle will dull significantly after the first stick, so it's generally better to use a fresh needle if you have to re-stick.

2) The rule of thumb is to use a spot within the "saddle" area (meaning the area where a saddle would be placed if the animal was a horse). That said, most cats become a LOT more sensitive and tender the further behind the shoulders you stick them, so it's best to stay at or slightly behind the shoulder area.

3) B12 supplementation is often helpful for cats receiving fluids, because B vits are excreted in urine. HOWEVER, it is NOT a good idea to mix B12 into the fluid bag itself. B12 degrades quickly when exposed to light and/or heat. Also, anything mixed into the fluids holds the potential to contaminate the fluids with impurities that may conceivably cause abscesses or other problems at the injection sites.

Instead of mixing B12 into the fluid bag, you should request a prescription for injectible B12 to keep at home in your own refrigerator. Then once a week, you can admin B12 with subQ fluids by injecting the dose directly into the injection port in the LINE (not the bag). That way, you don't have to stick your cat with another needle, AND the B12 won't enter the fluid bag itself. Of course, you'll need to buy lines with an injection port (in case the lines you're using now don't have an injection port).

This is how I give my kidney cats their weekly B12 with subQ's. After the first 25-50ml of fluids have gone in, I inject the B12 into the line. That way, there is enough of a fluid pocket already present to help warm and dilute the B12 as it enters the body, making it virtually undetectable to the cat. AND there is enough fluid continuing through the line to push the B12 through and clear the line.

The most popular needle for use in administering subQ fluids to cats by caretakers is the Terumo 20 ga x 1" Ultra Thin Wall needle available here:

Terumo needles

Here's a link to the IV sets (with injection port) I buy from the same source:

IV lines

I have never found a local source for buying a single bag or two of fluids at a time (other than my vet). I always buy by the case and get substantial savings that way. It is important, however, to call around to ALL local pharmacies and obtain prices on cases (and make sure you are pricing the name number of bags per case, since that varies by manufacturer and fluid type). Prices can vary WIDELY from pharmacy to pharmacy.

Laurie

I administered Sub-q fluids to my kitty for three years before she passed away a few weeks ago. I strongly urge you to view several "how to" videos on youtube...it was immensely helpful to me.

I used 18 gauge needles. I did try 20 gauge at one point, but the process took longer, which made the cat impatient. I always warmed the fluids in a bowl of warm water before administering. I hung the fluids from a hanger on my bedroom curtain rod and let kitty lie down on a sweatshirt, etc. for coziness.

The videos were incredibly helpful, though, and I do recommend them.

Good luck! My kitty was terribly sick when we started doing this, and her labs ended up stabilizing nicely. I enjoyed three more years with her and it wasn't her renal disease that killed her in the end.

Sending positive thoughts your way.

The nice thing about the 20 ga Terumo Ultra Thin Wall design needles is that they have a smaller exterior diameter than a standard 18 ga with an almost identical fluid flow rate.

Thanks to all for your info. Another question though:

When you began sub-q's regularly how often did you give them? How can one tell? If he seems "lethargic" should I assume he needs a "pick-me-up"?

The first animal I gave fluids to was one of my old cats in her late teens. My vet showed me that my cat was dehydrated by pulling her skin away from her body so that I could see how it was slow to retract because of the dehydration. He told me that if I gave fluids to my cat once a week it would help her feel better and enable her to live longer. Then he had a vet tech demonstrate with my cat, showing me how to do it, and I agreed to try giving the therapy at home.

As my cat aged and entered her twenties, another vet directed me to increase the frequency of the fluid treatments to twice weekly to keep up with her failing kidneys.

Very old cats often sleep much of the time, more so as they age, so lethargy alone isn't always an indicator that your cat needs more fluids, although it can be. By also checking the animal's skin for dehydration and observing if your cat appears nauseous or has a loss of appetite, you can get an idea of how he is doing. If you feel that your cat could use more frequent hydration treatments, I'd suggest that to your vet and see if he/she agrees. I've done so with at least one of my animals as they aged and gotten the green light to give the treatments more often. Sometimes my vet will suggest increasing the treatment frequency while examining my pet. This just happened with my current 20 year old cat who I took to the vet for another issue last week. The vet instructed me to start giving my old girl fluids every other day, so that is what we are doing now. We were previously on a once weekly schedule since she was about 16 yrs old or so.

I usually make an effort to stick with the vet recommended schedule as a general rule. Sometimes, however, you might miss a treatment if you have a hectic day, or decide on a given day that your cat looks like he could use a pick-me-up dose of fluids ahead of schedule, and that is OK.

I hope this helps. It can be somewhat overwhelming at first, but it gets easier as the process becomes more familiar to you and your cat. Don't hesitate to ask more questions here and at the vet's. You've gotten some very good info here, and also there are some forums on the web that are soley devoted to owners of CRF (chronic renal failure) cats, as well as "how to" videos on youtube as Junebug suggested. Good luck and let us know how it goes.

With a creat of 7.0, your cat should be receiving fluids daily IF his heart is healthy. If his heart is compromised in any way, though, he may not process fluids as efficiently as necessary to prevent fluid buildup and possible congestive heart failure. In that case, you may still be able to admin fluids daily, but at a reduced volume. This is something you need to discuss with your vet, since none of us know anything about your cat's cardiac health.

There are a number of physical indicators of dehydration in CRF cats: excessive thirst, constipation, slow capillary refill (press your thumb firmly against the gums and see how quickly the pink color returns when you remove your thumb), tacky gums (they should be slick and slimy), sunken and/or dull eyes, dull/clumpy/dandruffy coat, and slow rebound of tented skin.

It's better for the cat if you give fluids daily. If your vet prescribes 150ml every other day, administer it as 75ml every day. Not only will this be more comfortable for the cat during admins (large fluid pockets can be uncomfortable), but it will also keep him more evenly hydrated, which will improve his condition overall. When you admin a bolus of fluid, the cat processes that fluid typically within 12 hrs or so. So if you're giving fluid once a week, your cat has 12 hrs of good hydration, followed by nearly a week of increasing dehydration. Same holds true if you're giving fluid every 48 hrs. Your cat would be constantly swinging between overhydration and underhydration. But if you give fluids daily, the hydration level remains much more even and beneficial for your cat. Also, if there is any question about the health of your cat's heart, smaller volumes of fluid administered more frequently will help to avoid overwhelming the heart's ability to process a larger volume of fluids.

Again, with a creat as high as your cat has, daily fluids are typically recommended if his heart is healthy. Check with your vet.

Laurie

This post was edited by laurief on Tue, Jun 11, 13 at 23:42

Yet a couple of other questions:
1. Should the needle go in all the way? Thought I heard on one YouTube video to only insert half way(?). Maybe it doesn't matter.
2. Using the same catheter, I changed out my 1st tube using it again w/ the next pouch. Was told by my vet re-using the tube (a couple of times) would be fine. How easy is it to contaminate things?

1) If you're using 1" needles, they should go in all the way. If you're using needles that are longer than 1", switch to 1" needles.

2) I use a new IV line with every bag of fluids. Their inexpensive cost is worth avoiding the risk of contamination, esp. if you are injecting anything into the bag or line like B12. I prefer safe over potentially sorry.

Laurie

I agree with Laurie; I use one line per each bag of fluids. Better safe than sorry, and it is easier to just leave the line attached for the life of the bag.

The needles I use are longer than 1" because they do NOT go in all the way. They go in about 1/2 way. Whatever is easiest for you is the best way to go.

We kept a beloved kitty alive and comfortable for an extra year and a half with IV fluids.

I cuddled him in a towel on my lap during each session and gave him a special treat afterward -- that helped him make a positive association with the routine.

Also, I would gently pinch up loose skin and insert the needle at an angle, so as not to poke any muscles.

A local compounding pharmacist was able to get us all the supplies we needed at a lower price than the vet charged.