What are your thoughts on IP fluids?

Re: What are your thoughts on IP fluids?

Gillian Mostyn — Mon, 15 Sep 2014 12:09:06 GMT

I am another fan of s/c fluids in small furries, rabbits and cats. Brilliant for maintenance fluid requirements - obviously not for volume replacement.

Re: What are your thoughts on IP fluids?

Martin Atkinson — Mon, 15 Sep 2014 11:02:58 GMT

[quote user="Mark Holmes"]Look if it's drinking give it a bowl of water if it's not drinking drip it. I don't see the benefit of the sc route - besides which a useful volume is painful. If it's dehydrated and not drinking you have a problem which is not going to go away with 20 mls of sc fluids.[/quote]I think you are missing the point Mark. Of course IV is the best method of giving fluids or rarely intra-osseous if you can't find a vein but there are many occasions when an animal that is not drinking or has not had the opportunity to drink when SC fluids are very useful (and we're not talking just a miserly 20 ml). Here are just a few I would use on a daily basis:

* Peri-operatively for the old cat having a dental whose kidneys are OK but you just want to be sure but don't want to stretch to a drip

* The 7.30 pm D&V case

* The owners can't/won't pay for IV fluids

* Cats with CKD for ongoing additional fluid supplementation +/- through a skin button

60 ml is tolerated very easily by a cat, often twice this amount - this is significant amounts.

Re: What are your thoughts on IP fluids?

Kate Richardson — Sun, 14 Sep 2014 16:24:18 GMT

Subcutaneous fluids in cats are very useful for all the reasons stated above. I rarely find cats find it painful even if large volumes are given if administered the way John describes (ie via a giving set and needle) opposed to injecting- they always find this painful in my experience.

Re: What are your thoughts on IP fluids?

Hannah Wynne Richards — Sun, 14 Sep 2014 10:25:07 GMT

IV is my route of choice, but I will give s/c if necessary - usually because the owner won't pay for hospitalisation. I give 100 to 250 ml warmed Hartmans S/C It's amazing how quickly the lumps disperse, and how much brighter the cat is afterwards, so I would say it's well absorbed (ok, I don't work at uni, so it can't be EBM!). Obviously some discomfort whilst giving,but, given the cat is so much brighter in a very short time, I think the overall result is welfare positive.

Like Micheal, I've found warmed ip fluids life-saving in lambs - and I believe there was a paper in the VR (written by an academic, therefore EBM) during the late 80s which actually advocated it.

Having said that, I wouldn't even consider it in any other species, as I consider there are much better methods. Lambs don't have the same amount of loose skin as cats or rabbits or hamsters, and farmers certainly won't pay for drips - which would be my method of choice if they did.

Wynne

Re: What are your thoughts on IP fluids?

John Flynn — Sat, 13 Sep 2014 22:17:44 GMT

[quote user="Mark Holmes"]If it's dehydrated and not drinking you have a problem which is not going to go away with 20 mls of sc fluids.[/quote]

I tend to use much bigger volumes - if I was giving just 20ml then I guess a syringe and orally might be just as easy if the cat tolerated it.

If I figure that a cat might not drink for a day and is "5% dehydrated" and don't particularly want to drip it, then I might give it something between 200-500ml of SC fluid - a bit like a hump on a camel.

The administration does not appear particularly painful (as evidenced by the cat sitting there with a SC needle in and a drip bag running in), but I accept that this is likely to cause discomfort; whether this is a bigger negative effect on the cat's welfare than being "hospitalised" on a drip probably depends on the cat.

I accept that this is an exception rather than the norm for me personally, but I can see in my head theoretical benefits to not administering fluids intravenously with serious high blood pressure or serious risk of decompensated congestive heart failure. Equally, not all cats are amenable or aided by repeated oral syringing of fluids.SC fluids have a place I reckon and if anything I sometimes wonder if I underuse this method when compared to "admitting" for a drip.

Re: What are your thoughts on IP fluids?

Mark Holmes — Sat, 13 Sep 2014 20:49:12 GMT

[quote user="John Flynn"]

[quote user="Mark Holmes"]If it's only mildly dehydrated - give it a bowl of water.[/quote]

What if It's not drinking?

I use SC in cats on occasions; rarely as my method of choice (maybe an old cat that is anorexic/adipsic with mild dehydration and high blood pressure and under treatment for congestive heart failure; or alternatively a patient I think is better served by going home again than staying in on a drip).

[/quote] Look if it's drinking give it a bowl of water if it's not drinking drip it. I don't see the benefit of the sc route - besides which a useful volume is painful. If it's dehydrated and not drinking you have a problem which is not going to go away with 20 mls of sc fluids.

Re: What are your thoughts on IP fluids?

John Flynn — Sat, 13 Sep 2014 15:55:39 GMT

[quote user="Mark Holmes"]If it's only mildly dehydrated - give it a bowl of water.[/quote]

What if It's not drinking?

Re: What are your thoughts on IP fluids?

Michael Woodhouse — Sat, 13 Sep 2014 13:26:07 GMT

I use the technique in lambs and teach it to farmers - warmed glucose solution. The lambs are usually 'flat' but never seem in the slightest bit bothered when you stick 50-100ml into the peritoneum in a 5kg lamb (10-20ml/kg). I'm not convinced on the pain argument, but the risk of infection has to be greater. There are case reports of giving blood by that route in lambs.

I would consider the route in a small puppy or kitten if needed.

A quick literature search finds that the route has been used in children successfully.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2427569/

I only drip cats if I have to, I'm very fond of s/c fluids. Warmed fluids given under the skin seem to get into circulation very quickly. I'd love someone do study how quickly it produced urine output compared to IV.

Re: What are your thoughts on IP fluids?

ChrisBVSc — Sat, 13 Sep 2014 09:26:43 GMT

Unusual approach! Is this a UK grad? Old/young? (I realise these facts may give the game away but I'm genuinely intrigued!)

Re: What are your thoughts on IP fluids?

Mark Holmes — Fri, 12 Sep 2014 23:29:48 GMT

[quote user="Martin Atkinson"]

[quote user="Mark Holmes"]The only routes for fluids that are justified are intraosseous iv and oral. Anything else is a waste of time.

[/quote]I wouldn't go as far as to say that. Certainly in a state of life threatening dehydration or shock this is true but as a precaution in a mildly dehydrated animal both SC and IP are acceptable. I don't routinely give IP fluids but if pushed it must be better than SC for rate of absorption and it is often advocated as a route in small exotics. However I have performed IP dialysis in acute kidney failure cases and not had complications so I think the danger is over-played.

If this practitioner is confident and experienced with giving fluids by this route then I see no issue.

[/quote] If it's only mildly dehydrated - give it a bowl of water.

Re: What are your thoughts on IP fluids?

Evelyn Barbour-Hill — Fri, 12 Sep 2014 20:30:21 GMT

IPA? Thank you, I don't mind if I do.

Re: What are your thoughts on IP fluids?

Marie Kubiak — Fri, 12 Sep 2014 19:23:08 GMT

I don't understand why it is promoted as a suitable route for small furries - blindly injecting the abdomen in a small, wriggling animal with thin walled large hindgut seems a recipe for disaster. It has also been suggested (extrapolating from humans) that increased abdominal pressure with sudden fluid introduction causes quite significant discomfort. It doesn't take much more effort/skill to give fluids via a more sympathetic route and I would be concerned about someone who injected IP routinely without considering other options.

Re: What are your thoughts on IP fluids?

Martin Atkinson — Fri, 12 Sep 2014 09:48:42 GMT

[quote user="Mark Holmes"]The only routes for fluids that are justified are intraosseous iv and oral. Anything else is a waste of time.

If this practitioner is confident and experienced with giving fluids by this route then I see no issue.

Re: What are your thoughts on IP fluids?

Hannah Wynne Richards — Fri, 12 Sep 2014 08:58:22 GMT

Useful in dehydrated, freezing cold lambs. I've never tried it in anything else - and have no intention of doing so either.

Wynne

Re: What are your thoughts on IP fluids?

Mark Holmes — Fri, 12 Sep 2014 06:43:07 GMT

The only routes for fluids that are justified are intraosseous iv and oral. Anything else is a waste of time.

Re: What are your thoughts on IP fluids?

CatherineThomas — Thu, 11 Sep 2014 23:54:04 GMT

i don't think I've ever given IP fluids to anything in small animal practice. I definitely wouldn't give anything IP in a rabbit, their caecum and intestinal walls can be so thin and fragile that I think the risk of perforation would be too high. If you can't get a vein or just want to give a bolus then why not give the fluids subcut, surely far less risky? If subcut fluids are judged not sufficient then I would say IP fluids will not be sufficient either and a drip is needed.

Re: What are your thoughts on IP fluids?

Linda Filshie — Thu, 11 Sep 2014 23:02:13 GMT

Eek. I've only ever given IP fluids to dehydrated lambs way back in the day when I was a student. I suppose it might be one up from a s/c bolus, but only just.

You can get a vein on almost everything (as an aside I freaking love EMLA cream) and I don't see why you wouldn't use this route if you can.