Long term sub-cut. fluid therapy for cat with CKD

Re: Long term sub-cut. fluid therapy for cat with CKD

Martin Atkinson — Thu, 11 Aug 2011 13:54:05 GMT

[quote user="Simon Neuhoff"]

I use a butterfly generally which makes things easier to control, up to 50ml per site usually and I give 100ml per treatment. I have tried to teach owners how to do this but most seem to prefer to come in for the nurse to do it on a regular basis.

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Not wishing to labour the point: but this illustrates the whole situation: the owners are very much happier using a blunt needle with the skin button and they can perform it at home continually. Cats in near end-stage renal failure need large volumes of additional fluid on a daily basis so unless they're prepared to come in twice daily every day for 100ml each time its like trying to put out a house fire by pissing on it.

Re: Long term sub-cut. fluid therapy for cat with CKD

Simon Neuhoff — Thu, 11 Aug 2011 13:36:33 GMT

[quote user="Martin Atkinson"]

[quote user="Becky Filby"]

Do you not find them painful when giving large volumes in one site? Or do you usually splilt the volume required over the course of the day? I've never used a skin button but usually found giving subcut fluids that most cats tolerate up to around 10-15ml per site but beyond this seem to get uncomfortable, even when given very slowly. It's always put me off using subcut fluids on a regular basis.

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Some patients find it uncomfortable to start but once the sub cutaneous tissue is stretched it becomes easier and 50-100ml is possible. The skin button doesn't necessarily allow larger volumes to be administered but it is easier to control the cat than with it wriggling on the end of a hypodermic needle, is more comfortable than constantly injecting and most owners are happier not having to use a needle.

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Re: Long term sub-cut. fluid therapy for cat with CKD

Evelyn Barbour-Hill — Wed, 10 Aug 2011 13:21:20 GMT

[quote user="robloxley"]

[quote user="Becky Filby"]Do you not find them painful when giving large volumes in one site?[/quote]

Many cats will quite happily sit for large volumes - 100ml plus. I'm not saying all, however.

[/quote]

In other contexts or other threads people would now be jumping about saying how cats conceal pain and how difficult it is to assess.

Re: Long term sub-cut. fluid therapy for cat with CKD

Alex Gough — Wed, 10 Aug 2011 12:49:00 GMT

I once tried to get hold of a valve device that you could bury subcutaneously. You could access it with a needle, but the tubing could then lead into the abdomen (or elsewhere). I was thinking of using it for chronic ambulatory peritoneal dialysis for chronic renal failure. However, the company was american, and refused to supply it for veterinary use without FDA approval!

alex

Re: Long term sub-cut. fluid therapy for cat with CKD

Martin Atkinson — Wed, 10 Aug 2011 09:50:58 GMT

[quote user="Becky Filby"]

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Re: Long term sub-cut. fluid therapy for cat with CKD

Rob Loxley — Tue, 09 Aug 2011 23:14:38 GMT

[quote user="Becky Filby"]Do you not find them painful when giving large volumes in one site?[/quote]

Many cats will quite happily sit for large volumes - 100ml plus. I'm not saying all, however.

Re: Long term sub-cut. fluid therapy for cat with CKD

Becky Filby — Tue, 09 Aug 2011 21:20:07 GMT

Re: Long term sub-cut. fluid therapy for cat with CKD

Martin Atkinson — Tue, 09 Aug 2011 09:47:22 GMT

[quote user="Simon Neuhoff"]

Are they placed under local Martin or do you have to do a GA? Where do you get them from?

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I tend to sedate moderately with medetomidine which of course you can reverse and also infiltrate the site with a bit of local. The skin button kit comes with a skin punch to make a small hole you wiggle the button through and then it is best secured with a few stay sutures, these can come out after a week and the skin has healed into the button. The buttons are available in the UK from Direct Medical Supplies tel. 07041 527007 and cost about £40 for the kit which also has a small supply of access needles and instructions. Spare access needles are available. The advantage over just using a hypodermic needle is the user-friendliness for clients, toleance by the animal and because the access needle locates firmly into the button it is less likely to pull out if you choose to drip the fluid in with a giving set. Whether the complication I had which was mentioned in the OP is a common occurrence in the long term remains to be seen.

Re: Long term sub-cut. fluid therapy for cat with CKD

Rob Loxley — Tue, 09 Aug 2011 00:12:44 GMT

I have had a few cases where I have sent cats home on s/c fluids. I (& they) have got on well with a 1l bag of fluids, giving set and green needle and just running it in over a couple of minutes.

The FAB sheet is useful to print out for owners http://www.fabcats.org/owners/kidney/subcutaneous/info.html

Have had a look at the endo-sof s/c catheter from Dechra (http://www.dechra.co.uk/Step-by-Step-Guides/Endo-Sof.aspx) but haven't used it

Re: Long term sub-cut. fluid therapy for cat with CKD

Simon Neuhoff — Mon, 08 Aug 2011 17:46:20 GMT

Are they placed under local Martin or do you have to do a GA? Where do you get them from?

Re: Long term sub-cut. fluid therapy for cat with CKD

Martin Atkinson — Mon, 08 Aug 2011 17:26:37 GMT

[quote user="Claire Edgington"]

With the risk of sounding stupid, what is a skin button? I've never come across this before.

[/quote]

You're not stupid Claire, precious few other people other than those who follow my ramblings or have been to a lecture by Kit Sturgess have heard of them either. They are little latex ports with a valve that you suture into a small incison in the scruff and which then 'heal' into the skin, through which you can inject fluid in large volumes with a blunt access needle with no objection from the patient. Cunning.

Re: Long term sub-cut. fluid therapy for cat with CKD

Claire Edgington — Mon, 08 Aug 2011 16:42:57 GMT

With the risk of sounding stupid, what is a skin button? I've never come across this before.

Re: Long term sub-cut. fluid therapy for cat with CKD

Martin Atkinson — Mon, 08 Aug 2011 14:25:24 GMT

[quote user="Alice Courtney"]

Does anybody know what the VDS's stance is on subcut fluids? I once got a referral of a cat with CRF, whose own vet had been told that the VDS would not support any problems as a result of subcut fluid therapy? Obviously the client needs adequate training in administering the subcut fluids, and needs to be aware of any potential problems, but if the cat is not on medication, how often does everyone see the cat for re-examination?

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I hadn't even considered the question. I can't see why the VDS would have any difficulty defending a case if the client had been shown how to do it and performed it front of the vet any more than if they were giving insulin - less so in fact as you're unlikely to kill the patient with an overdose. Especially if you are using a skin button as it is specifically designed for the purpose. However maybe a consent form or disclaimer may be a good idea in future.

Second part of the question: I would think that almost by default the patient would be being treated for a condition that required other medication and regular monitoring so it would be back pretty frequently anyway. The 3 cases of CKD in cats with skin buttons that I've been referring to were seen at least once a week.

Re: Long term sub-cut. fluid therapy for cat with CKD

Alice Courtney — Mon, 08 Aug 2011 13:38:23 GMT

Re: Long term sub-cut. fluid therapy for cat with CKD

Thomas Johnson — Mon, 08 Aug 2011 09:04:15 GMT

I saw a client recently who had been staying with family in Italy with her dog. Whilst in Italy the dog was very unwell and diagnosed with renal failure. After initial hospitalisation the dog was discharged for the owner to continue subcut fluids at home, with ranitidine and metoclopramide added to the drip bag.

I am generally quite cautious about using metoclopramide in animals with renal disease, but the dog did very well for several months before needing to be euthanased.

Re: Long term sub-cut. fluid therapy for cat with CKD

Martin Atkinson — Thu, 04 Aug 2011 18:25:23 GMT

[quote user="pjmontgo"]

I have a cat which is on sub cut fluids, spent 3 days in the hospital in may in the incubator as it was unable to maintain its temperature and its urea and creat were off the scale, it was sent home with sub cut fluids but given a guarded prognosis and has suprised us all!! It has aproximately 50ml a day, much less than your cat and is eating well and gaining wt. Maybe you are trying to give too much fluid?

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Thanks for your reply, a month on I have some more experience from this case. I don't think its a question of too much fluid, I personally think that 50ml daily is nowhere near enough. Given that for the first 6 weeks of giving this volume of fluid it was absorbed like a sponge, it was odd that it should suddenly stop. Subsequent to the OP, the owner had since managed to give the fluids sub cut by hypodermic needle and varied the injection site whereupon the 150-200ml (50ml 3-4 x daily) of fluid was absorbed easily again, and only used the skin button once a day with about 20ml just to maintain its patency. My assumption now is that some sort of false cystic cavity due to inflammation/granulation was formed. The cat in question was PTS last week over 11 weeks after being diagnosed with terminal renal failure and being advised it should be euthanased by another vet. I've never had a cat go longer than 2 weeks without peritoneal dialysis or regular diuresis once its renal failure was as bad as this one. It would have been nice to have done a PM exam to investigate the reason for non-absorption but the owner took the cat home for burial. I believe that this is testament to the value of supplementary fluids in renal failure in cats and to the abilty of the client to carry out the procedure at home. Whether it is right or wrong or if it was worth the trouble and expense is another question but the owner was happy and sensible enough to request euthanasia once the cat was moribund, the cat was very tolerant of its treatment and had nearly 3 months of additional quality life. For clients who are not as adept at giving sub cut fluids using a hypodermic syringe the skin button offers a viable alternative method.

I would be interested to know what your cat's renal parameters are now and if it was a reversible acute renal failure pj.

Re: Long term sub-cut. fluid therapy for cat with CKD

pjmontgo — Thu, 04 Aug 2011 17:11:12 GMT