Giving Your Cat Subcutaneous Fluids: Treating Chronic Renal Failure (CRF)

One easily spotted symptom of Chronic Renal Failure (CRF) in cats is that the kidneys no longer process fluids as they should. If you use scoopable litter you may notice clumps of passed liquids much larger than you're used to seeing. Your cat may also seem obsessed with water, teasing around faucets or coming into the shower to lick it up. (If this describes your cat, get it to a vet now.)

This is happening because the kidneys can no longer take in regular water and send it out to the body. Thus your cat may become seriously dehydrated, even though he's drinking - and passing - much more water than he used to. The way around this is to give your cat fluids subcutaneously (sub-q fluids in medical jargon). This way they can be absorbed directly into the body, bypassing the kidneys. This means sticking your cat with a needle, and yes, that's scary. But you can get used to it, and it can not just prolong your cat's life but greatly improve his quality of life and give you both more happy time together.

The hardware's pretty simple. First, you'll need a bag of Lactated Ringer's solution (LR), the actual fluid. You can't use regular or distilled water. Essentially LR is water, but water that's adjusted to the proper saline level to match live tissue (which is what the kidneys would normally do). Second, you'll need an IV line, which is just a plastic tube with the fittings you'll need. And finally, you'll need some needles. Your vet can provide all this equipment and show you how to use it. It's simple stuff and not very expensive.

Now, the process. First you'll assemble your kit. It's pretty easy. Start with the IV tube, which should come sterile in plastic. It will have a roller clamp you can operate with your thumb. Make sure that's closed so you don't leak LR all over the place. Next find the end with the drip chamber. Just above that should be a good sized hollow tube of hard plastic with a sharp point. That goes into a sleeve on the bottom of the bag of fluids. Once you push it far enough up in there, it will pierce the bag and fluids will drip into the drip chamber. You've now got the line attached and can leave it there until you've used up the bag - and you'll probably get more than one treatment out of a bag.

Once that's done, attach the needle. The needle should come in a sterile packet with a cover over the needle itself. Leave that cover on. These needles are sharp, and it's easy to jab yourself if you're not careful. There will be a plastic collar at the rear of the needle. At the loose end of the IV line will be a plastic cap. Take it off and you should see a small fitting. The collar on the needle goes on over that. Get it on there nice and firm so it doesn't leak. The kit's now assembled. Next, purge the line. You'll have to remove the needle cover for this. Then open the roller clamp. Water will drip from the bag into the drip chamber, run down the line and squirt out the needle. Let just a little come out, enough so you can see that there aren't any leaks, and that there's no air in the line, then clamp it off again and cap the needle.

Now you're ready to go. This is best treated as a two-person job. One to hold and comfort the cat, and one to handle the gear. The best place is the bathroom. For one thing it's got a sink, which is handy when purging the line so you don't just squirt fluid around the house. For another, it's a confined space. And if you have other cats you can shut them out. The last thing you need in the middle of this is another cat getting curious and coming to investigate. Or play. And finally, your bathroom probably has a place to hang the bag. For this to work, the bag needs to be held up above the cat, and that's pretty awkward if you try to do it by hand. There should be a flap at the top of the bag with a hole. That's meant for hanging the bag from a rack in the hospital. But you can just take a wire coat hanger and thread the hook through that hole. Then you can hang the bag from a towel hook, the shower rod, whatever's handy.

Finally, bring in the cat and get him ready. It's probably best if you sit on the floor. Cats are hugely variable so only you can predict how well your cat's going to tolerate this. But you need to hold him still or it will just be worse for both of you. Then uncap the needle and carefully insert it. Your vet will show you how to do this but you basically just pull up a bit of skin at the scruff of the neck and carefully slide the needle in. One thing working in your favor is that we're talking subcutaneous, not intravenous. That means you don't have to find a vein. All you have to do is get it through the skin, into the space you've pulled up between his skin and muscle. It's much easier. Be careful not to poke the needle into muscle - that will hurt - or go all the way through the flap of skin and out the other side.

Once you're sure you've got the needle in place, open the roller clamp and fluid should start to flow. The drip chamber is your indicator. If it's dripping, then the fluid is flowing, and you can tell roughly how fast. It's not unusual for a little fluid to leak out around the needle site, but if you're getting soaked then fluid's not getting into the cat and you've done something wrong. But hopefully fluid's now running properly and all you have to do is keep the cat calm and still so it doesn't yank the needle out, and keep an eye on the gauge printed on the bag. Your vet will tell you how much of the bag you should use at one time for your cat. When you get to that point, just close the roller clamp and gently slide out the needle.

The worst is over. You've done it. Note that it's likely you'll see a big lump on your cat wherever the fluid has collected beneath his skin. This looks strange, but it's harmless. The fluid will be absorbed over the next few hours and that lump will disappear. You can let him go. All you have to do now is put the kit away. First, take the needle off and put the plastic cap back over the end of the IV line to protect it. Throw the needle away. Don't try to reuse it as it's no longer sterile. For some reason the needles seem reluctant to come off the line after use - put the cover on the needle before you start messing with it. If you do jab yourself, these needles will go deep. The wound will bleed more than you'd think it would, and it will hurt. Best to just keep that thing capped at all times.

The rest of the kit you'll be reusing next time. It's already assembled and closed off so the fluid's still sterile. The easiest thing to do is just loop the line over the coat hanger so it's controllable, and hang the whole kit up in a spare closet. You'll probably get two or three uses out of a bag of fluid. The IV line you can keep on reusing indefinitely, but check it whenever you use it. If anything seems wrong with it, go ahead and get another one. All these pieces are quite affordable.

And you're done. Obviously this isn't fun for you or your cat, but you can take comfort in knowing you've not only helped extend his life but you've also made him more comfortable. Your cat can't take care of this problem himself, so it's up to you to overcome your nervousness and help him. He's counting on you, and you can do it.