How to make sub-Q fluids pain free for all

One of the most challenging “homework” assignments that we, as veterinary professionals, sometimes ask of our clients is to administer subcutaneous (sub-Q or SQ) fluids at home-usually to a senior cat in renal failure, though many dogs can benefit from this at-home therapy as well.

Not surprisingly, many clients (and patients) find this task daunting, and their nervousness about performing this procedure is often exacerbated by the fact that they were not properly shown how to administer the fluids during their in-clinic demonstration. Here are a few things to keep in mind when tutoring clients on how to perform this procedure at home:

Instill confidence

The instant most clients see the bag, the lines and especially the 20- or 18-ga needles, they tend to immediately feel intimidated by the equipment and deflated by the whole thing. Because of this, it's really important to:

> Reassure your clients that if their veterinarian thought that this procedure was not able to be successfully performed at home, she would likely not have ordered it. Let them know that given the specifics of their situation, such as their pet's personality and their physical abilities, there's a good chance they'll be able to pull this off, and that it will get easier with practice.

> Inform them that subcutaneous fluids are a cost-effective, simple, relatively painless way to not only extend the longevity of their pet's life, but to also greatly increase the quality of that time. For this reason alone, attempting to perform this procedure at home is absolutely worth trying.

> Reduce their needle anxiety by informing them that, in actuality, the larger bore the needle, the quicker and more painless the procedure will be. But make sure they know that attempting to administer 100 ml of fluids with a 25-ga needle is not the way they want to go.

Make sure they understand the medicine

A lot of clients don't let on to just how confused they are by what their veterinarian or technician is telling them, so take the time to explain things to them thoroughly. By helping them to understand the pathophysiology behind their pet's condition and then going further to explain how these fluids will make a real and tangible difference in their pet's health, you'll motivate them to really try to get it right at home.

Make sure they understand the equipment

Without being condescending, make sure they have a good understanding of how to put together and use the equipment involved, keeping in mind that the way you should explain this to an auto mechanic is going to differ from how you explain it to a grocery store clerk. Knowing who your client is and what they do for a living is always something that both technicians and doctors should keep in mind when communicating with clients.

Be competent throughout the demonstration

A competent fluid demo should go as follows:

> Have the animal, the client and yourself (with or without an assistant) in the room with the unopened fluid bag, the unopened fluid line, an unopened needle, a towel and a fluid hanger.

> Offer the client pen and paper to take notes, or offer to write the steps down for them. (From the client's perspective, it's so easy to think you have a handle on something, only to get home and realize you've completely forgotten everything the technician said.)

> Open each part of the packaging of the bag, the line and the needle for them, showing them where to rip the tabs and how to uncap and re-cap the needles. This may seem heavy on the “spelling it out” approach, but the undertaking of using needles and administering fluids to their own animals can be so overwhelming. For the sake of the pets and their owners, it's important to show them clearly how everything, down to the smallest detail, works.

> Show them where the lock is on the fluid line and how to maneuver the roller from open flow to locked, and recommend that they lock the line prior to puncturing the access port.

> Demonstrate where and how to puncture the bag with the fluid line, familiarize them with how the bag is marked, and make sure they know how much they are supposed to be administering in one session. Mark their bag with a Sharpie at the appropriate intervals if necessary.

> Point out the height at which the bag should hang to ensure smooth fluid flow, and recommend ways that they can achieve that at home, such as hangers hung on cabinets or something similar. Give them any helpful suggestions either derived from your personal experiences of having to give fluids to animals at your own home or that you know from having to deal with their pet personally. Make it friendly, make it individual.

> Show them how to lock and unlock the roller and how to run fluid through the line (into the sink or trash can) to load the line with fluid.

> Show them how to attach the needle to the end of the line.

> Position the animal on the towel, speaking to them in a soothing, gentle tone to keep everybody-client, patient and technician-relaxed.

> Demonstrate how to make a “skin tent” in between the animal's shoulder blades and where to insert the needle. Make sure they know that hesitation is going to be their enemy in this step. Tell them to be confident with the insertion of the needle without “jabbing” the animal with unnecessary force-but that the worst thing that can be done in this stage is a series of clumsy, under-forced (and therefore missed) attempts at inserting the needle.

> Show them how to unlock the line to allow the fluids to flow. Demonstrate what rate of flow they want to achieve and how to maneuver the needle to maximize the flow rate, thereby maximizing efficiency and reducing the time it takes to administer the fluids.

> When the animal has received the appropriate amount of fluids, show them how to lock the line, remove the needle and put slight pressure on the puncture site in case a small vessel was incidentally hit during the process. Let them know that a small amount of blood or fluid leakage is perfectly normal and can easily be stopped by minimal pressure with gauze or a paper towel.

> Finally, offer the pet a treat as a reward and recommend that the client make a habit of doing the same at home so the pet associates the procedure with a reward at the end.

The most important thing to remember when demonstrating any procedure to clients, whether it's SQ fluids, an insulin injection or anal gland expression, is that demos are a really, really important part of our job as technicians. Don't rush through it-or worse, act annoyed because you have a thousand other things that you need to be doing.

Remember that even though you may have performed this procedure 1,000 times, it's going to seem incredibly scary and foreign to most clients, especially when they're having to perform it on their own fur baby at home. Reassure them that you're showing them how to provide their animal with this important therapy in a way that minimizes any potential damage to the relationship between pet and client. After all, having the patience to do demonstrations thoroughly and accurately is one of the hallmarks of a great technician.

Katie Beam, LVT, has spent the majority of her working time as adoption coordinator, vet tech and equine rescue program manager for the Middleburg Humane Foundation in Marshall, Virginia, a private nonprofit farm shelter that specializes in the rescue and rehabilitation of abused and neglected animals. She also assists in managing the boarding business on her mother's 30-acre horse farm in northwestern Virginia.