Presentation on theme: "SUBCUTANEOUS FLUID ADMINISTRATION"— Presentation transcript:
1SUBCUTANEOUS FLUID ADMINISTRATION PRESENTED BY MAJ PATTI GLEN
2INTRODUCTION-Fluid given under the skin, subcutaneously (SQ), is absorbed into the blood stream and can be used to correct or prevent dehydration.-The most frequent disease for which fluids are given is chronic kidney failure. Dogs with chronic kidney failure pass large amounts of urine and may not feel well enough to drink enough to prevent dehydration.-Subcutaneous fluids may be given a few times a week to supplement the water the dog is drinking in order to prevent dehydration and help flush waste products through the kidneys.-The most common fluid type given to dogs with chronic kidney failure is Lactated Ringers Solution (LRS).
3SUBCUTANEOUS FLUID ADMINISTRATION INDICATIONS Slightly ill and mildly dehydrated animalSlightly prolonged skin tent or capillary refill timeMild diarrhea or vomiting of short duration
4SUBCUTANEOUS FLUID ADMINISTRATION TECHNIQUE Three general techniques used to give SQ fluidsWith a syringe and needle With a syringe, needle and flexible tubing called an extension set From a vinyl bag using a solution drip set
5GUIDELINES Subcutaneous fluids are tolerated by most dogs 10-20 ml per kg of body weight (5 -10 ml per pound) can be given in one spot (e.g. 50 ml for a 10 pound dog) before moving to another locationIt usually takes 6 to 8 hours for all the fluids to be absorbedCheck to see if the previously administered fluids have been absorbed before giving more fluidsEven though the fluids are given on the back, gravity will cause the fluids to accumulate on the belly, so check for residual fluids on the belly before giving more
6PREPARATIONThe skin is usually not cleansed before inserting the needle (if the dog has a normal immune system, the few bacteria that are pushed under the skin with the needle will be killed by the dog's immune system)Alcohol on a cotton ball can be used to make the hair lay flat so it is easier to see where the hair ends and the skin starts. Alcohol takes about 30 minutes before bacteria are killed, so just swiping the hair with alcohol is not an effective way to kill bacteria.If dog has an abnormal immune system several patches of hair may be shaved and the injection sites scrubbed with an antiseptic solution such as Novalsan® or Betadine® before placing the needle to prevent pushing bacteria under the skin
7NEEDLE SELECTION The thickness of a needle is measured by gauge (g), the smaller the number, the thicker the needle. An 18 gauge needle is thicker than a 20 gauge needle.Needles may also be different lengths, one-inch and one and one-half-inch are most commonly used. The plastic hub is the wide part of the needle that attaches to the syringe.20g needles are most commonly used to give SQ fluids although larger needles (18g) may be used in large dogs and may be used to draw fluid from the container of fluids.Smaller needles (22g) may be recommended forsmall dogs.
8NEEDLE DISPOSALNeedles are packaged in rigid plastic cover and wrapped in paper or plastic to keep them sterileKeep needles in original package until useDo not dispose of needles or syringes in the trash.Keep used needles and syringes in a puncture-proof container such as a biohazard containerDon't use the same needle that was placed under the skin to draw more fluids from the container of fluids or bacteria will be introduced intothe container of sterile fluids
9SYRINGE SELECTIONUsually a large (60 ml) syringe is used for fluid deliveryThe syringe is often packaged in a plastic caseKeep the container if the syringe is to be used more than once
10SYRINGE DESCRIPTIONThe syringe is marked in milliliters (ml) and ouncesThe syringe is marked at 5 ml increments (5 ml, 10 ml, 15 ml, etc.)Each line between the numbers is 1 mlThis syringe contains 26 ml of fluid.There is a small air bubble in this syringe. It is not necessary to remove tiny air bubbles such as this one when you are giving fluidsSQ.
11FLUIDS Fluids are in plastic bags or glass bottles Bags of fluids come packaged in plastic wrapperRemove the wrapper from the plastic bag just before usingThe fluid type most often given SQ is Lactated Ringers Solution (LRS)Fluids do not contain a preservative, ideally they should only be used only once and then any remainder should be discardedMost veterinarians stock fluids in 1,000 ml bags, a much larger volume than is usually given to a dog at one time
12PREPARING INJECTION PORT The neck of the bag of fluids has 2 ports; the injection port that is covered with a rubber stopper and a port covered by plastic (blue) in which the spike of a solution set is insertedClean the rubber stopper of the injection port with an antiseptic solution such as Novalsan® (chlorhexadine) or Betadine® (povidone iodine) before inserting the needle, if more than one puncture will be made through the stopper.Alcohol takes about 30 minutes of contact before bacteria are killed, so it is not a good solution to use.Always use a sterile needle to draw fluids from the sterile containerDo not use the same needle to give the fluids to the dog, and then place that needle back into the fluid container as it will become contaminated with bacteria from the skin.
13NEEDLE PLACEMENT INTO FLUID BAG Remove plastic cap from needlePlace tip of needle into injection portNeedle must be inserted into the center of the rubber stopperThe injection port itself is held so the needle is inserted straight into the injection port.
14INCORRECT NEEDLE PLACEMENT This needle is placed off-center and is puncturing the injection port
15DRAWING FLUID INTO SYRINGE Draw back on the syringe plunger while holding the syringe barrel steady so the needle does not pull out of the fluid bagFill the syringe to the volume desiredDo not fill a 60 ml syringe past 50 ml as the plunger may accidentally be pulled out of the barrel of the syringe and spill the fluid
16RE-DRAWING Replace the 18 g needle with a 20g needle When you have given the first syringe full of fluids, change back to the 18g needle to draw another syringe full and change back to the 20g needle to inject the dogKeep the plastic caps on the needles as you exchange them. Use one new 18g and one new 20g needle each time you give fluids to the dog; alternating needles between syringefulls of fluids.
17ADMINISTERING THE FLUID Pinch up a fold of skin anywhere along the neck or back using your left hand if you are right-handedUse your right hand to place the needle that is attached to a 60 ml syringe, into the skin fold along the long axis of the foldIf you place the needle in the opposite direction, across the skin fold, it is more likely that the needle will go through one fold of skin and out the other fold of skin
18ADMINISTERING THE FLUID Before injecting the fluid, pull back on the plunger of the syringe.If air bubbles appear in the syringe, the needle has gone through both folds of skin and you are sucking room air into the syringe.Remove the needle from the skin and try again.If you get blood, the tip of the needle is in a blood vessel.Remove the needle and try again.
19ADMINISTERING THE FLUID Once the needle is correctly placed let go of the skin fold and push the plunger to inject the fluidsThe plunger can be pushed using one hand by holding the syringe between your fingers and pushing the plunger with the thumb of the same hand The other hand can be used to steady the syringe or comfort the pet
20ADMINISTERING THE FLUID Alternatively, hold the syringe in one hand and push the plunger with the otherThe fluids can be injected as fast as the plunger can be pushed
21ADMINISTERING THE FLUID If the needle is not directly attached to the syringe, but is attached to a flexible piece of tubing (an extension set) first, the dog can move around a bit while the fluids are being injected.The extension set will be packaged in a plastic/paper wrapper. Remove from wrapper, remove the white plastic cap from one end and firmly place on the tip of the syringe. Remove the cap on the other end and place into the hub of the needle.The two ends are different, the female endfits over the tip of the syringe. The maleend fits into the hub of the needle.
22ADMINISTERING THE FLUID The needle attached to the extension set is inserted into the injection portDraw the prescribed amount of fluid into the syringeReplace the 18g needle with a 20g needle and recap the 18g needle with the plastic needle capPush some of the fluid through thetubing to evacuate air from the tube,a procedure called priming.
23ADMINISTERING THE FLUID The syringe containing the fluids is laid on the table. Pinch up a fold of skin anywhere along the neck and back using your left hand if you are right-handed.Use your right hand to place the needle into the skin fold along the long axis of the fold.Pull back on the plunger of the syringe. If air bubbles appear in the syringe, the needle has gone through both folds of skin and you are sucking room air into the syringe. Remove the needle from the skin and try again.If you get blood, the tip of the needle is in ablood vessel. Remove the needle and try again
24ADMINISTERING THE FLUID Once you have checked that the needle is correctly placed, let go of the skin fold and push the plunger to inject the fluidsThe plunger can be pushed using one hand by holding the syringe between the index finger and middle finger and pushing the plunger with the thumb of the same hand
25ADMINISTERING THE FLUID If this is difficult, hold the syringe in one hand and push the plunger with the other.The yellow X marks the site the needle is entering the skin.
26ADMINISTERING THE FLUID The third method to give SQ fluids is to attach a solution drip set to a bag of fluidsRemove the solution set from the plastic/paper wrapperBoth ends are covered with plastic caps. After removing the cap, the male end fits into the hub of the needleThe white spike is punctured into thespike port of the bag of fluids afterremoving the plastic tube that covers thespike
27ADMINISTERING THE FLUID The spike port on the bag of fluids is covered by a blue plastic coverThis cover is pulled offThe cover is tightly covering the spike port and you have to pull firmly to remove it
28ADMINISTERING THE FLUID The white spike on the solution set is pushed into the spike port. Hold the spike port in your left hand to guide the spike straight into the port. If you push the spike in at an angle, it may puncture the bag of fluids.
29ADMINISTERING THE FLUID Attach a needle to the other end of the solution set
30ADMINISTERING THE FLUID The plastic tubing has 2 clamps that must be opened to allow fluid to flow The dark blue pinch clamp has a tapered slot, the tubing is pushed to the widest part of the slot to open and pushed to the narrowest part of the slot to stop fluid flowThe light blue clamp is a roller clamp. Use your thumb to roll the white disk up, toward the solution chamber to open and in the opposite direction to closeThe fastest flow of fluids occurs with both clamps fully openBefore placing the needle in the SQ, open the clamps and let fluid flow until the air is evacuated from the tubingYou will see drops of fluid drop in the drip chamber when the clamps are open. If the drip chamber fills with fluid so that you cannot see the drops forming, turn the drip chamber upside down and squeeze some of the fluids back into the bag
31ADMINISTERING THE FLUID The skin is tented and the needle inserted along the long axis of the fold.You cannot suck back to check for air so watch the site at which the fluids are entering the skin fold to make sure the hair isn't getting wet suggesting the needle is incorrectly placed
32ADMINISTERING THE FLUID The fluids can be dripped into the SQ space as fast as the drip will goThe higher you hand the bag, the faster the fluids will flow
33ADMINISTERING THE FLUID The bag can also be rolled up and the fluids squeezed out of the bag for faster deliveryIf instructed to use the same fluids and solution set for more fluids later, place a clean needle covered by its plastic cover on the end of the solution set