Subcutaneous fluids for kitty
April 5, 2024 1:06 PM Subscribe
My cat Archie was diagnosed with stage 4 kidney failure about a month ago. With treatment, he's stabilized and some of his numbers have even slightly improved. We are struggling with the sub-q fluids though.
The first week he got 150-200ml every day with limited fussing. Now, he's supposed to get 100ml 3x weekly and it is a STRUGGLE. He wiggles and fights and the needle comes out and fluid gets everywhere and he doesn't get as much as he's supposed to. I am holding him and inserting the needle, my partner is holding the bag above our heads and squeezing so it goes in a bit faster.
Things we have tried:
> happy hoodie, barely tolerable and doesn't seem to help
> warming the fluid slightly, didn't seem to help
> putting him in a box/basket, made it worse
> giving him a churu while administering fluids, helped the first time and now he doesn't even want one while we're doing fluids
> having him sit on his self-warming cat bed, didn't help
> purrito, couldn't figure out a way to both purrito and still have a place to insert needle
> gabapentin 2 hours before fluids, makes him a drugged lil baby, but he still struggles when it's time for fluids; it is easier to pill him tho
> varied the time when i give him mirtazapine (appetite stimulant that makes him anxious for a couple hours after), didn't seem to make a difference
the vet showed me how to insert the needle, and i watched a ton of videos. the first couple times he barely reacted, and now he jerks every time. i'm not doing anything different: bevel down, pulling up fur between shoulder blades to tent the skin, inserting in one fluid motion.
it just makes me so sad. i'm willing to do this for him, but he hates it so much and makes it difficult and i don't want to hurt him and i want him to get the fluids he needs instead of it all getting wasted spraying everywhere.
any tips to make this go smoother for him?
The first week he got 150-200ml every day with limited fussing. Now, he's supposed to get 100ml 3x weekly and it is a STRUGGLE. He wiggles and fights and the needle comes out and fluid gets everywhere and he doesn't get as much as he's supposed to. I am holding him and inserting the needle, my partner is holding the bag above our heads and squeezing so it goes in a bit faster.
Things we have tried:
> happy hoodie, barely tolerable and doesn't seem to help
> warming the fluid slightly, didn't seem to help
> putting him in a box/basket, made it worse
> giving him a churu while administering fluids, helped the first time and now he doesn't even want one while we're doing fluids
> having him sit on his self-warming cat bed, didn't help
> purrito, couldn't figure out a way to both purrito and still have a place to insert needle
> gabapentin 2 hours before fluids, makes him a drugged lil baby, but he still struggles when it's time for fluids; it is easier to pill him tho
> varied the time when i give him mirtazapine (appetite stimulant that makes him anxious for a couple hours after), didn't seem to make a difference
the vet showed me how to insert the needle, and i watched a ton of videos. the first couple times he barely reacted, and now he jerks every time. i'm not doing anything different: bevel down, pulling up fur between shoulder blades to tent the skin, inserting in one fluid motion.
it just makes me so sad. i'm willing to do this for him, but he hates it so much and makes it difficult and i don't want to hurt him and i want him to get the fluids he needs instead of it all getting wasted spraying everywhere.
any tips to make this go smoother for him?
Ask the vet if using a different gauge needle might help. Bigger needle = much faster flow so less angsty time; smaller needle = smaller puncture so possibly less skin irritation. Also seconding the suggestion to ask about alternative needle sites.
posted by ReferenceDesk at 1:52 PM on April 5 [1 favorite]
posted by ReferenceDesk at 1:52 PM on April 5 [1 favorite]
I'm sorry you and he are going through this. We did one month of daily fluids for our sick cat; it never got easier, I'm afraid to say. And then we stopped. Our beloved girl began a slow decline that ended about a year later. I regret that we didn't have more time with her, but I was very happy to spare her this daily torment which she never, ever accepted easily. :(
posted by BlahLaLa at 2:02 PM on April 5
posted by BlahLaLa at 2:02 PM on April 5
My friend had to do this. She hung the IV bag up on a louvered door near the stabbin' station so that both of us could keep hands on the cat. My sympathies: having to do this sucks for all. Vets need to figure something out, like maybe a permanent port.
posted by Don Pepino at 2:21 PM on April 5 [3 favorites]
posted by Don Pepino at 2:21 PM on April 5 [3 favorites]
Yeah, this is hard. I went through this with a cat suffering kidney failure. She was very compliant for a couple of months, and was a very laid-back cat in general, but after a certain point, she just wouldn't put up with it. We stopped giving her fluids, and her decline was rapid after that. I don't think there's a right answer to this. It's that quantity vs quality of life problem.
posted by adamrice at 2:22 PM on April 5
posted by adamrice at 2:22 PM on April 5
Some stuff to try:
- If you can get him into a harness the even pressure on his body might keep him from wiggling so much.
- When you are not giving him fluids get him snuggling with you and gently but thoroughly investigate the insertion area for swelling, redness, tenderness, bruising, infection, etc. This can be really hard to see in cats because of their coats and tendency to either completely ignore or completely overreact to pain and irritation.
- I would actually avoid squeezing the bag or otherwise going faster on the fluids. Try a very gentle small flow with the bag held lower, maybe twisting the tube shut briefly a few times to let the fluids in there get absorbed before pushing in more. If you can’t get him to endure the whole time it takes to do this, hopefully you’ll at least get in some fluids and waste less of it and stress him out less over all.
- Since you mention him rejecting treats are there other things he especially likes? This is a transition for all of you and different stuff might bring him more joy now than treats. Outside time, being allowed in previously forbidden areas (with supervision), different toys, catnip and/or silvervine, sitting on fresh laundry… you can’t make him enjoy getting fluids but you can help him enjoy the rest of the time you have together and that might help lower his stress response to the fluids anyway.
- Most cats I’ve known have a pretty good sense of time and love a set schedule. It might be crazy but could you do a much smaller amount of fluids at the same time every day instead of a larger volume three times a week? I know a cat who needs an inhaler, she knows she has to endure a ten second countdown with the thing on her face at the same time every day, and also swallow a pill, and then it’s dinner time. It took a while for her to get used to it and she still doesn’t like it but she doesn’t fight it. Ask your vet about this and think about your cat’s daily routine, maybe pick a time he is normally at his most receptive and snuggly, like after being fed or mid morning nap? If he learns the fluids don’t take as long and happen every day at the same time so it’s never a surprise, he might get more used to it.
- Be sure you aren’t keeping the fluids somewhere too cold.
- Ask your vet for recommendations and suggestions.
posted by Mizu at 2:54 PM on April 5 [1 favorite]
- If you can get him into a harness the even pressure on his body might keep him from wiggling so much.
- When you are not giving him fluids get him snuggling with you and gently but thoroughly investigate the insertion area for swelling, redness, tenderness, bruising, infection, etc. This can be really hard to see in cats because of their coats and tendency to either completely ignore or completely overreact to pain and irritation.
- I would actually avoid squeezing the bag or otherwise going faster on the fluids. Try a very gentle small flow with the bag held lower, maybe twisting the tube shut briefly a few times to let the fluids in there get absorbed before pushing in more. If you can’t get him to endure the whole time it takes to do this, hopefully you’ll at least get in some fluids and waste less of it and stress him out less over all.
- Since you mention him rejecting treats are there other things he especially likes? This is a transition for all of you and different stuff might bring him more joy now than treats. Outside time, being allowed in previously forbidden areas (with supervision), different toys, catnip and/or silvervine, sitting on fresh laundry… you can’t make him enjoy getting fluids but you can help him enjoy the rest of the time you have together and that might help lower his stress response to the fluids anyway.
- Most cats I’ve known have a pretty good sense of time and love a set schedule. It might be crazy but could you do a much smaller amount of fluids at the same time every day instead of a larger volume three times a week? I know a cat who needs an inhaler, she knows she has to endure a ten second countdown with the thing on her face at the same time every day, and also swallow a pill, and then it’s dinner time. It took a while for her to get used to it and she still doesn’t like it but she doesn’t fight it. Ask your vet about this and think about your cat’s daily routine, maybe pick a time he is normally at his most receptive and snuggly, like after being fed or mid morning nap? If he learns the fluids don’t take as long and happen every day at the same time so it’s never a surprise, he might get more used to it.
- Be sure you aren’t keeping the fluids somewhere too cold.
- Ask your vet for recommendations and suggestions.
posted by Mizu at 2:54 PM on April 5 [1 favorite]
We had to do this for one of our cats for a couple months, and the best advice I can give is: practice A LOT on a stuffed animal (you can use one of the used needles for this), and be confident when you do it on your actual kitty. Don't waver, don't try to make it easier, and don't show trepidation - just go in in one motion and be as firm as you can be with it. It is super hard to do this, because it's traumatic, but the faster it starts, the faster it ends, for everyone involved. And yeah, don't squeeze the bag - that could actually be causing some extra pain or pressure. Use the little roller thing on the tube to adjust the flow rate.
We had slightly better luck with the purrito approach, honestly, by cutting a hole in an old blanket and going in through the hole in the blanket while the other one of us held mr. kitty and was very reassuring and calming, giving head skritches and making all sorts of eye contact while the other of us did the unpleasant part. We'd switch off who did what, so he wouldn't get overly angry at either one of us.
I can't sit here and tell you those things worked 100%; it was still a struggle a lot of days and he never was happy about the process. But those things made it a few degrees easier. I feel for you and your partner and the lil' guy.
posted by pdb at 3:06 PM on April 5 [1 favorite]
We had slightly better luck with the purrito approach, honestly, by cutting a hole in an old blanket and going in through the hole in the blanket while the other one of us held mr. kitty and was very reassuring and calming, giving head skritches and making all sorts of eye contact while the other of us did the unpleasant part. We'd switch off who did what, so he wouldn't get overly angry at either one of us.
I can't sit here and tell you those things worked 100%; it was still a struggle a lot of days and he never was happy about the process. But those things made it a few degrees easier. I feel for you and your partner and the lil' guy.
posted by pdb at 3:06 PM on April 5 [1 favorite]
My family did this too long for a golden retriever of ours when I was growing up, until other problems forced our hand. In retrospect, we all agree now that was fine for a while, but then at some point she was clearly over living that way and it became more about us not wanting to say goodbye.
If it's temporary, that's different.
I'm very sorry you're dealing with this, it was tough enough with a very compliant and gentle golden. I would really struggle to force it on an unhappy cat.
posted by snuffleupagus at 3:54 PM on April 5
If it's temporary, that's different.
I'm very sorry you're dealing with this, it was tough enough with a very compliant and gentle golden. I would really struggle to force it on an unhappy cat.
posted by snuffleupagus at 3:54 PM on April 5
So I've had 4 cats with kidney issues; the first had a congenital problem and the other 3 were elderly. With 3 of those cats I did sub-q fluids. The 4th cat did not like to be handled. He especially did not like to be handled by me. I knew the only way I would be able to give him fluids is if he permanently lived in the bathroom so I wouldn't have to chase him down for half an hour every couple of days. It would have been torture for him. So with my vet's approval we just didn't do the fluids. When he declined enough we let him go. That was what was best for him.
As for the other 3, I always did the fluids in the bathroom with the door closed. I used a wreath hanger to suspend the fluids. If necessary I would kind of sit on the cat (gently), trapping them between my legs so my hands were free to do the needle. Sometimes we would just chill together in the bathroom for awhile first, and I would sit on the floor and pet them. Then treats afterwards. Good luck! Kidney disease can be a real rollercoaster with cats and it's awful.
posted by jenjenc at 4:22 PM on April 5 [3 favorites]
As for the other 3, I always did the fluids in the bathroom with the door closed. I used a wreath hanger to suspend the fluids. If necessary I would kind of sit on the cat (gently), trapping them between my legs so my hands were free to do the needle. Sometimes we would just chill together in the bathroom for awhile first, and I would sit on the floor and pet them. Then treats afterwards. Good luck! Kidney disease can be a real rollercoaster with cats and it's awful.
posted by jenjenc at 4:22 PM on April 5 [3 favorites]
If you have not checked this site out, do that first - it is a FANTASTIC one-stop-info site for families of cats with renal failure. Here is the section that deals with giving subcutaneous fluids, with tips for how to do it.
What others say about checking with your vet about whether there's something causing issues is wise. That said - when the late great Zach had early-stage renal failure, my vet put him on sub-q fluids as a preventative measure for the month while we waited to see if the prescription kidney diet and the daily vitamin helped. I was told that this would help Zach feel better overall. But - Zach always put up a fight - and Zach was always a tough little putz. (One of my favorite stories about him was that at one of his last vet visits, he literally beat the vet up.) I did manage to do it a few times, but most of the time he was fighting tooth and claw to get away - and after a couple weeks, I finally decided that you know, the whole point of the fluids was to make sure he felt well, and if he was fighting me THAT hard he probably felt pretty hale and hearty enough as it was. And so - fuck it, I'd just keep an eye on him and only give it to him when he looked a little droopy as opposed to doing it daily.
Again, Zach was in more of an early stage and so that's something you should discuss with your vet. But if he's fighting you that much, that's probably a small positive sign, at least.
(To wrap up Zach's story - ultimately, the thing that brought him down was colon cancer, which my vet picked up in him at the age of 18 - about 6 months after we'd caught the renal failure. That vet visit where he beat her up was the one where she detected it, in fact. He'd stopped eating - and he was always an enormous glutton, so that was an issue - and the vet checked him over thoroughly, including doing a blood test and urinalysis to check the kidney function. We got the results back a week after she confirmed the colon cancer and we'd ascertained that treating it would probably kill him itself, so he was on hospice care; but at that point, his kidney function had recovered so well that he was testing normally again.)
posted by EmpressCallipygos at 4:55 PM on April 5 [3 favorites]
What others say about checking with your vet about whether there's something causing issues is wise. That said - when the late great Zach had early-stage renal failure, my vet put him on sub-q fluids as a preventative measure for the month while we waited to see if the prescription kidney diet and the daily vitamin helped. I was told that this would help Zach feel better overall. But - Zach always put up a fight - and Zach was always a tough little putz. (One of my favorite stories about him was that at one of his last vet visits, he literally beat the vet up.) I did manage to do it a few times, but most of the time he was fighting tooth and claw to get away - and after a couple weeks, I finally decided that you know, the whole point of the fluids was to make sure he felt well, and if he was fighting me THAT hard he probably felt pretty hale and hearty enough as it was. And so - fuck it, I'd just keep an eye on him and only give it to him when he looked a little droopy as opposed to doing it daily.
Again, Zach was in more of an early stage and so that's something you should discuss with your vet. But if he's fighting you that much, that's probably a small positive sign, at least.
(To wrap up Zach's story - ultimately, the thing that brought him down was colon cancer, which my vet picked up in him at the age of 18 - about 6 months after we'd caught the renal failure. That vet visit where he beat her up was the one where she detected it, in fact. He'd stopped eating - and he was always an enormous glutton, so that was an issue - and the vet checked him over thoroughly, including doing a blood test and urinalysis to check the kidney function. We got the results back a week after she confirmed the colon cancer and we'd ascertained that treating it would probably kill him itself, so he was on hospice care; but at that point, his kidney function had recovered so well that he was testing normally again.)
posted by EmpressCallipygos at 4:55 PM on April 5 [3 favorites]
When I was giving my KD cat fluids, I hung the bag on a sturdy hanger from an upper cabinet knob (or shower rod or whatever's the right height). You could then have both people focused on the needle and cat.
posted by GrimmblyTuna at 2:13 PM on April 6 [1 favorite]
posted by GrimmblyTuna at 2:13 PM on April 6 [1 favorite]
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Hats off to you for your efforts though. I tried to help my brother give sub-q fluids to his uncooperative cat, and it was nerve wracking. I hope that you find a solution that works for you!
posted by eekernohan at 1:10 PM on April 5 [2 favorites]