If you're about to begin providing fluid replacement therapy for your CRF cat and you are uncertain whether you can manage it, here's a story about Carol, David and Duncan and how they learned.
If we can do it, you can do it!
The Feline CRF Information Center Staff as Neophytes
March 12, 2007
We have long been advocates of fluid replacement therapy as the best possible treatment for CRF cats. Although we have assisted others in administering fluids we had never actually done the procedure ourselves on our own cat. Neither of us had ever done the entire setup from beginning to end and neither of us had ever actually inserted a needle except for the time that Carol had practiced on a chicken from the grocery store.
Because we basically had to start from scratch, we felt that presenting the story of how we learned to give fluids would be helpful to others who are frightened, overwhelmed or just unsure about doing the procedure at home.
We began with several disadvantages. Duncan had just returned from an extensive stay in the hospital where he was given a course of intravenous fluids. After being gone for an entire week, he was not inclined to be sociable and he spent a lot of time curled up under a bed. Another problem was that Duncan had never allowed himself to be held for any extended period of time. In fact, he became panicky if he was immobilized for more then 20 seconds or so. Even though he was only slated to receive 100 ml of Ringer's solution per day, it would take a lot more than 20 seconds. Also, Duncan had been overweight and when we had to start his fluids, his weight loss was not sufficient to make it easy to find any loose skin on his back under which to insert the needle. On top of all these other problems was our basic fear of hurting our cat.
Our friend, Sandy, came over to advise and assist in our first fluids session. Sandy is part of our website staff and has also had several CRF cats. While David prepared the bag under Sandy's supervision, Carol tried to figure out how to get Duncan out from under the bed. When the bag was hung and all was in readiness, Carol and Sandy moved the bed so that they could take Duncan to the kitchen where the fluids were set up. While Carol and Sandy were struggling with that, David was standing in the kitchen with a needle in his hand, trying to keep his mind empty and his demeanor as calm as possible.
Duncan was brought out to the kitchen and placed in a cat bed on the counter and Sandy and Carol tried to hold him down while leaving enough space for David to insert the needle. Duncan reacted as expected and struggled to get away. In spite of the difficulties, David made the stick successfully after a couple of false starts.
That first stick was extremely difficult for both David and Duncan. David didn't know how hard or how fast to push the needle in, so he spent a few seconds pushing the point against the skin instead of through it. When it finally did go in, David likened it to pushing a nail through a piece of carpet.
All in all, the first fluids session was pretty much a disaster. Holding the needle in place and working the roller clamp and then turning the needle to get the best possible flow becomes second nature after a while, but the first time, it can all be too much. A lot went wrong in that first session. When Duncan tried to bolt, David pulled the needle out before turning off the flow. In the end Duncan got some fluids. He didn't get the whole 100 ml, but it was close. When we were done, Carol had more wine than Duncan had fluids. We were a bit disheartened and we wondered if we would ever get better at this.
The second day, Sandy came over again. As before, Duncan struggled. The stick was a little better this time, though. David felt the needle pop through and he remembered that feedback sensation for later reference.
If anything, the second and third sessions were worse than the first. Both of them ended with the needle being withdrawn before the full 100 ml were administered and the two assistants being drizzled with Ringer's solution before David could close the valve. We noticed, though, that Duncan was waiting longer each time before he started to struggle.
The next five sessions were really pretty bad. We were only successful once in getting the full 100 ml into Duncan. In spite of all that, David was learning the setup and stick routine to the point that everything was going smoothly except for the lack of cooperation from the patient.
Gradually, Carol evolved the wrestling hold with which she had tried to keep Duncan from moving into a much gentler hand on the rear end and a hand on his head. She put her face close to his and talked to him and he stayed longer each time before he reared up to get away.
Some time in the second week, everything sort of fell into place. Duncan stayed still with minimum effort on Carol's part and David had the routine dialed in. Duncan was finally getting his prescribed fluids.
One day, we warmed up a new bag of fluids by immersing it in warm water. When the chill was off the fluids, we attached the administration set and hung the bag and half-filled the drip chamber. Carol brought Duncan out and we started the procedure. David made the stick quickly and without hesitation. Duncan was motionless and Carol was calm. Then David looked at the drip chamber and couldn't see any drops. He turned the needle and looked at the chamber again. There were still no drops. He checked the roller clamp again and made sure that the line had not been crimped. There were still no drops falling into the chamber. David was on the edge of panic when he looked at the bag itself. It showed that 110 ml had been delivered. A closer look at the drip chamber revealed a thin continuous stream of fluids instead of the individual drops that we had seen previously.
This was a landmark day for us. For a time, we had been stressed out getting any fluids into Duncan at all. This time, we were stressed out because everything had gone perfectly. Since then, we have had no serious problems giving Duncan his fluids. In fact, most days, it is as smooth and routine as we hoped it would become.