Difference between SubQ and IV??

Hi,

I went to my local gouging vet a couple days ago when my cat was dehydrated (neck skin stood tented up).    She said I would have to leave the cat for hours and it would cost $280 for the IV.   When I complained to the tech after the vet left, she said they could do a subQ for like $35.

So really, what is the difference besides the cost obviously?

Thanks

IV fluids are administered directly into a vein (IV stands for intravenous) and is the way it is done for humans.  It goes slowly, drip by drip, and cannot be rushed.  The cat would have to be anesthetized or restrained for the amount of time it takes to administer the appropriate amount of fluids.  SUBQ fluids are given under the skin (SUBQ is short for subcutaneous which means under the skin).  The needle is inserted under the cat's skin and make sort of a water balloon there, and the fluids are then sowly absorbed by the cat over hours.  This is NOT a method used to give fluid to humans as we do not have loose fitting elastic skin like a cat does. 

SubQ fluids are often used on cats with kidney disease to help flush out toxins because these cats cannot drink enough water to overcome the lack of efficient kidney function so toxins accumulate.  They are also used when a cat is dehydrated to the point where he could not likely drink enough to rehydrate himself in a reasonable amount of time, but he is not in danger of going into shock or organ failure from dehydration.

IV fluids are necessary when a cat is severely dehydrated and needs the blood volume to be increased quickly to avoid shock and organ failure, and there is no time to wait for fluids to be absorbed from under the skin.

Thank you for the very informative post.   I learned alot.   A question...   is it possible for that `water balloon` from sub-q fluids to leak out totally.   I ask since after my cat got sub-q (the vet didnt bother to explain the balloon so I was alarmed until I  googled it) a few hours later the floor around the litter box had a puddle around it and the cats `balloon` had dissappeared.   The liquid near the litter box looked clear and didnt smell like urine.

Some of the fluids may leak out of the injection site, especially if there was a very large amount given, but all of the fluids will not leak out this way.  As the pressure goes down, the tiny needle hole closes, and the rest of the fluids are absorbed by the body.

I've only had a leak happen once when Cocheezie kept moving and I had to re-insert the needle a couple of times. The leak was immediate and through a previous injection site (you could see the fluid running in a trickle down her side). What I should have done was waited an hour or so and then finished the sub-q fluids. (Learned a lesson and now wait before I try again if the procedure is not going well.)

If your cat received a large amount of fluid and desperately need that fluid, it would be sucked up by the body quickly. I've had days when balloons disappeared quickly. The balloon is just gone. And I've had days when it took a couple of hours for the fluids to be absorbed and the balloon to go away.

I find that the urine smell in the litter box is almost non-existent since I've been giving sub-q daily. It could be that your kitty, not used to having such a full bladder, didn't quite make it to the box.

When Cocheezie had her first urine sample taken, her bladder was empty. She stayed at the vet's for a few hours and was given sub-q. The tech couldn't believe how fast the water was absorbed into her system.

I guess it didnt leak back out the injection site totally though I was confused because I noticed her fur in the area was quite wet.   I attributed it to a sloppy tech that was careless and didnt shut off the flow before yanking the needle.    But I didnt notice anything squirting out as I palpated the bubble.    At the same time she was on her 3rd or 4th dose of prednisone that probably forced her bladder to kick into overdrive with very dilute pee.

I think it is..... what`s the word... irresponsible at the least to give a pet back to an owner without explaining what a subQ is and what to expect.   I should sue them for mental anguish as I thought my cat burst a vein or grew a tumor or something.

I'm so sorry you were scared by the fluid balloon.  As you noted, the vet was already gone when the tech offered to do the subQ fluids for you.  They do this so much that it may not have occurred to them to explain it to you.  Techs are trained to work with the animals but not necessarily trained to explain things to clients.  I'm glad the tech offered you the subQ choice so your cat did get the fluids she needed, and now you know how to tell if she is dehydrated because the skin does kind of stand up by itself after tenting, whereas when she is hydrated, it snaps back down.  You are learning a lot today!  Good for you.  The more you know, the better cat guardian you can be.

zoneout said:

 
I guess it didnt leak back out the injection site totally though I was confused because I noticed her fur in the area was quite wet.   I attributed it to a sloppy tech that was careless and didnt shut off the flow before yanking the needle.    But I didnt notice anything squirting out as I palpated the bubble.    At the same time she was on her 3rd or 4th dose of prednisone that probably forced her bladder to kick into overdrive with very dilute pee.

I think it is..... what`s the word... irresponsible at the least to give a pet back to an owner without explaining what a subQ is and what to expect.   I should sue them for mental anguish as I thought my cat burst a vein or grew a tumor or something.

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The wet that you saw could be from when she took the needle out (sometimes, if the cat moves quickly, there is not time to turn the fluids off before the needle comes out), or it could be from the initial injection when the tech thought she was in, but wasn't. This can happen fairly often because you have to go by feel. I've done it myself from time to time. I've even seen a not-good-and-never-went-back vet do it, and I was the one who had to point out to her that she wasn't "in" while she was busy chatting away about why she was better than the emergency vet I had taken my cat to. If nothing else, by washing the wet part afterwards, it allows the cat to put itself back to right after an experience it did not choose to be a part of.

If your cat is really old or really dehydrated the skin doesn't always close up right away and it can cause the sub-q fluid to leak out. As you have probably noticed the fluid will form a pocket or ball and as the cat moves gravity usually sends it down to an arm pit, bottom of the chest, or by the stomach. If the cat is lying down the fluid can be pushed around and there is always the chance of it leaking back out again if the insertion point hasn't sealed up. This is usually common shortly after the sub-q and not hours later but it does happen. I see this with my guy from time to time after he gets a sub-q and it can leak back out but not often. If this is something he/she will need all of the time then it is probably something you should learn how to do because it is easy and your cat would rather you did it than someone else. On the cost side you can buy the stuff to give the cat a sub-q for about $10 a bag which is roughly 10 - 100ml injections so you also save a lot.

Thanks.. I am learning alot.    Can the needle be reused or does it need to be sanitized each time with alcohol.   And how long can a bag of fluid be kept once it is open.

That Guy said:

 
As you have probably noticed the fluid will form a pocket or ball and as the cat moves gravity usually sends it down to an arm pit, bottom of the chest, or by the stomach.

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This made me smile, because Sebastian's pocket of fluid that ends up at his armpit will sway or bounce when he runs to me. 

zoneout said:

 
Thanks.. I am learning alot.    Can the needle be reused or does it need to be sanitized each time with alcohol.   And how long can a bag of fluid be kept once it is open.

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I use one 18 gauge needle per session and I never reinsert. I get a 1,000 ml bag of fluid, and Sebastian gets 100 ml every other day. They send me home with 12 or so needles, 10 for each 100 ml session, and a couple more in case I mess up. If I insert the needle wrong and have to pull out, I toss it and grab another. My vet trained me to never reinsert, but I'm sure every vet practice trains differently.

I use a 20 gauge x 1" needle for my guy because it hurts less when it is inserted and never is a needle used twice. The edges of the needle are very fine and you actually fold it over a bit each time you insert it which dulls it out. You want to make all of this as pain free as possible and using fresh needles each time is an easy way to do it. I have to give other injections with a needle and I use one needle to extract the fluid from the bottle and then change it and use a fresh needle to give the injection. When you finish each sub-q you want to put in a fresh needle and then store the bag in a cool place out of the sun and then it will be good for the entire bag. I buy everything bulk for my guy and get it from Stevens Medical Supply but I am in Canada so this may not work for you.... http://stevens.ca/ It is about $10 per sub-q bag with needles and the hose kit which are thrown away after each bag is used up.

I was also told to use a fresh needle each time. I've recently switched from 18 to 20 gauge. The clinic just throws a handful of needles into the bag with the sub-q fluids.

Also, check with your local pharmacy or health unit for information regarding sharps containers. You may be able to get one for free (our municipality does not want needles going to the dump where someone might get stabbed). There is also free disposal of sharps containers in my area. My vet wanted to sell me a sharps container for $35 and I was told to bring it back when full for a $15 disposable charge.

I use an empty Pringles can with a small slit cut in the top.