sub-q fluids question

i give my snick sub-q's every other day, and have for several years now. i just started using braun giving sets, instead of hospira's, and yesterday went to remove the used needle in order to then add a fresh unused needle. the braun set up is a little different than hospira giving sets, and when i removed the used needle, the 'line' popped out of my hand and the (needle) end of it without a needle on it hit the kitchen cabinet. so it was no longer sterile. i went and got a fresh giving set, got ready, and quickly removed the old giving set from the fluids bag and inserted the new giving set. i do think that some air got into the fluid bag during the giving set switch.

now to my question -- are the fluids in the bag still sterile? never having had this happen before, i want to be very careful and make sure it's safe to use the rest of the bag of fluids -- there are 5 doses of fluids left in the bag. it's not a big deal if that bag can't be used, as i have plenty more bags of fluids.

@cocheezie -- may i ask for your opinion on this?

I think that is something you should probably ask your Vet about. Theoretically speaking, the needle you insert into your cat is exposed to air, so would some air getting in the fluid bag make the fluid unsterile - I don't know.  I also don' t know if having air in bag itself might present a problem.  I am thinking out loud, However, I think this type of question should be answered by a Vet.  Best of luck.

GreenCatEyes said:

 
I think that is something you should probably ask your Vet about. Theoretically speaking, the needle you insert into your cat is exposed to air, so would some air getting in the fluid bag make the fluid unsterile - I don't know.  I also don' t know if having air in bag itself might present a problem.  I am thinking out loud, However, I think this type of question should be answered by a Vet.  Best of luck.

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thank you for your reply.

yes, i figured i'd call my vet and ask. they'll be open again on monday. in the meantime, i'll play it safe and simply set up a fresh bag/giving set and use that.

I agree. Best to be safe. There are too many variables; I believe it would be irresponsible for anyone not in the medical profession to give you advice.

i mean, it may be perfectly safe to use that bag of fluids with the fresh giving set. i figured that maybe some other members who i know have done sub-q's might have had this circumstance come up. but i'd never take any risk with my snick's fluids.

Sorry to take so long to answer, but my Vet says it's perfectly ok to use the same IV set up over and over again, (moving from one bag to another) so I would think if THAT's ok, then it would be ok to insert a new IV set-up into a bag, as long as you insert it exactly into the same punch hole you used originally, and the new IV set-up didn't touch anything, which I'm sure it didn't since you are obviously so studious about things.  That being said, if there is any leakage at all, then I wouldn't use it, since that means contamination can still occur.  I guess the only way to tell on that is to squeeze the bag up at the top where the set-up is inserted and see if any liquid comes out. 

BTW, I double checked this with my hubby, who is a retired nurse.

wHI -

I give my cats Sub-Q as well,

(and use Braun too).

I would not worry about contamination as you described it.

Any bacteria that was received by the touching of the counter with that end of the line wouldn't travel up the fluid in the line so quickly as to infiltrate the bag.

(I assume you immediately replaced the line, not minutes later.)

I would flush the new line a good minute or two into a hand towel to be on the safe side.  I always do that anyway, for a few seconds when changing lines to replace the air with fluid.

(sorry if this is a crude example - but it is much like a gal peeing after sex; it gets any potential bacteria out of the line replacing it with what is supposed to be there.  lol)

Heh - The scariest part of the whole procedure is seems, with my cats is the NOISE the clinking of the sliding lock and the spit-spat of any air bubbles coming out,

so I try to take that out of the equation before cat gets in the mix.  I use sharp scissors and cut those locks off.  I just use the quiet rolling lock.

mrsgreenjeens said:

 
Sorry to take so long to answer, but my Vet says it's perfectly ok to use the same IV set up over and over again, (moving from one bag to another) so I would think if THAT's ok, then it would be ok to insert a new IV set-up into a bag, as long as you insert it exactly into the same punch hole you used originally, and the new IV set-up didn't touch anything, which I'm sure it didn't since you are obviously so studious about things.  That being said, if there is any leakage at all, then I wouldn't use it, since that means contamination can still occur.  I guess the only way to tell on that is to squeeze the bag up at the top where the set-up is inserted and see if any liquid comes out. 

BTW, I double checked this with my hubby, who is a retired nurse.

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thank you for your reply!

i did go ahead and check with my vet this morning. i was told that they change the line there at the office when the end has been "compromised", and that as long as i didn't touch any of the ends (of the fluids bag or the new line), the fluids will be considered sterile still. you're right, i'm extremely careful while handling/working with snick's fluids -- heck, i even wear disposable gloves (a practice i used when working years ago in a field/career that required maintaining a sterile environment).

my next issue was starting using braun brand sodium chloride fluids bags. the fluids simply don't 'behave' the same as in hospira's fluids bags. i kept waiting for the fluid level in the bag to start lowering, so it would get down to the first mark and it never did lower. it seems like maybe there is some air in the hospira bags vs no air in the braun bags. anyhoo, i ended up giving my snick could be anywhere in the range of 200 to 300 cc's yesterday (she usually gets 150 cc's every other day) before i realized that the braun fluids bag just wasn't behaving in such a way that i can actually get a definite reading as to how much fluids i've given. i'll check snick to make sure she has absorbed all those fluids before giving her more on tuesday. so, i ordered a digital hanging scale with a hook at the bottom that measures in grams -- 100ml (or cc's) equals 100 grams. the hanging scale weighs up to 1000 grams, though i read one review were someone said theirs weighed up to 1080 grams. but all reviewers stated that the scale is very accurate. actually, i ordered two of those hanging scales, because with important things i always like to have a back up.

To really be safe and worry free I wouldn't use the bag but dispose of it and use a fresh one. Your only going to worry about snicks. Why did you change from something that has been working so well?

4catsNcounting said:

 
wHI -

I give my cats Sub-Q as well,

(and use Braun too).

I would not worry about contamination as you described it.

Any bacteria that was received by the touching of the counter with that end of the line wouldn't travel up the fluid in the line so quickly as to infiltrate the bag.

(I assume you immediately replaced the line, not minutes later.)

I would flush the new line a good minute or two into a hand towel to be on the safe side.  I always do that anyway, for a few seconds when changing lines to replace the air with fluid.

(sorry if this is a crude example - but it is much like a gal peeing after sex; it gets any potential bacteria out of the line replacing it with what is supposed to be there.  lol)

Heh - The scariest part of the whole procedure is seems, with my cats is the NOISE the clinking of the sliding lock and the spit-spat of any air bubbles coming out,

so I try to take that out of the equation before cat gets in the mix.  I use sharp scissors and cut those locks off.  I just use the quiet rolling lock.

Click to expand...

thank you for your reply!

yes, i quickly grabbed a new line and made the switch.

yes, i did flush the air out of the new line carefully.

i did check with my vet this morning, just to be very thorough and careful (like i always am with snick and working with her fluids), and they confirmed what you and @mrsgreenjeens said.

that's what i do too -- get everything set up and ready, then my girl is brought to get her fluids.

do you use braun brand fluids bags as well? i'm asking because i found it very hard/impossible to be able to accurately read how much fluids had been given. i mean, the bags have measuring lines on them, but the fluids don't lower in the bag like they do in hospira bags. so i ended up ordering a digital scale with hook at the bottom that measures in grams, up to 1000 grams. i actually ordered two scales, because i'm a firm believer in having an extra on important things. this scale does lower it's reading as the weight lowers.

Stewball said:

To really be safe and worry free I wouldn't use the bag but dispose of it and use a fresh one. Your only going to worry about snicks. Why did you change from something that has been working so well?

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thank you for your reply!

that was my concern, and i would have worried about my snick. but both replies as well as my vet told me the same thing, that the lines can be changed and as long as i didn't 'compromise' (like touch anything with them) the ends (of the fluids bag and the line) the fluids will still be sterile. i was very careful and the ends weren't compromised.

it wasn't my choice to change fluids brands. here in the US there is actually a very real fluids shortage. fluids are being rationed and can be very hard to find at times. the fluids shortage is supposed to ease up sometime this year, but i'm not going to count on that -- i'll wait and see. i have always bought a years worth of fluids bags in case quantities once a year. i have two reasons why i do this -- the price is much better when bought in cases (and when you have a cat with medical issues, the money saved can be used for other of their medical needs), and the fluids must be shipped in either spring or fall (to avoid being exposed to extreme heat in the summer months, or extreme cold/becoming frozen during the winter months).

i decided to switch to braun 'giving sets' because the cost was lower, and over time the savings will be significant. i'm getting used to these slightly different to work with giving sets.

Wow, you're a diligent caretaker!  That sounds like a nifty addition to the process.  I have always been cavalier (to a point) about how much fluid I'm giving, and err on the side of overshooting it,

as the subcutaneous absorption is so nice and slow, I don't think I'm overtaxing the kidneys terribly, unless it is real end stage renal failure. So if it looked from where I was sitting that the line was 'stuck" at 200, I would give it another few moments before ending the session.

To answer your question - I do indeed notice that the Braun brand has a more clingy nature to the plastic of its bag.  I think it could be because it is a thicker plastic, less pliable.

If you give it a squeeze, it kind of rights itself, but this is impossible if your containing your cat and baby-sitting the needle. A 2nd person would be needed.

It wouldn't be because Hospira has air in it- that would cause bacteria to grow.

Some folks warm their fluid for the cat's comfort- that may soften the Braun plastic and get it to behave more accurately.  Another step, though.  Gah.

I tried to continue buying Hospira, but the online supplier I use:  Express Medical Supplies (not "Express Medical Supply, Inc."   -which is a story for another day!)

seems to have switched which brand of regular ol' plain Ringer's Lactate they go with.

I like their prices though. 

Some vets charge $25 per bag.  Highway robbery.

mickNsnicks2mom said:

thank you for your reply!

that was my concern, and i would have worried about my snick. but both replies as well as my vet told me the same thing, that the lines can be changed and as long as i didn't 'compromise' (like touch anything with them) the ends (of the fluids bag and the line) the fluids will still be sterile. i was very careful and the ends weren't compromised.

it wasn't my choice to change fluids brands. here in the US there is actually a very real fluids shortage. fluids are being rationed and can be very hard to find at times. the fluids shortage is supposed to ease up sometime this year, but i'm not going to count on that -- i'll wait and see. i have always bought a years worth of fluids bags in case quantities once a year. i have two reasons why i do this -- the price is much better when bought in cases (and when you have a cat with medical issues, the money saved can be used for other of their medical needs), and the fluids must be shipped in either spring or fall (to avoid being exposed to extreme heat in the summer months, or extreme cold/becoming frozen during the winter months).

i decided to switch to braun 'giving sets' because the cost was lower, and over time the savings will be significant. i'm getting used to these slightly different to work with giving sets.

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I will always give you my input if I'm able to.

I found this thread while searching for info about sub-q fluids...and wanted to add that my vet charged me $37.36 for a 500ml bag of LR and $10 for one IV set.  Apparently the 16g needles were free 

crimmie said:

 
I found this thread while searching for info about sub-q fluids...and wanted to add that my vet charged me $37.36 for a 500ml bag of LR and $10 for one IV set.  Apparently the 16g needles were free 

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vet's generally do charge more for bags of fluids and iv sets/needles, partly because they do make some profit on everything they sell. but also, there has been a fluids shortage going on for around about a year now. the shortage is for both fluids for animals and those for humans. last i heard (from my vet's), fluids were being rationed to them. if i'm not mistaken, this fluids shortage started when hospira began upgrading their manufacturing facility(-ies). i believe the first type of fluid manufactured to be effected was the sodium chloride, and possibly the lactated ringers, but other fluids came into short supply when animals/humans were switched to them because of the shortage on sodium chloride and LR. a vicious cycle kind of thing.

in fact, last september/october when i placed my yearly order of sub-q fluids for my snick, i ordered from a company in Canada and had it shipped to me. the surprising thing was that although the cost of shipping via Canada Post was extremely high, the cost per bag of fluids (which i ordered by the case) was lower than here in the US by enough that i ended up saving money by buying and having shipped from Canada. and i wasn't even able to buy more than 6 bags of fluids (sodium chloride) from anywhere here in the US at that time.

because of the 'scramble' to locate fluids for my snick -- we weren't completely out of fluids at the time but it was the time of year that i refill our yearly supply, i ended up with a little more than half the year's supply in sodium chloride and the rest in plasmalyte-a (which can sting when being given sub-q). please note that i did check with our vet, to make sure that the plasmalyte-a would be okay to give my snick, and was given the okay by our vet. not ideal, but i do still have over half of the (years) supply i bought last september/october. we're using up the sodium chloride first, then we'll use the plasmalyte-a -- vet did say to switch that way, and not alternate types of fluids (alternating types is not a good thing to do, per vet).

we're still a couple months away from ordering the next year's supply of fluids for this year, and there still looks to be (from my quick checks at online suppliers based in the US) a shortage going on. this means that soon i'll check with the Canadian supplier to make sure they've got them, and ask whether they're starting to experience any signs of a shortage.

I think the fluids shortage is over now, as we are currently having NO issues getting them (DID for awhile). 

OUR Vet charges $69 for ANY PART of the deal, whether we just want an IV-set up, a bag of fluids, or both.  I get a bag of fluids for $11.99 at Walgreens, and get my IV-set-ups for $1.10 each (by ordering 25 at a time) on-line.  Can't remember how much the needles were because I ordered 100 and haven't needed to re-order those yet since Callie started on fluids, so the needles are 3 years old. 

mrsgreenjeens said:

 
I think the fluids shortage is over now, as we are currently having NO issues getting them (DID for awhile). 

OUR Vet charges $69 for ANY PART of the deal, whether we just want an IV-set up, a bag of fluids, or both.  I get a bag of fluids for $11.99 at Walgreens, and get my IV-set-ups for $1.10 each (by ordering 25 at a time) on-line.  Can't remember how much the needles were because I ordered 100 and haven't needed to re-order those yet since Callie started on fluids, so the needles are 3 years old. 

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i knew the shortage was supposed to be over by 'mid-2015', but there still seems to be some of the usual websites (i've kept an eye on that sell fluids) that are continuing to set limits on how many bags can be ordered at one time. i sure hope the shortage is over though.

i'll tell you though, i will be comparing the cost of buying from an online supplier here in the US to the cost of buying from a Canadian supplier (plus shipping) again. i'll start looking into all that around late july/early august, with plans to place my yearly order in september/october.

i buy my IV-set-ups/giving sets online and order enough to get a discounted price too. but then, i order a years supply of those too. same with the needles.

Can you give us a link to the Canadian vendor you use?  That would be most appreciated.

I had quite the debacle receiving my case of fluids from the U.S. it took 6 months and much back and forth about why (since I was next in line for their rationing of 1 case per month) I wasn't getting it.

Apparently they were mislead from the manufacturer about how reliable that once/month shipment to them really would be.

Anyway - they finally shipped the case, and UPS damaged the box so badly, 2 bags punctured and leaked all over the rest! Then they deceptively ripped off the labeling, repackaged it in another and tore off the "1 of 2, 2 of 2 boxes" part of both labels to conceal what they'd done.  A 3rd bag was half full, tore open as well.

I finally got compensation from the shipper, and gave them ample pictures to pursue UPS reimbursing them.

Sheesh.

I believe the "back to normal" availability will be a slow, gradual process.  I don't think it will be over in any given month like clockwork.