To optimize the success of fluid therapy, it is critical to provide staff training on assessment of patient fluid status, catheter placement and maintenance, use of equipment related to fluid administration, benefits and risks of fluid therapy, and drug/fluid incompatibility. A variety of veterinary conferences and online resources from universities and commercial vendors provide such continuing education.45
IV fluid administration is ideally monitored continually by trained technical staff. Without adequate monitoring, severe consequences can occur and patient care is compromised; however, there are many practices that are either unable to provide 24 hr care or are geographically unable to refer to a 24 hr facility. If it is not possible to monitor around the clock and unmonitored fluid administration is deemed necessary, take the following steps to make the process as safe as possible:
- Consider giving higher rate of fluids while staff members are present, and administer subcutaneous fluids overnight.
- Use fluid pumps whenever possible, and check them regularly for proper function and calibration.
- Use a smaller volume of fluid in the bag to reduce chance of overloading (note that even 250 mL could fatally volumeoverload a small patient. Know the maximum volume for safe infusion over a given time [based on rates described in this document], and match the unattended volume to that value).
- Consider using an Elizabethan collar to prevent patient removal of the catheter.
- Luer lock connections prevent inadvertent disconnection.
General guidelines for IV fluid administration
- Use a new IV line and bag for each patient, regardless of route of administration.46
- Ensure lines are primed to avoid air embolism.47
- Fluid pumps and gravity flow systems require frequent monitoring. Check patients with gravity flow systems more frequently because catheter positioning can affect rate.
- If using gravity flow, select appropriate size/volume bag for patient size, particularly in small patients, to minimize risk of inadvertent overload if the entire bag volume is delivered to the patient.
- Use a buretrol if frequent fluid composition changes are anticipated to reduce changing entire bag.
- Consider using T-ports to easily medicate a patient receiving IV fluids and Y-ports in animals receiving more than one compatible infusion.
- Consider using a syringe pump to either infuse small amounts of fluids or to provide a constant rate infusion. For small volume infusions, place the end of the extension set associated with the small volume delivered close to the patient’s IV catheter so that the infusion will reach the patient in a timely manner.
- Consider a pressure bag for the delivery of boluses during resuscitation.
Catheter maintenance and monitoring
- Clip the hair and perform a sterile preparation.
- Maintain strict aseptic placement and maintenance protocols to permit the extended use of the catheter.
- Place the largest catheter that can be safely and comfortably used. Very small catheters (24 gauge) dramatically reduce flow.
- Flush the catheter q 4 hr unless continuous fluid administration is being performed. Research suggests that normal saline is as effective as heparin solutions for this purpose.48
- If a nonsterile catheter is placed in an emergency setting, prepare a clean catheter site and insert a new catheter after resolution of the emergency.
- Unwrap the catheter and evaluate the site daily. Aspirate and flush to check for patency. Replace if the catheter dressing becomes damp, loosened, or soiled. Inspect for signs of phlebitis, thrombosis, perivascular fluid administration, infection, or constriction of blood flow due to excessively tight bandaging.
- To minimize the risk of nosocomial infection, the Centers for Disease Control recommend that fluid administration lines be replaced no more than q 4 days.46