Hearing the news that your cat needs to receive regular subcutaneous fluid therapy can be disheartening, scary and overwhelming. It's normal to feel that way at first--I know I did when I learned my precious kitty Sterling, who suffers from polycystic kidney disease, would be needing them. But as with most challenges in life, giving sub-Qs becomes easier over time. All it takes is a little patience, practice and a positive attitude. And it's so worth it, because in the end, you are giving your cat a second chance at life.

After a year and a half of giving subcutaneous fluids--first every other day, then daily and now twice per day--I've learned a thing or two. Here are my best tips. Don't feel like you have to follow them exactly; it's OK to tweak the procedure to what works for you and your cat. As long as your feline friend gets hydrated with as little stress as possible, that's all that matters.

1) Preparing the bag: I've found that warming the fluids first makes a world of difference. It's more comfortable for your cat--he or she will be more likely to sit still during the procedure, which makes it easier on you. Warm up the fluids in a bathroom sink filled partly with hot water. This usually takes 7-10 minutes for a full bag, and around 3-4 minutes if the bag is only halfway full. Do not immerse the end of bag where the line goes in. Ideal temperature: In the winter, my cat prefers it to be between 95-99 degrees. If the bag is too hot, you can run it under cold water for a few seconds or until you get it back to the right temperature. The temperature can be a little lower in the spring or summer, depending on the weather. To measure the temperature, I like to use Radio Shack's Non-Contact Infrared Thermometer. After drying off the bag, hang it up high so the fluid flows easier. I hang my bag from a vent near the ceiling, about 6 feet up from the floor. Use a black marker. Figure out how much you need to give, and draw a line to where you need to go. Make sure from where you're sitting on the ground for the procedure that you can see this line clearly. (Your vet can show you how to read the bag.)

2) Preparing the line: Always check the entire length of the line for air bubbles. A few tiny bubbles are OK, but sometimes an air pocket an inch or so in length gets stuck in the line. You must let these air pockets out before giving the fluids. It is dangerous to have big air bubbles going into your kitty. Opening the line: To get ready for giving fluids, pinch off the line with the green slider. Next, open the white roller device and massage the line to make sure it pops back to shape. You'll use the green slider to open and close line when giving fluids. (It's easier that way.) Your drip line has a small, clear chamber near the top. It should be about halfway full of liquid at all times. You will look at this chamber during fluid administration to ensure the fluids are flowing properly. Don't let the chamber fill completely with fluids; you won't be able to see the drip flow. If it happens to fill completely, before getting started, simply invert the bag and squeeze the chamber gently to push the excess liquid back into the bag.

3) Handling the needle: Make sure it's a new needle each time. And for sterility reasons, make sure it is always capped when not in use. If the needle you use pops out of your cat, you need to get a new needle and try again. In the beginning, you might go through two or three needles in one morning. But obviously you want to poke your cat the least amount of times as possible. Have extra needles nearby just in case. I use 18 gauge needles (often green in color). The pink 20 gauge needles may be slightly less painful for your cat, but the fluids will flow much slower with a 20 gauge needle, so you'll need to be able to hold your cat in place for a longer period of time.

4) Procedure: Some people like to place their cat in a small cardboard box for fluids, but I've found my cat does better when he feels less confined. I lay him down on a soft blanket, with a small pillow (to block his view) on one side and me on the other. Have your kitty lay down on his tummy, facing away from you. You can secure his back hips gently with your knees (if necessary). Gently pinch his neck skin in the back so he knows you're the Mommy cat telling him to stay put. I like to hold him and pull the skin up with my left hand, so my right hand is free to insert the needle. Summon up all your confidence. Your cat will sense if you're nervous, so try to be as fast, gentle, precise and calm as possible. It will make it so much easier for both of you. Using the skin around the lower neck/shoulders area, pull up some skin into a "tent" and insert the needle (angled side up) in the somewhat lower portion of the tent. (Do not do the same place every day; try to switch sides and remember where it went last time.) Your vet should show you in person how to insert the needle properly before you try it on your own. Slide back the green clamp to open the line; the fluids should start going in. If the fluids are not going in, you need to troubleshoot (see below). If the fluids are going, watch the bag every few seconds or so, so you know when you need to turn it off (it will take about one to two minutes, depending on the amount). You don't want to give too much. A tiny bit too much is OK and nothing to worry about, but you should try not to do this. A big ball will start to form under his skin. Don't worry, that's normal. While the fluid is going, you probably need to keep gently pinching his neck skin to hold him in place, but also pet him and tell him how good he's doing. (My cat starts getting fidgety if I stop talking to him and petting him.) When you get to the stopping point, slide green clamp to shut off the line. Pull the needle out gently. Press lightly with your hand on the insertion area for a couple of seconds to minimize leaking. Tell him he's a good boy and feed him a treat!

5) Finishing up: Roll the white clamp back down to shut the line tightly. Open the green slider at this point if the roller ball is in place. Change the needle so a clean one is ready to go for the next day. Never throw needles in the trash. You should collect them in a small plastic container and give them to your vet for disposal. You'll notice soon that the fluid has slipped down into your cat's front leg like a water balloon. This is normal. It will be soaked up over the next few hours.

Sanitation
Remember, keeping everything sanitary is really important. Wash your hands when handling the needle. If you use a needle once, throw it away. When you pull the needle off to change it, do not touch the end of the line that is exposed, or the end of the new needle. Also, when you pull the line out of the fluids bag (to attach to a new bag), make sure the end of the line and the opening of the new bag do not touch anything. You need to change to a new line approximately every three months.

Troubleshooting
Bleeding: I wouldn't say bleeding is normal, but on a rare occasion sometimes it happens. Just press a paper towel against it with light pressure; the bleeding should stop immediately or in a minute or so. If he's bleeding excessively for an extended period of time, he may need to go to the vet (although this hasn't happened to me). It usually looks worse than it is because the blood mixes with fluid solution, making it look like there's more blood than there really is. Needle is in, but fluids are flowing down his body on the outside instead of inside the body: Two things you can do here. One, gently pull the needle "out" of the hole—this is a teeny movement, like 1 mm. It might be "poking" out the other side, and this pulls it in. Two, if that doesn't work, and the leakage seems to be in a completely different location than today's needle, a hole from yesterday may be leaking. You can use your fingers to gently push the hole closed and keep the fluids entering his body instead of pouring out. This is rare though. It's only happened a few times. If neither works, you may need to try again with a new needle in a new spot. Needle is in, but fluids are not flowing: I don't know why this happens, but sometimes it happens. It may be that the needle is not in all the way, or some of his scar tissue is getting in the way. Sometimes just gently adjusting the needle (in teeny tiny movements) will fix the problem. Sometimes you can pull the skin up around the needle to provide an "area" for the fluids to flow into. A couple of times I've just had a "bad" needle that was blocked. You may need to change out the needle and poke him a second time. Not all the fluid went in: It's really important that the full amount goes in. However, if once in a while only 90 percent of it goes in, it's not the end of the world. But if, say, you only get in 75 mL out of 100 mL, and then he jumps away, you should probably get a new needle to get in that last 25. Keep in mind it's dangerous to give fluids if the previous fluids haven't finished soaking in yet. You need about 12 hours in between (for twice a day) or 24 hours in between (for once a day) for it to be safe, but an hour give or take is OK.

Buying supplies in bulk can save a lot of money. One supplier of bags and needles is VetCentric (www.vetcentric.com)--you need a prescription from your vet to make a purchase, and they'll ship directly to your home.

It wasn't easy giving Sterling fluids in the beginning; I would get a pit in my stomach whenever that time came. But months later, this once insurmountable obstacle has become just another part of my daily routine. The best part is, not giving up on him has added months--if not years--to his life, without compromising the quality of it. I'm lucky, too, because he's a wonderful patient--Sterling never holds a grudge, and while he might sometimes growl quietly during fluids, the second they're over, he's instantly happy and ready to eat his treat and go play or do his other favorite cat things.

Note: The above article is not intended to provide medical advice, and sub-Qs are not appropriate for every cat with kidney failure. Always talk to your veterinarian before starting home fluids therapy.

About the Author: Charlotte Jensen is a freelance writer and lives with her husband and cat in Orange, California. She is also Kathleen's sister, and although initially a Reiki skeptic, was amazed at Sterling's response to the distant treatments Kathleen sent him when he became ill a few years ago. She decided to learn Reiki so that she could offer Sterling Reiki whenever he needed it, and now gives him regular Reiki to help support his health. Since learning Reiki, she has not only offered Sterling Reiki, but also the myriad of injured wild animals that now seem to find their way to her yard, and her healing hands.