Page 14 - 2013 AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats

2013 AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats

y 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.
y Consider a pressure bag for the delivery of boluses during
resuscitation.

Catheter Maintenance and Monitoring
y Clip the hair and perform a sterile preparation.
y Maintain strict aseptic placement and maintenance
protocols to permit the extended use of the catheter.
y Place the largest catheter that can be safely and
comfortably used. Very small catheters (24 gauge)
dramatically reduce flow.
y Flush the catheter q 4 hr unless continuous fluid adminis-
tration is being performed. Research suggests that normal
saline is as effective as heparin solutions for this purpose. 48
y If a nonsterile catheter is placed in an emergency setting,
©2013 AAHA
prepare a clean catheter site and insert a new catheter after
TABLE 6 resolution of the emergency.
y Unwrap the catheter and evaluate the site daily. Aspirate
Relearning What You Thought You Knew*
and flush to check for patency. Replace if the catheter
y Current recommendations for routine anesthetic fluid rates dressing becomes damp, loosened, or soiled. Inspect
are for  10 mL/kg/hr to avoid adverse effects 6,7 for signs of phlebitis, thrombosis, perivascular fluid

y The use of a K-containing balanced electrolyte solution does administration, infection, or constriction of blood flow
not increase blood K in cats with urethral obstruction 51 due to excessively tight bandaging.
y To minimize the risk of nosocomial infection, the Centers
y LRS will not exacerbate lactic acidosis 52 for Disease Control recommend that fluid administration

y Patients with subclinical hypertrophic cardiomyopathy may lines be replaced no more than q 4 days. 46
be able to tolerate cautious fluid boluses for hypotension if
their volume status is questionable, but they should be closely Conclusion
monitored for fluid overload and congestive heart failure 53 Fluid therapy is important for many medical conditions in veterinary
patients. It is dictated by many factors and is highly patient vari-
y LRS or acetated Ringer’s solution may be used in liver disease.
LRS contains both D- and L-lactate and is unlikely to increase able. Fluid selection for a given patient may change during therapy,
blood lactate levels 52 depending on patient needs. The goal of these guidelines is to assist
the clinician in prioritizing goals, selecting appropriate fluids and
y When flushing an IV catheter, normal saline is as effective as rates of administration, and assessing patient response to therapy.
heparin solution 48,54 The reader must recognize the highly individual patient vari-
y In general, the choice of fluid is less important than the fact that ables and dynamic nature of fluid therapy. Because fluid therapy
it is isotonic. Volume benefits the patient much more than exact can be highly individualized in complex cases, having a relation-
fluid composition. Isotonic fluids won’t have a severe negative ship with a referral facility for consultation can be helpful.
impact on most electrolyte imbalances, and their use will begin Ongoing research is challenging current dogma regarding fluid
to bring the body’s fluid composition closer toward normal administration rates, particularly rates for administration during
pending laboratory results that will inform the clinician of more anesthesia (Table 6). There are few evidence-based recommenda-
specific fluid therapy 36 tions, and limited research has been performed related to fluid
administration in veterinary patients. The reader is encouraged to
* See text for details. be alert to future data as it becomes available and incorporate that
LRS, lactated Ringer’s solution. information in practice protocols. n

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