Page 13 - 2013 AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats

2013 AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats

Fluid distribution abnormalities include edema (pulmonary, General Guidelines for IV Fluid Administration
peripheral, interstitial) and effusions (pleural, abdominal, through y Use a new IV line and bag for each patient, regardless of
the skin of burn patients). Two main causes of edema/effusion are route of administration. 46
loss of intravascular oncotic pressure and loss of vascular integrity. y Ensure lines are primed to avoid air embolism. 47
Consider concurrent dehydration and whole patient volume defi- y Fluid pumps and gravity flow systems require frequent
cits when treating patients with abnormal fluid distribution. monitoring. Check patients with gravity flow systems more
Suggested specific approaches to fluid therapy include the frequently because catheter positioning can affect rate.
following: y If using gravity flow, select appropriate size/volume bag
y Pulmonary edema/volume overload: stop fluid for patient size, particularly in small patients, to minimize
administration, consider diuretics, address cardiovascular risk of inadvertent overload if the entire bag volume is
disease if present, and provide mechanical ventilation with delivered to the patient.
positive end-expiratory pressure (if indicated). y Use a buretrol if frequent fluid composition changes are
y Pleural/abdominal effusions: stop fluid administration, anticipated to reduce changing entire bag.
administer diuretics if indicated, address cause(s) of y Consider using T-ports to easily medicate a patient
effusion, perform either abdomino- or thoracocentesis if receiving IV fluids and Y-ports in animals receiving more
respiration is compromised. than one compatible infusion.

Equipment and Staffing
Staffing considerations and a description of useful equipment for
delivery of fluid therapy are described below.

Staff
To optimize the success of fluid therapy, it is critical to pro-
vide 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 con-
sequences 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:
y Consider giving higher rate of fluids while staff members
are present, and administer subcutaneous fluids overnight.
y Use fluid pumps whenever possible, and check them
regularly for proper function and calibration.
y Use a smaller volume of fluid in the bag to reduce chance
of overloading (note that even 250 mL could fatally
volume-overload 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).
y Consider using an Elizabethan collar to prevent patient
removal of the catheter. ©2013 AAHA
y Luer lock connections prevent inadvertent disconnection.

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