Liz Hughston, MEd, RVT, CVT, VTS (SAIM, ECC), VetTechXpert
Liz Hughston, MEd, RVT, CVT, VTS (SAIM, ECC), practices as a relief veterinary nurse and consultant in the San Francisco Bay Area for both general and emergency/specialty practices. She is dedicated to advancing veterinary nursing through training and mentorship and is frequently sought-after as a national and international speaker. Liz graduated from Foothill College in 2006 and earned her VTS certification in both small animal internal medicine and emergency and critical care in 2012. She was honored in 2013 with California’s Registered Veterinary Technician Association’s inaugural RVT of the Year award, which recognized her efforts to improve veterinary nursing in California and beyond.
FUN FACT: When Liz was growing up in San Francisco, she attended rodeo camp every summer for 10 years. She can rope a calf, tie a goat, and herd cattle!
Veterinary nurses can teach clients to administer SQF at home, which has several benefits:
Chronic kidney disease (CKD) is characterized by structural or functional deficiencies (or both) that have been detectable for 3 months or longer in one or both kidneys,2 leading to a progressive loss of the ability to3:
Because the kidneys cannot concentrate the urine, free water is lost, leading to dehydration that in turn leads to decreased flow through the glomeruli and increased plasma concentrations of waste products, particularly nitrogenous waste in the form of urea (ie, blood urea nitrogen [BUN]).
In CKD patients, uremia (ie, increased BUN) is a primary cause of clinical signs (eg, vomiting, anorexia, weight loss, lethargy, ulcerations of the mucous membranes) that lead to poor quality of life. SQF helps prevent dehydration, dilute waste products in plasma, and reduce BUN, all which improve quality of life.3,4
The following information should give veterinary nurses the confidence to teach clients how to administer SQF.
Figure 1 A bag of fluids, a fluid administration or drip set, and needles are necessary for at-home SQF administration.
Most patients will be prescribed SQF for ongoing at-home treatment and have several bags of fluids dispensed at a time.
Figure 2 The client should spike the bag with the piercing pin on the drip set and ensure the bag is not punctured. Photos courtesy of Liz Hughston, MEd, RVT, CVT, VTS (SAIM, ECC)
Allow the client to actively participate until he or she feels comfortable with this step.
Show the client the drip chamber where he or she will monitor the rate of fluid administered to the pet. Explain what constitutes a good rate and what indicates the needle has been properly inserted.
Again, allow the client to practice.
Needle safety is critical when teaching clients how to deliver SQF at home. Many do not have experience with needles of any kind; some may be intimidated by the thought of sticking their pet, while others may need to overcome a general fear of needles. The following steps will prepare clients for safe and effective needle use.
When demonstrating proper needle insertion, use a towel as a stand-in for the patient. A towel provides more resistance to the needle than the patient’s skin and allows the client to practice performing a quick, decisive stick.
Figure 3 The veterinary nurse can use a towel to simulate the skin tent needed to create a subcutaneous space for fluid administration. The client can practice inserting the needle into the towel.
Figure 4 An approved sharps container is made of thick, puncture-proof plastic with a sealable lid.
Clients must know how to safely dispose of used needles at home. In many states, veterinarians are barred from accepting used needles from clients, but many pharmacies and medical offices provide needle return services as long as the needles are disposed of in an approved sharps container. (See Figure 4.)
Mail-in sharps disposal services also can be purchased at local pharmacies. All used needles must be discarded safely to avoid possible injury.
Figure 5 A walk-in closet offers excellent confinement for the pet’s at-home SQF administration and also makes elevating the fluid bag easy.
Any client can be taught to provide SQF therapy at home. Education is crucial for making clients feel confident and secure, and if they are effectively taught the required skills, they may find SQF administration a rewarding experience that gives them an active role in promoting their pet’s health.
1 Many clients are afraid of needles and the veterinary team should be well-trained to educate clients thoroughly, both at the practice and with material to take home, to help allay any concerns.
2 When teaching clients SQF administration, allow them to practice the procedure as many times as they need to feel comfortable.
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