Canine Kidney disease...and how to deal with it

Giving subcutateous fluids injections (click images to enlarge)

One of the first and best things you can do after diagnosis of renal disease to help your dog is subcutaneous sodium chloride fluid injections SubQ for short
The main reason to do this is to keep your dog properly hydrated, since your dog is most likely urinating more than normal and dehydration is very bad for the kidneys, this will help both your dog's overall well being and replenish electrolytes due to dehydration.

The dosage is 5 to 15 ml per pound of body weight at one time but to get the exact dosage I suggest you consult your vet, certain other health conditions may require adjustments to the dosage or keep you from exploring this option so please consult.
There are many ways to do this and your vet may show you a different method, other websites or resources as well but the goal is the same and the equipment needed will be similar.

This is how we do it:

First of all you will need the sodium chloride solution (saline), this needs to be the injectable kind and can be bought at your vet's or certain drugs stores carry it and should be no more than 10$ for a 1000 ml bag.

Next, you will need one 21 gauge winged infusion set, three 60 ml luer-lok tip syringes, two 18 gauge needles and about six cotton alcohol swabs

The gauge may vary but we found that a 21 gauge is small enough to be easily inserted without hurting the dog and big enough to allow the fluids to flow freely and easily.

These are the items that should be available and ready before you summon the dog for the injection

21 gauge winged infusion set
60 ml luer-lok tip syringes
18 gauge needles
Cotton alcohol swabs

Before you begin start to heat up some distilled water (easily found at any drug store) in a regular non-Teflon saucepan for the purpose of disinfecting all the equipment when you are done.
Try to time it so that the water comes to a boil as your are finishing the injections.

*Please note that this will NOT sterilize any of the equipment, the goal here is at best case disinfect or worse case thoroughly clean the equipment.

You are now ready to begin.

Have everything readily available. As the distilled water slowly heats up and the dog is nearby; begin by twisting on the needle to the syringe
....and cleaning the saline bag's nozzle with a alcohol swab.

The next step is to fill the syringe:

1. Insert syringe into the saline bag's nozzle

2. Begin extracting the saline slowly to avoid air bubbles from building up

3. Extract a bit more than needed to allow for pushing out of any air bubbles

4. Pull out and hold upright to bring any air bubbles to the top and tap a few times to consolidate them and press on syringe until saline squirts out and no bubbles are left.

Remove the needle and put it into the distilled water saucepan. You will be adding things into the pan as you use them.

The next step is to twist onto syringe a winged infusion set, alcohol swab it and like with the needle, push out some saline until you see liquid come out at the end.

Time to get your dog to come over, keep in mind that with time this will become very routine and your dog should not come to see this as a negative thing and should not be painful, if it hurts your dog, you're doing it wrong. Ideally two people should be involved to help hold the dog and hand over accessories but the pictures will show one person only since some people will have no choice but to do this on their own.

Preparing dog for injection:

1. With the dog standing either on the floor on better yet on some kind of table if possible, alcohol swab thoroughly a small area on the dog's back along the spine against the grain of the dog's fur to easily reach the skin. Note: if you have multiple injections to give depending on your dog's weight leave your self room for the next ones by starting near the shoulder blades.

2. Next squeeze up the dog's skin next to where you swabbed as if you were picking up a briefcase, a dog's skin on their back is generally very loose so it should not hurt.

3. With your index finger dig a dimple right where you swabbed originally, this is where you will inject, doing this pretty much ensures that the saline will go in under the skin and not between the layers of the skin.

4. Parallel to the dog's back, insert the infusion needle quickly and all the way in, DO NOT HESITATE on the way in this will slow the insertion and will hurt the dog, the quicker you go in the better and painless it will be.

5. Make sure that the pointed tip of the infusion needle is at the bottom for easier entry into the skin.

Injecting the saline solution involves the followings steps:

1. Place your index finger over the wings of the infusion set and with your middle finger form a V shape, this is to guide the saline off to the side and avoid it from staying near the needle puncture so it won't leak out when done.

2. Continue injecting the saline in a slow steady pace and be sure to STOP just before reaching the end since there is almost always one air bubble left over.

3. Place index and thumb near the injection entry and quickly pull out the winged set.

4. Pinch the entry area for 15 seconds.

5. Swab thoroughly.

The final step is the clean up and disinfection of the accessories with the by now boiling distilled water in the saucepan for about 10 minutes, remember this in no way will sterilize.
I suggest using things no more than 3 times before discarding particularly the winged infusion set since they loose some sharpness each time they are inserted.

The way to disinfect a winged infusion set is while the other accessories are in the boiling distilled water:

1. Use a spare syringe and fill it about half way with the now boiling water. 2. Hold it upright some water should leak out this is normal 3. Connect the winged infusion set and empty out the syringe back into the pan, while periodically dipping the infusion set into the boiling water. 4. When empty, be sure to pull out any remaining liquid from the infusion set's tube.

Continue to boil the accessories for a total of 10 minutes at medium heat and allow to air dry on a paper towel, after an hour or so, put away in a cool dry place until next usage.

Reference links :

Scooter's Mail Order Supplies for Chronic Renal Failure (CRF)
Dogaware.com/kidney

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