IV Treatment

IV Treatment Overview

If lethargic, paws are not warm, or gums are not pink, or <5lbs:

1. Place an IV catheter

2. Run a PCV/TP/BG with the blood from placing the catheter

3. Start dog on a pump set to 3x maintenance with a 1l LRS fluid bag that has 3ml metoclopramide and 10ml (20mEq) KCl

   1. If BG is under 100 (under 80 for larger dogs), or the dog is under 5lbs, add 5% dextrose to the fluid bag

   2. If TP is <3, or PCV is <25%, tell vet and start on 1.5x maintenance

   3. Maintenance is calculated by (60*((weight in lbs)/2.2)*(maintenance level)/24

   4. Flush the IV line by letting the fluid run through it before hooking it up to the dog.

• LRS - 10 mL/lb SQ SID 

• Baytril (100mg/mL) - 0.05 ml/lb SQ SID Must be on the same shift as LRS

• Cefazolin (250mg/mL) - 0.04 ml/lb IV slowly (over 3 minutes) BID

• Metoclopramide- 0.05 cc/lb SQ Once on intake 

• Cerenia (10mg/mL) - 0.04ml/lb SQ or IV SID

• Ondansetron (2mg/ml) - 0.05ml/lb SQ or IV BID

• Panacur - 0.2ml/lb PO SID for 5 days 

Detailed Structure of IV Treatments

1. Draw up and label all patient's medications and Heparin flush if not already prepared. Get an alcohol swab

2. Perform your brief exam - check gums, paws, mentation

3. Check for swelling below or above the catheter site. Compare with the opposite limb.

   • Swelling above IVC - stop pump and notify clinic and/or co-volunteer. Replacement needed.

   • Paw swelling - Loosen vetwrap and tape (experienced volunteer needed) 

4. Clean IVC port with alcohol swab

5. Clamp the upstream fluid line and flush the catheter to check for patency.  (if not clamped, fluid will go up into the bag). Only 0.5-1mL needed.

   • If mild to moderate resistance when flushing, IVC may have blown. Try pulling the plunger of the flush of the synringe back to check If blood is drawn, If so, it is in the vein.

   • If  completely resistant to flushing (unable to push any flush), there is likely a blood clot. Push syringe with lots of force to push clot through, or "fish out" cloth with sterile needle. IV pump alarm/occlusion error will be going off with an occluding blood clot. 

   • Unclamp the fluid line when finished!

6. Administer antinausea medications first

7. Administer antibiotics slowly, over 2-3 minutes.

8. Flush catheter when finished with meds - residual Heparin in IVC will prevent clots

9. Check pump bag for sufficient fluid for 12 hours

10. Check VTBI (Preset), Rate, and rate units (ml/hr)

11. Especially if Hetastarch was administered via pump, check VTBI & Rate

12. Place pump on dry hand towel 

13. Hit the "start" button if the pump was stopped!

IVC Maintenance

When patients become more critical (lethargy, pale gums, increased vomiting, and/or bloody diarrhea), they are placed on IV medications and IV fluids as a constant rate infusion (CRI) continuously throughout the day. This is accomplished by placing an IV catheter (IVC). The IVC must be maintained properly.

• Checks prior to treating:

  • Swelling above or below the catheter

    • Paw swelling below the catheter - the tape or vet wrap is too tight (swelling from vein constriction): carefully loosen it.

    • Arm swelling above the catheter - a blown vein (swelling from SQ blood and fluids); the patient needs a new IVC on a different arm. May be painful or result in abscess.

  • Flushing the catheter

    • Plain LRS or NaCl fluids can be injected into the catheter to check for patency, meaning there are no blood clots clogging the catheter and that the vein has not blown. A patent catheter will have almost no resistance when pushing/administering the flush. 

      • If its a blood clot: There will be moderate to high resistance. Remove the clot by pushing the flush through it, or carefully remove any visible clots with a needle. 

      • If the catheter is blown: There will be low to moderate resistance and swelling above the catheter site.

    • Flush before, between and after medications. Only use however much is needed - as little as 0.2-0.5mL.

    • The drug Heparin, and anticoagulant, is often added to the flush to help prevent blood clots forming inside the catheter

      • Review the dangers of Heparin on the medical chart.

• Catheters should be changed every 72 hours

• Cleaned the IVC port with an alcohol swab prior to administering medications.

IV Medications

As a general rule, most IV medication are clear in color and nothing colorful should be injected IV.  The most common result of injecting a drug not meant for IV use is seizures and/or death. Never inject something into a dog without knowing what it is and what route is safe.

See the following for images of each drug/LRS:

• Cefazolin - https://www.pfizerinjectables.com/products/Cefazolin

• Cerenia - https://ar.zoetis.com/products/caninos/cerenia.aspx

• LRS - https://www.valleyvet.com/ct_detail.html?pgguid=30e072f0-7b6a-11d5-a192-00b0d0204ae5

• IV CRI - Patients are typically on an IV CRI for several days until they start eating again.

  • Lactated Ringers Solution is the most common and affordable crystalloid fluid solution given IV. 

  • Always read the full name of the fluids/drugs before drawing up or administering anything. 

  • Sometimes donations will have LRS + Other Drugs. 

  • Additional medications can, and frequently are, added to the fluid bag depending on need

  • Review the three common drugs added into a fluid bag to be given as a CRI on the medical chart page.

    • Dextrose - sugar

    • Reglan - antinausea

    • KCL (Potassium Chloride) - electrolytes

• IV Drugs - administered every 8-12 hours 

  • IV ports are cleaned with an alcohol swabs before touching the needle

  • Common IV medications -by day 4 of training, you should be familiar with these

    • Ampicillin and Cefazolin (antibiotics)

    • Famotidine (antacid)

    • Cerenia (antiemetic)

  • Less common IV Medications - study these on the medical chart page. Know the type, which ones need to be administered differently than other IVs, and which ones are refrigerated. As always, know the dangers as well.

    • Famotidine

    • Anzemet

    • Dextrose

    • Oxytetracycline

See the following links for images of medications:

• Dextrose - http://www.livestockpros.com/vitaminsinjectables2.htm

• Vetrimycin - https://www.vetdepot.com/vetrimycin.html

• Famotidine - http://www.west-ward.com/en/Products/ProductsRoot/Famotidine%20Injection%20USP

Hetastarch

See https://www.pfizerinjectables.com/products/Hetastarch_in_Sodium_Chloride for image of Hetastarch.

• • Hetastarch is a colloid fluid that contains proteins, unlike crystalloid fluids (LRS). Protein helps draw fluid from outside cells into the blood vessels, this increasing blood volume and pressure. Increased pressure helps improve circulation to all internal organs.

  • This drug is typically used on critical, and/or crashing dogs, especially when their gums are pale/grey/white. It is most commonly given as a bolus in the AM and PM shifts. It will be prescribed, for example, as "Hetastarch 50mL over 20 minutes". You must be able to calculate what fluid rate (mL/hr) to set an IV pump to. (The rate is 150ml/hr).

  • Some dogs may be on a Hetastarch CRI to replenish and maintain protein levels

  • Dangers - this drug must be given slowly, and can only be given a certain amount (depending on weight) a day. Overdosing can cause severe fluid overload, fluid in the lungs, and/or internal bleeding. Use caution with this drug and triple check dosage and time.

  • The most critical patients will be on Hetastarch, especially with severe bloody diarrhea, pale to grey/white gums, and/or severe lethargy.

  • For detailed information on Hydrostatic and Oncotic Pressure, which is stabilized by Colloid Fluids such as Hetastarch, consult the Wikipedia Article and see the following video:

IV Pumps

An IV Pump is used to administer a CRI (constant rate infusion) of fluids throughout the day. They are generally simple to use, but small mistakes can result in severe medical consequences. Carefully check that the IV Pump has the proper settings with every use.

See http://apexx-equipment.com/veterinary-mfg/leading-edge/Conntrol-V-935i-IV-Pump-from-Leading-Edge for an image of a common pump.

• VTBI

  • The VTBI, also called 'Preset' on some pumps, is the total volume of fluid that will be administered to the patient.

  • For Hetastarch, set the VTBI/Preset to the dose prescribed by the doctor (i.e. 50mL)

  • For a CRI, set the VTBI to 9999mL, as we are unsure how many days the patient will continue to be on IV fluids

• Rate

  • The rate is always prescribed in mL/hr and NOT drops/mL

  • The doctor will prescribe the fluid rate in mL/hr (i.e. 12mL/hr) based on the patients body weight

  • The Hetastarch rate must be calculated. If the doctor prescribes 50mL over 20 minutes, set the rate to 150mL/hr and the VTBI/Preset to 50mL. The IV Pump will administer Hetastarch at a rate of 150mL/hr until it has given 50mL

• Troubleshooting - review the common 'errors' of the IV pump and be aware of the flow chart to assist in troubleshooting a problem.

  • Occlusion

  • Air

  • Upstream Occlusion

  • Battery

• Maintenance - pumps are expensive and parvo puppies are messy! Please take care of our pumps

  • Clean any vomit or diarrhea with a damp washcloth

  • Set the pump on a dry, folded up wash cloth incase of urine or diarrhea pooling under the pump