Stress-Free Restraints and Handling
Imagine...you are a small child, your parents bring you to a strange place, and they allow a stranger to take you away.
The stranger speaks an unknown language, drags you across the floor, and forces you into a cold, steel cage. The smell of feces and urine linger in the air. Uncertainty quickly turns to fear as you hear footsteps approaching your cage. You press yourself as hard as you can into the back corner, hoping the hands won't reach in and grab you. Against your will, you are placed onto another cold, steel surface.
People are all around, holding you down, saying things you cannot understand. You begin to fight. You are so scared you urinate on yourself. It’s difficult to breathe. You scream for your mother. OUCH! What was that? You begin to feel sleepy, the room spins, and the lights go out.
All canine and feline patients should be handled using low stress restraints and techniques, regardless of their temperament.
We would never allow a pediatrician to treat our children like this, yet it’s an all-too-common scenario for pets in veterinary clinics.
All canine and feline patients should be handled using low stress restraints and techniques, regardless of their temperament. To reduce stress, it is important to recognize actions that trigger patients’ fear or anxiety (ie, walking certain dogs within sight of aggressive canine patients) and note them in the patient’s records.
The primary cause of aggression in both dogs and cats is fear.1 Stressed animals can be hypersensitive to pain, which can exaggerate their reaction to a needle stick or other procedures. A rushed approach becomes the source of the problem when veterinary technicians feel pressured to complete all their tasks by the end of the day, overlooking the importance of proper patient handling and going slowly.
Most of us just need to modify our own behavior.
In her book Low Stress Handling, Restraint and Behavior Modifications of Dogs and Cats, Dr. Sophia Yin outlines the 10 principles of stress-free handling of patients.1 The first is a proper greeting to make the patient comfortable as soon as it walks through the door. Other principles include controlling the animal's movement, supporting the patient's body, and avoiding resistance during restraint.
Low Stress Tips When Approaching and Handling Dogs:
- Greet them in a friendly, nonthreatening tone.
- Avoid quick movements and go slowly!
- Kneel down at the dog’s level and approach from the side.
- Have owners apply a basket muzzle to historically aggressive dogs before they enter the clinic. The owners should also get the animals accustomed to the muzzle by putting sticky treats like peanut butter or squeeze cheese in the muzzle at home for several days prior to the vet visit.
- Treats should be used whenever they do not compromise the patient’s health. If treats will be used, ask the owner to withhold food at home so the patient arrives hungry.
- The reward should be given just before the needle stick or other painful procedure, and continue until the procedure is over; ie, 1 dry or semi-moist treat such as squeeze cheese, Kong paste, or Premier LikiSticks, can be given every 0.5 second. Each treat will help distract the patient and encourage it to associate the treatment with the reward.
- Support dogs against your body with the leash controlling their head movements when they are picked up (Figure 1).
- Use non-skid mats and rugs on the exam tables or floors to provide traction.
- Hold the leash at a short distance and make the dog sit so that it does not pace nervously.
- Head halters (ie, Gentle Leader, Halti, and Snoot Loop) are effective for controlling body and head movements.
- Hold smaller, wiggly patients in dorsal or lateral recumbency for venipunctures (Figure 2).
- Avoid uncomfortable positions; ie, an older dog with arthritic hips may be uncomfortable on its back during a cystocentesis.
- Consider a thick towel wrap or an Elizabeth neck collar to block potential bites, which allow very little force to be used while the animal is held.
- If a patient continues to physically struggle after various handling techniques have been tried, administer chemical restraint, preferably before the patient becomes too aroused.
- Supply oxygen via a face mask when restraining patients with respiratory compromise such as brachycephalic, collapsing trachea, or laryngeal paralysis. The mask can be used to direct the muzzle without holding the mouth shut.
- Desensitize patients when they are hospitalized by taking time for some general TLC.
Low Stress Tips When Approaching And Handling Cats:
- As with dogs, take a “less is more” approach.
- Tell owners that an ideal carrier has a removable top.
- Give owners tips on acclimating cats to the carrier to help decrease the level of anxiety: http://www.hillspet.com/pdf/en-us/tips-on-taking-your-cat-to-the-veternarian.pdf.
- Instruct owners to remain calm while in the exam room, ie, speaking softly and moving slowly around the cat.
- Some people report that cats can be relaxed by blinking slowly in their direction without completely closing your eyelid, a so-called “calming signal." Explain to the owner that this is like giving the cat a hug without actually having to touch them.
- Reduce auditory stimuli, especially loud unexpected noises.
- Place soft, preferably non-slip surfaces, between the cat and the exam table.
- Stand off to the cat’s side, which is less threatening, and avoid staring directly into its eyes.
- Give the cat an opportunity to walk out of the cage while you take the history from the owner (but do not allow it to leave the exam table).
- Always provide a hiding spot, like a small box, for a cat that will be staying in a clinic cage for some time.
- If the cat refuses to come out of the carrier, most of the exam can be performed in the carrier by removing the top portion.
- If pain is expected, examine the painful area last. If the cat if it starts to vocalize or tries to flee, various towel techniques can keep the cat’s head covered and body accessible to complete the physical, give injections, and draw blood samples.
- Try to limit petting to the head or neck. However, an aroused or fearfully defensive cat may become aggressive even with gentle petting and it is best to towel wrap these cats.
- Scruffing, and especially stretching, should not be the standard restraint technique in cats. Try placing 3 middle fingers on top of the cat’s head, with your thumb and pinky finger at the base of its ears, instead of a scruff.
- Treats will help to distract the cat and associate the treatment with the reward (Figure 3). Feline pheromones can be sprayed on a towel, but these sprays are offensive to some cats, so apply it 30 minutes before using the towel, and do not spray it in the cat’s presence. Diffusers can also be set in treatment areas.