Proper Animal Handling & Restraint

Introduction

• Effective restraint is an important part of veterinary medicine that we simultaneously take for granted but also need to be successful. Restraint techniques are passed on in an almost cultural fashion with sometimes little thought given to their logic and effectiveness. Historically, animals were restrained by physically overpowering them. This often resulted in injury to the animal or involved personnel,
  and/or the restraint attempt failed which prevented successful completion of the intended procedure.
• Choosing techniques that build on natural behavioral responses results in more empathy and awareness of the animal as well as a greater likelihood of success.
• Safety and success are much more likely when personnel strive to reduce actions that the animal may view as threatening or aggressive. Adversarial handling typically increases the probability of the animal becoming aggressive or attempting to escape.

General Principles

• A number of factors are involved in triggering aggression and/or escape responses in animals. The most common include fear, pain, punishment (which induces fear and anxiety) and excessive physical contact. Most animals show fear/defensive aggression because they find some aspect of the processes threatening. This may be the environment, the personnel, the equipment, the procedure, the restraint technique used or any combination of these.
• Animals are particularly likely to react to handling of certain body regions as well. These include the head/neck, the legs and feet, the groin/perineum, the abdomen, and any area that is painful. These areas are natural targets in serious attacks because they are areas where it is relatively easy to deliver an incapacitating or fatal injury. Restraint techniques should be chosen with these factors in mind. In particular, avoid directly restraining the animal’s legs whenever possible as this universally induces even more struggling and aggression. Protection of the legs is a biologically hard-wired behavior.
• It also is important to remember that what matters is whether the animal finds an interaction threatening — not whether the veterinary professional does. Often, in the process of trying to be friendly to an animal, we portray body signals that actually mean the opposite. This is particularly true around horses and dogs. The way the average person greets a dog is a perfect example. Most people approach dogs from the front, lean over, and extend their hand to allow the dog to sniff it or to try to pet the dog. There are several elements in this approach that directly threaten the dog: the direct, frontal approach; making eye contact; leaning over; and reaching out over the dog’s head. These are intensified if they are done in a quick, tense or agitated manner.
• Good restraint is all about empathy, finesse, and technique – it has little to do with strength. If any procedure requires more than two people to actually hold the animal, there is something wrong with that technique for that procedure on that animal for that day. The more people that are involved, the more threatened the animal will feel and the more easily someone will be injured.

Restraint Methodology

• Appropriate restraint is all about empathy, finesse, and technique – it has little to do with strength. If any procedure requires more than two people to actually hold the animal, there is something wrong with the employed technique for that procedure on that animal for that day. The more people that are involved, the more threatened the animal will feel and the more easily someone will be injured.
• Restraint also does not necessarily mean immobilization. Animals have 5 basic reactions to stress or threat. These include fight, flight, freeze, faint, and fidget (or fooling around). The latter is an often overlooked sign of stress. Staff members frequently assume animals that are obnoxious and hyper in the room are just plain stupid or untrained, but this is a simplistic outlook considering the situation the animal is in. Keep open minded that the animal’s hyperactivity might actually be a reaction to stress. Punishing these animals usually raises their stress level and exacerbates the behavior.
• Restraint dictates that we move into the animal’s personal space without the animal’s permission. This puts personnel in the “critical zone” where animals are often more likely to attach rather than to try to run away, especially if escape is blocked. Making wise choices as to how you invade the animal’s space can reduce this reaction in most animals.
• Always use the least amount of restraint necessary for the procedure and invade the animal’s “intimate space” as little as possible. Restrain the animal for the behavior that it is currently showing – not for the behavior that you think it may show in the near future.
• Restraint requires patience! Some animals need time to adapt to the process; trying to rush the animal will only increase its anxiety.

Fundamentals of Patient Interaction

• Personnel should move around and interact with the animal 25-50% slower than their natural inclination. A universal observation I have made in watching people handle animals is that they move too quickly and pay too little attention to what the animal is telling them at any moment. Animals almost ALWAYS warn before escalating attack or escape, especially dogs. The problem is that we tend to miss these warning signs.
• Doctors and staff should remain calm and neutral no matter how badly the animal may behave. Poor behavior should be ignored; however, any trend toward better behavior—no matter how small—should be immediately rewarded in some way.
• In 98% of cases, injuries to humans occur because someone did something unwise, became complacent while working on the animal, or did not know how to read the animal’s body language. Remember that behavior is constantly changing. Just because the animal is friendly at the beginning of the exam or procedure, does not mean the animal will remain so three seconds later. Always assume the animal may injure you at any time – be cautious and prudent, but not paranoid. Always keep your body parts away from the animal’s weapons.
• Restraint techniques should never involve any of the following: physical reprimands of any type (jerking on leashes, hitting or striking the animal, biting the animal, etc.); pinning the animal’s head or neck in doorjambs or under your body; alpha rolls; scruff shaking; cuffing under the chin; hanging with leashes or choking the animal in any way; or “pile-ups” (having several people grab hold of the animal and pin it to the ground or table).
• Avoid scruffing cats as a routine restraint method. Scruffing alone is actually not a secure way to restraint a cat, and it aggravates many cats more than necessary. Scruffing does not trigger some magical relaxation in cats. Cats do have a flexor reflex when picked up by the scruff when they are kittens, but there is no biological advantage for an adult cat to go limp when grabbed by the back of the neck. Adult cats are only subjected to this action in four general contexts: fighting, play fighting, breeding and predatory attacks. Alternative methods can be more successful.

Interpreting an Animal’s Body Language and Behavior

• Changes in the patient’s environment may cause normal behavior patterns to change
• Body language communicated by the animal can demonstrate clearly how it feels toward other animals, people, and its surroundings
• Body language can help you determine how easy or difficult an animal may be during handling and restraint

The Friendly Patient

• Relaxed, alert, is able to stand, sit or lie with a comfortable appearance, ears up and forward
• Amendable to being handled
• However, all veterinary staff should be alert to any change in behavior
• Behavior changes can occur rapidly depending on the procedures being performed

The Frightened Patient

• Has the potential to be difficult to handle and can become aggressive quickly – always use caution and calmness with these patients
• Stiff stance, shaking and/or tremors from nervousness, avoids direct eye contact, lays their ears flat or back on the head, lowers their body or tail towards the ground
• Submissive pets can react instinctively when they feel threatened

The Aggressive Animal

• Shows Aggressive behaviors…growling
• Stiff stance, baring teeth, head lowered to the ground, staring, and tail raised
• Dominance aggression – “pack” animal instinct and social status within a group
• Fear aggression – defense reaction to being harmed and the instinct for an animal to protect itself
• Territorial aggression – refers to an animal’s protective nature of its environment (Cage Aggression)
• Redirected aggression – predator instinct where the animal turns its aggressive behaviors on the owner and staff
  • This is the most serious type of aggression

Patient Restraint Considerations

• Restraint is the process of; holding back, checking, or suppressing an action and/or keeping something under control using safety and some means of physical, chemical, or psychological action.
• Restraint is a necessary tool used by veterinary staff to allow an animal to be controlled for various procedures
  • Safety of the patient and staff are paramount!
• Sedatives/Tranquilizers – are sometimes necessary to keep a patient calm or pain free during certain stressful procedures or circumstances.

Animal Safety

• The patient’s safety is of the highest concern when selecting and implementing restraint techniques.
• Patients who are not well socialized or accustomed to human contact, will become easily stressed in a new environment
• Young animals must always be handled with care, as they can be very fragile
• Older patients should also be handled with care, as they may be arthritic and have increased pain
• The safety of the patient and staff must be considered every time restraint is necessary
• Never allow non-veterinary staff or an owner to restrain any animal
  • This can have potential legal repercussions

Why Proper Restraint Techniques?

• Prevents injury
• Necessary for examinations and treatments
• More comfortable for animal and handler
• A First Aid Kit should be available for all bites and scratches
• All Animal bites must be reported to the NY Dept. of Health

Planning the restraint procedure

• When preparing to restrain a patient, always make sure the area has enough room, is clean, dry, and well lit
• A plan should be discussed:
  • Move any costly equipment
  • Nonslip area
  • Temperature should be considered
  • What should be done if animal happens to get away from restrainer
  • Back up plan (Plan B!)

Rabbit Restraint & Handling

• Picking Up
  • Grab scruff of the neck with one hand and lifting up while placing the other hand under the rump for support or wrap patient securely in a towel.
• Holding
  • Use the same technique but the hand under the rump is moved to support the abdomen.
• Rabbits seldom bite but many cause injury with their hind legs or may be injured if placed on a smooth surface
  • Rabbit’s foot pads are covered with fur which causes a lack of traction
  • Can lead to dislocation of their hip or spinal fracture, when they try to move or hop

Rodents & Ferret Restraint & Handling

Mice

• Grasp the tail close to the body with one hand
• Use the other hand to grasp loose skin in the neck and shoulder area.

Larger Rodents and Ferrets

• Make sure the animal is awake to avoid bites
• Hold in one hand, cup other over its head
• Wrap thumb and index
• finger around neck and under chin
• Do not over tighten fingers around chest as this can impair breathing

Avian Restraint

Birds

• Highly trained personnel
• Can stress easily
• Do not squeeze thorax
• Sensitive to overheating
• Small to medium sized
• Grasp from behind, finger and thumb on sides of head, others around body
• Large birds require 2 hands
• Towel can also be used

Restraint Equipment

• Muzzles
  • Commonly used for dogs, cats, and horses
  • Made of nylon, leather, wire, or basket materials
  • Can be made with gauze, tape, or leashes
• Towels
  • Used to restrain small animals
  • Used to wrap and contain
  • Swaddle fearful patients

Cats Restraint & Handling

• Cats tend to be one of the most difficult during restraint when they become upset and aggressive from stress
• Safely restrain and have control over head
• Cat bags: control the limbs and head
• Squeeze cages: wire boxes with small slots that allow injections to be given
• To work around head:
  • Wrap or swaddle in a blanket or place in “cat bag”
  • Allows handler to grasp and hold the back of the head between the thumb and fingers

Cats

• Anesthesia chamber can be used when absolutely necessary. However, there are many safe anesthetic protocols that can be used to sedate aggressive cats
• When necessary, the scruff technique can give the handler control over head. This can also be used to distract their attention away from an area you are working on. However, other more effective restraint techniques should be considered first.
• The stretch technique involves scruffing the cat with one hand while in lateral recumbency and using the free hand to hold the rear limbs and pull them dorsally

Dog Restraint & Handling

• Standing restraint
  • Place one arm under the dog’s neck with the forearm, holding the head
  • The other arm is placed around the animal’s body to pull it close to the handler
  • Can be used on floor or table
  • Use
    • General Exams
    • Specimen Retrieval
    • Nail Trims
• Sitting Restraint
  • Same technique as standing restraint, but dog is sitting
  • Can be against wall to keep dog from backing up
  • Use:
    • General Exams
    • Cleaning ears
    • Blood draw
• Lateral Recumbency
  • Begin in Sitting Restraint
  • Carefully place in lying position
  • Hold legs that are on down side of table/floor
    • prevents dog from standing
  • Pay attention of head of animal!
  • Use:
    • X-Rays
    • Blood Draw
    • Nail trims (extreme)
• Sternal Recumbency
  • Place dog in sitting position
  • Use light pressure to encourage dog to lie down on its chest
  • “Bear-hug” dog to maintain restraint
  • Use:
    • Close examination
    • Blood draw
• Dorsal Recumbency
  • Will need more than one person
  • Place in lateral recumbency, then carefully roll dog to its back
  • Front legs are pulled forward to head
  • Rear legs are pulled towards tail
  • Use:
    • X-Rays
• Venipuncture
  • Cephalic
    • Cephalic vein in front leg
    • Sitting/Sternal Recumbency
  • Jugular
    • Jugular vein on either side of neck
    • Sitting/Sternal Recumbency
  • Saphenous
    • Inside of thigh in rear limb
    • Lateral recumbency
• Muzzles
  • prevent biting
  • can be simple narrow strips of gauze or cloth
  • make a loop in the material
  • Loop is then slipped over the dog’s nose and mouth
  • The ends are crossed under the jaw to bring them up behind the ears for tying in a bow