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

Elizabethan Collars

  • Elizabethan Collars (or E-collars) prevent dogs and cats from reaching injuries with their teeth.
  • They also protect facial sores from pawing or scratching nails.
  • You can get them at pet- supply stores, catalogs, or from a vet.
  • They can also be home- made.

Making an E-collar – Cone of SHAME

  1. Measure the pet’s neck and the distance from his collar to the tip of his nose
  2. Mark these measurements on a piece of rigid cardboard or plastic.
    • We’re going to use construction paper
  3. Make a V-shaped cut from the outer edge to the inner circle.
  4. Punch holes along both edges of the collar.
  5. Lace a shoe string or yarn through the holes to secure the collar around your pet’s neck.

Additional Canine Techniques

  • Rabies pole or snare pole should only be used when absolutely necessary.
    • A rabies Pole has a noose on the end, and acts as a leash
    • Captures and restrains dogs
    • Pulling can cause severe head and neck injuries

Large Animal Restraint

  • Livestock, horses, cattle, sheep, goats, and swine
  • Instincts of prey animals
  • “Fight or Flight” instinct as part of reaction to restraint
  • Capable of:
    • Kicking
    • Biting
    • Rearing up into the air
    • Using their large bodies to injure

Canines In Summary

  • Proper restraint of a patient allows for the effective treatment of the patient but also the safety of the patient and the handler. Proper restraint techniques are an absolutely vital skill for every veterinary professional.
  • Dogs: Most dogs are well behaved, well socialized family pets and can be easily handled. However, even the best trained dog may bite when he or she is painful or feels threatened. The first step towards appropriate dog restraint is recognizing behavior cues.
  • When Handling Dogs: Not every dog will respond in the same way to handling. Above all else, rough handling should be avoided as this may lead even a good dog to bite in an attempt to defend itself.
  • When Attempting to Restrain One Should:
    • Use the least amount of restraint necessary for patient and staff safety
    • Stay calm and relaxed
    • Be firm but not aggressive
    • Remember that even very good dogs may bite/resist if something is painful
    • Use a muzzle for painful procedures (unless the patient has head or neck trauma), muzzles should never be left on for more than 15 minutes without giving the dog a break
    • Avoid handling injured areas
    • Use caution with older or arthritic dogs
    • Attempt to comfort the animal, either through petting and/or verbal reassurance
    • Consider having the owner leave the room as the patient may feel the need to protect their owner, become more distressed if it senses its owner’s distress, also dogs may behave better without their owner’s present
    • Do not allow an owner to restrain their own fearful or aggressive dog as this may lead to the owner being injured or bit
    • Consider giving pain medication if the patient is painful or if pain is expected to be induced during a procedure
    • Consider chemical restraint/sedation if the patient is overly aggressive, nervous, or difficult to handle as it may b e safer for both the patient and the handler
    • Always remember that your safety is of the utmost importance
    • Keep head above one’s shoulders

Restraint Tools Reviewed

Restraint Tools Include:

  • Flat leashes – short leashes that have a choker type loop at one end. used to lead a dog but also as a “lasso” to remove a fearful/cage protective animal from a kennel
  • Choker collars – when used properly, can be an effective tool, should never be continually kept tight, should not be u sed in patients with neck or back pain
  • Harnesses – are very useful in small dogs or in dogs that have tracheal/neck problems as a “handle” by which the dog can be controlled
  • Muzzles – should be used whenever a painful procedure is attempted, or the patient has previously demonstrated aggressive or nervous behavior, can be canvas, leather or made using a flat leash or gauze, may have a calming effect on a dog
  • E -collar – very useful in brachycephalic dogs (pugs etc.) that are difficult to muzzle, will keep the mouth away from the handler
  • Blankets/towels – very useful for removing small dogs from kennels by wrapping the blanket around the animal and lifting them out
  • Cage door – can be used as a “squeeze cage” with extremely aggressive animals in order to sedate them, extreme caution should be used with this technique
  • Capture pole/rabies pole – should only be used in extreme cases where there is a definite danger to staff.
  • The most important tool for an aggressive or fearful patient is experienced personnel!

Felines in Summary

  • Felines will not respond to the same restraint techniques as dogs. Cats tend to be nimbler and quicker than dogs, more likely to be fearful in a hospital setting. Additionally, bite/scratch wounds from cats are more likely to become infected.

Handling Cats

When Attempting to Restrain One Should:

  • Use the least amount restraint necessary for patient and staff safety
  • Stay calm and relaxed
  • Be firm but not aggressive
  • Only attempt when all participants are ready as some cats have a limited amount of time they will tolerate handling
  • Close all doors and windows
  • Allow the cat to leave its cage or carrier of its own volition if possible
  • Watch carefully for warning signs (beginning to growl, swishing the tail) as unlike dogs, cats rarely attack without warning
  • Do not allow an owner to restrain their own fearful or aggressive cat as this may lead to the owner being injured or bit
  • Scruffing the cat by the neck is one way to control the cat without hurting it
  • Consider giving pain medication if the patient is painful or if pain is expected to be induced during a procedure
  • Consider chemical restraint/sedation if the patient is overtly aggressive, nervous, or difficult to handle as it may be safer for both the patient and the handler
  • Always remember that your safety is of the utmost importance

Restraint Tools Reviewed

  • Towels/blankets – can be very useful in removing cats from cages, also can be used to wrap a cat to control the legs
  • Cat restraint bag (aka “cat bag”) – usually a nylon bag that a cat can be placed in to control the legs, can be difficult to initially get the cat inside, must be careful to not get fur/skin caught in the zippers
  • Protective gloves – can reduce the likelihood of a serious scratch but cat teeth are sharp enough to penetrate them, can make it more difficult to grasp the scruff of the neck, can lead to applying too much pressure due to the inability to feel the cat through the gloves
  • Flat leashes – can be used with caution when removing a cat from a lower cage
  • Muzzles – useful to prevent bites but also to cover the cat’s eyes and reduce stress
  • E-collar – will keep the mouth away from the handler though because cats are more agile, they are more likely to remove them
  • The most important restraint tool is an experienced veterinary professional, as cats are typically much more difficult to handle than dogs!

References

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