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Safe humane restraint (Proceedings)
Effective restraint is one of those aspects of veterinary medicine that we simultaneously take for granted but also wish we could do better.
Effective restraint is one of those aspects of veterinary medicine that we simultaneously take for granted but also wish we could do better. Restraint techniques are passed on in an almost cultural fashion with 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 preventing successful completion of the intended procedure.
Good restraint is about empathy, finesse, and technique.
It has little to do with strength. Choosing techniques that build on natural behavioral responses results in a greater likelihood of success. This approach also encourages increased empathy and awareness of the animal as an emotional and sentient being. 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.
A number of factors are involved in triggering aggression and/or escape responses in animals. In laboratory settings, restraint stress has long been used as a way to study acute and chronic stress responses in animals. This has important in a clinic setting not only for the welfare of the animal but in terms of diagnosing and treating the animal's medical disorders.
In a clinic setting, the most common actions or interactions that prompt aggressive responses include fear, pain, and excessive physical restraint. 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. The determination as to whether something is aversive or painful to an animal is based on the animal's response, not on the opinion of the staff or veterinarian.
Often, in the process of trying to be friendly to an animal, we portray body signals that actually mean the opposite. 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.
Animals have 5 basic reactions to stress or threat – the five "F's": 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.
Personnel should always use the least amount of restraint necessary for the procedure.
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. Involved personnel need to 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.
Note: 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 on that day. The more people that are involved, the more threatened the animal will feel and the more easily someone will be injured.
Animals are particularly likely to guard certain body regions.
These include the head/neck, the legs and feet, the groin/perineum, the abdomen, and any area that is painful. These areas are targeted in serious conspecific or interspecific (predatory) attacks because they are areas where it is relatively easy to deliver an incapacitating or fatal injury. Restraint techniques should be chosen with this factor in mind. In particular, avoid directly restraining the animal's legs as this almost universally triggers the animal to struggle more than is necessary. Protection of the legs is an evolutionary hard-wired behavior.
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 actually is not a secure way to restraint a cat, and it aggravates many cats more than necessary. There is no magical "limpness" button on a cat's scruff and the analogy of a mother cat carrying her kittens is inaccurate. This flexor reflex occurs only in kittens and they outgrow this as they mature. Adult cats are grabbed by the back of the neck in only 4 natural situations: fighting, play fighting, reproduction, and predatory attack – none of which are desirable to mimic in a clinic setting. Alternative methods can be more successful. Also avoid "half-nelson" (restraining the dog around its neck with your arm) type restraint techniques with dogs that are unruly, highly fearful of people, or aggressive to people. This technique is unsafe with dogs that respond in any of these ways.
In most 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.
Avoid direct, particularly prolonged, eye contact and approaching the animal from the front.
Whether it is in a cage, on a table, or on the floor. Do not attempt to approach or restrain fearful or aggressive dogs without first having control of the leash.
Puppies and kittens are often not tolerant of much physical restraint.
Distraction techniques work best for very young animals. Do not reserve this just for problem animals; offer it to every puppy and kitten. The most powerful of these will be food distraction such as squeeze cheese, canned food, baby food, liverwurst, peanut butter, etc. Offer it during the entire examination process. Physical distraction (e.g. vigorous rubbing and massaging) or distraction with toys also is useful in many cases.
Adult dogs often require and are tolerant of more physical restraint. They usually are more accustomed to physical handling and restraint. Their experiences may have been positive and/or negative so a particular animal's reaction to such restraint may vary greatly even from moment to moment. Similar to puppies and kittens, food and physical distractions are still powerful tools for adult animals. Dogs should not be allowed to roam unrestrained during your procedures. They also should not be allowed to turn and put their faces near yours; keep their head directed forward by maintaining a guiding hold on their collar (not the leash).
Do not grip dogs around the muzzle during restraint.
This is an extremely threatening thing to do to a dog, and you can easily be bitten with your fingers so close to the dog's mouth. Use a muzzle if necessary but be sure the muzzle is large enough that the dog can easily get its tongue out of its mouth. This helps reduce panic reactions, allows for normal respiration and thermoregulation, and allows you to try food distraction as well. It will also help prevent aspiration in potentially vomiting animals. Stiff Elizabethan collars (e.g. Saf-T-Shield) are an excellent alternative to muzzles for dogs that cannot be muzzled for behavioral or medical reasons (e.g. nasal tumor).
Dog appeasing pheromone.
Available in a spray or electric diffuser can be very helpful for reducing stress in dogs during handling or hospitalization.
Physical restraint techniques should be humane and focus on restraining over bony structures. When restraining a dog's head, cup the dog under the jawbone with the angle between your thumb and fingers on one hand. Place the other hand, with fingers facing forward toward the dog's nose, across the back of the dog's head where it meets the neck (the occipital region). This hold gives excellent control of the direction of the dog's head and keeps your fingers clear of the dog's mouth. It also prevents the holder from digging his/her fingers into the dog's intermandibular space or holding the dog around the throat – both of these actions are painful to the dog and will make it struggle. Particular care should be taken when examining the dog's ears, eyes and mouth until you know how the dog is going to react to the procedure.
For most dogs, jugular venipuncture is the safest and most humane method of collecting blood.
It allows you to avoid restraining the legs and you can pull a large amount of blood in a short period of time. It also permits humane restraint without the holder having to lean over and put his/her face near the dog's head (as happens when holding off a foreleg vein). For dogs that are apprehensive about head restraint, a lateral saphenous vein is the next preferred method. Dogs that are visually reactive often can be calmed by gently placing a towel completely over the dog's head. This is possible even during jugular venipuncture. Head collars (e.g. Gentle Leader?) are also useful for controlling fractious dogs.
There are a variety of special restraint tools on the market for dealing with cats. Some of these are useful while others are quite impractical (and often expensive). For the population of cats that can be handled safely awake, the procedures in question can typically be accomplished with six simple tools or steps. As with dogs, food and physical distractions can be powerful tools for feline restraint.
Safety zones and towels are the two most helpful tools for cats.
Safety zones include cat beds and carriers. All cats should arrive at the clinic in a modern style cat carrier. Although, cats seemingly detest their carriers at home, the carrier often becomes the place they are the most comfortable once the cat reaches the clinic. Cats should never be dragged or dumped out of a carrier. Take the carrier apart and allow the cat to remain resting in the bottom half. Physical examinations, venipuncture, skin scrapings, vaccinations/injections, and other procedures can be accomplished with the cat still in the carrier. We have even performed cystocenteses with cats in their carriers. Cats should be transported around the hospital (e.g. to radiology) in their carrier. If the cat must be put in a cage, at least the bottom of the carrier should be placed in the cage with the cat if at all possible. Cats can be gently wrapped in towels in a variety of ways to control their head, forelegs and hind legs. This method is preferable to actually holding the cat's feet or legs with your hands since is it safer for the holder and less irritating to the cat. Cat muzzles have poor efficacy. Stiff Elizabethan collars (e.g. Saf-T-Shield) are an excellent and inexpensive alternative.
Feliway spray is a synthetic pheromone that appears to have anxiolytic properties in many cats.
This can be sprayed on towels used to handle the cat, on Elizabethan collars or even on your hands. Analgesic doses (0.2 mg/kg IM) of butorphanol often have a very calming effect on cats. This opioid is short acting and usually does not sedate the cat to objectionable levels. It is intended to take the irritable edge off the cat. Used in combination with Feliway and the above tools, it can make a dramatic difference in a cat's demeanor.
Sometimes simple changes in the immediate environment can dramatically affect an animal's reaction. These include where the procedure is performed (e.g. exam room versus outside the clinic), presence or absence of the owner, presence or absence of another animal, and the personnel's' attire (e.g. lab coats). Note: Animals should never be taken away from the owner in order to perform a restraint method that you would not be willing to do in the owner's presence.
Some animals are too distraught to be handled safely awake no matter how perfect your handling may be.
These animals should be sedated promptly at the start rather than after someone has agitated the animal by trying to make the animal "submit". The safest restraint method for seriously aggressive dogs (dogs that cannot be touched at all) is the barrier method. The dog's leash is threaded through an open barrier such as a cage door or chain link fence. The dog's head is rapidly but calmly pulled up against the fence while someone else simultaneously injects the sedative intramuscularly into the dog's hind leg. This entire process should take less than 5 seconds! The dog should be immediately released and placed somewhere quiet to allow the sedation to take maximal effect. Rabies ("catch") poles should not be used on client owned animals. They are potentially very dangerous to the animal. Their use can habitually be avoided by adequately monitoring an animal's behavior and being proactive in making restraint and decisions. Always keep in mind that you can kill pets with your restraint procedures alone!!!