Restraint, handling and administration of medication

Correct handling and restraint of the patient are essential if you are to perform any procedure effectively. If the animal is allowed to move it may hurt itself or you. An animal that is held firmly will feel much more secure and will be less inclined to struggle or to make an escape.

The majority of animals that are brought into the surgery are used to being handled, but this does not mean that they necessarily enjoy having things done to them, especially by a ‘strange-smelling stranger’. There will also be a small proportion of animals that are wary of human contact and this includes stray dogs and feral cats. These animals may be unpredictable and potentially dangerous and you must protect your own safety and that of anyone around you.

When handling any species you must approach quietly and confidently; you must know exactly what you are going to do and get it right the first time – the more often you have to attempt a procedure the more frightened or aggressive an animal becomes and the more likely you or the animal are to get hurt. Animals become very upset by clumsy inept handling, but respond positively to someone with a calm, confident demeanour.

So, at the very least, before you start anything:

1. Know how to do the procedure correctly – this will give you confidence and affect your attitude to the animal.

2. Have all your equipment prepared and ready to hand – this may include restraint equipment such as dog catchers or cat bags.

3. Organize assistance if you think you are likely to need it – having a ‘go’, failing and then deciding you need help causes delay, upsets the patient and may upset the watching client.

Procedure: Muzzling a dog (Fig 1.1)

It will not be necessary to muzzle every canine patient, but it is essential to be able to perform this technique quickly and effectively when you need it. It is rarely necessary, and it is much more difficult, to muzzle cats. If you do need to muzzle a cat there are suitable commercial muzzles available.

Figure 1.1 Tying a tape muzzle.

1. Action: Place the dog in a sitting position on the floor or on a stable examination table covered with a non-slip mat.

Rationale: In this position the dog will feel comfortable and will be less likely to wriggle.

2. Action: Ask an assistant to stand astride the dog, or if on a table to stand behind the dog, and grasp the scruff on either side of the head just below the ears.

Rationale: The head must be held firmly to prevent it moving around, allowing the muzzle to be tied quickly.

3. Action: Using a length of cotton tape or bandage, you should tie a loop in it.

Rationale: Any long strip of material can be used (e.g. a tie or even tights) but the material must be strong enough to hold the jaws together.

4. Action: Approach the dog slowly and deliberately, crouching down to its level if necessary.

Rationale: Crouching low prevents fear aggression; standing over the dog may provoke it to jump up and bite.

5. Action: Place the looped tape over the dog’s nose and tighten it quickly with the knot over its nose.

Rationale: Any delay in tightening the loop may give time for the dog to shake its head free.

6. Action: Bring the long ends of the tape downwards and cross over under the chin.

Rationale: Further throws around the nose before finally crossing over will strengthen the muzzle.

7. Take the two ends of the tape backwards and tie them in a bow behind the ears.

Rationale: A bow allows a quick release if the dog becomes distressed.

8. Ask the assistant holding the dog to keep the head pressed down.

Rationale: This position prevents the dog from lifting its forefeet to pull the muzzle of its nose.

9. If the dog is a brachycephalic breed insert another length of tape under the loop on the nose and under the piece at the back of the head.

Rationale: This prevents the muzzle from slipping off the short nose. This technique could be used for cats.

10. Bring the two ends of this piece of tape together and tie them into a bow on the bridge of the nose.

Rationale: The dog must be carefully observed as pressure over the nose of a brachycephalic breed could lead to respiratory distress.

NB Never leave a muzzled animal unattended, as there is always a risk of asphyxiation by vomit or saliva. There are commercial muzzles available. These come in a range of sizes and may be quicker to put on, but they are much more expensive.

Restraint for general examination

When examining any animal it is important that it is restrained correctly. This allows you to complete the examination quickly, efficiently and confidently without damage to yourself or to your patient. Restraint may be carried out by a nurse, the client or by you, the veterinary surgeon – in many cases it is perfectly possible to both restrain and examine at the same time. You should understand how to restrain an animal so that you can explain it to the person assisting you.

Dogs

Procedure: To examine the cranial end of the body

1. Action: Using a correct technique, lift the dog on to a stable examination table covered in a non-slip mat.

Rationale: If the table does not shake and the animal’s paws do not slip, the animal will feel more secure and will be less inclined to try and escape.

2. Action: Stand to one side of the dog.

3. Action: Place one hand under the dog’s neck and pull the head close to your chest with your hand.

Rationale: If the head is held firmly against your chest the dog cannot move to bite you.

4. Action: Place the other arm over the dog’s back with your elbow pointing towards the far side.

5. Action: Apply pressure with your elbow along the spine making the dog sit down.

Rationale: In a sitting position the dog will feel secure.

NB Always remember that the closer you are to the animal the less able it will be to bite you!

Procedure: To examine the caudal end of the body or take the rectal temperature

(This continues from the previous procedure.)

1. Action: Keep one arm under the neck pulling the head close to your chest.

Rationale: If the head is held firmly against your chest, the dog cannot move to bite you.

2. Action: Move the other arm and place it under the abdomen, gently lifting the dog into a standing position.

3. Action: Pull the body close to your chest by bringing your forearm up under the abdomen.

Rationale: In this position the dog is held securely against you, preventing movement during the examination and reducing the risk of your being bitten.

4. Action: If you are required to restrain the dog for a long period of time, move your hand to lie over the spine but be careful that the dog does not sit down again.

Rationale: This position may be more comfortable for you while still retaining control of the dog.

5. Action: If the dog starts to move or to object to the procedure, quickly return to the previous position.

Rationale: You must always be aware of the dog’s mood and respond quickly to prevent anyone being bitten.

Procedure: To examine the dog on its side or to provide stronger control (Fig. 1.2)

Figure 1.2 Restraining a dog on its side.

1. Action: Apply a tape muzzle if appropriate (Fig. 1.1).

Rationale: This method is used to restrain more aggressive or more difficult dogs so you should be prepared for trouble.

2. Using correct lifting procedure, lift the dog on to a stable examination table covered in a non-slip mat.

Rationale: If the table does not shake and the dog’s paws do not slip, the dog will feel secure and less inclined to try and escape.

3. With the dog in a standing position, stand to one side of it.

4. Reach over the dog’s back and grasp the foreleg and hindleg furthest away from you (Fig. 1.2) at the level of the radius and tibia.

Rationale: It may be difficult to reach over the back of large dogs especially if you are short or the table is too high.

5. As quickly and as firmly as possible, pull the dog’s legs away from you supporting its spine against your chest.

Rationale: This must be done quickly before the dog begins to struggle and change position.

6. Action: Gently lower the body down to the table.

Rationale: Avoid letting the body drop to the table as it may frighten or injure the animal.

7. Action: Place your arm across the chest and neck and apply firm pressure to keep the dog’s head on the table.

Rationale: Most dogs will become submissive in this position, but some will try to stand up again and you must be prepared. With a large dog you may have to lean quite heavily on it, but you must always observe the condition of the animal.

NB This position uses minimal restraint but will allow you to examine the whole body and take the rectal temperature.

Procedure: Restraint for examination of a fractious cat

1. Action: Firmly grasp the scruff of the cat with one hand.

Rationale: Some fractious cats seem to have the ability to ‘use up’ their scruffs by hunching their shoulders and letting their heads sink down, which makes the scruff very difficult to grasp. Adult tomcats also develop thickened scruffs that are difficult to hold for any length of time.

2. Action: Pick up the cat and, with the other hand, grasp its hindlegs.

Rationale: You should never suspend a cat by its scruff for any length of time. Always be prepared to support its weight as quickly as you can.

3. Action: Place the cat on the table in lateral recumbency extending its head and hindlegs.

Rationale: The cat is unable to move against the strength of the handler’s arms, but a really angry cat will continue to attempt to escape and a great deal of growling and mewing may be heard!

4. Action: As the cat struggles, make sure that you keep your arms wide apart to maintain the position.

Rationale: As the forelegs are not restrained you must be careful to avoid getting scratched.

NB This position allows examination of most of the body but it is inadvisable to use it to take the rectal temperature as the cat may struggle and injure itself. For the welfare of the cat, another method of restraint should be adopted as soon as possible.

Restraint equipment, which can be useful for more aggressive cats, includes crusher cages, cat grabbers and cat bags out of which the head or legs can be extended while the rest of the body is retained inside. Wrapping an aggressive cat in a towel is also a useful and cheaper means of restraint. Chemical restraint is widely used, principally by means of an intramuscular injection, but some form of contact with the cat is still required.

In the surgery when moving a cat from room to room it is important to ensure that it does not escape – cats are far more likely to try to escape than dogs. The procedure used depends very much on the nature of the cat.

Procedure: Lifting a friendly cat used to being handled

1. Action: Approach the cat calmly and confidently, talking to it quietly.

Rationale: Most cats are used to the sound of the human voice and will be reassured by a low quiet tone.

2. Action: Assess whether the cat is safe to stroke.

Rationale: A frightened or aggressive cat will warn you by hissing or growling as you approach, while a friendly cat may rub itself against your hand and even purr!

3. Action: If safe, gently stroke the top of the head and run your hand along its back.

Rationale: This will reassure the cat and may elicit a purr. If the cat hisses, use another method of lifting and restraint.

4. Action: Gently but firmly grasp the scruff of the neck with one hand and lift the cat.

Rationale: Picking a cat up by the scruff mimics the way in which the queen carries her kittens. It initiates an innate relaxation response which in the wild would enable the queen to move her kittens safely from place to place without the risk of them struggling and escaping.

5. Action: Place the other hand under the sternum and support the cat.

Rationale: Kittens and smaller cats may be lifted by the scruff, but heavier cats need added support.

6. Action: Place the cat on an examination table covered in a non-slip mat.

Rationale: If the cat feels insecure, it may try to scratch bite or escape.

Procedure: Lifting a frightened or aggressive cat

1. Action: Grasp the scruff of the cat quickly and firmly.

Rationale: If you do not take enough scruff or make any mistake in handling, you are likely to get bitten or scratched.

2. Action: Lift the cat by the scruff letting the body hang down.

Rationale: Do not leave the cat ‘hanging’ for more than a few seconds, as this is unpleasant for the cat, particularly if it is large.

3. Action: Place the cat on a table and restrain in an appropriate way.

Rationale: Aggressive cats may have to be restrained using such equipment as a crusher cage or a cat bag.

Procedure: Carrying a cat (Fig. 1.3)

Figure 1.3 Carrying a cat.

1. Action: Place the body of the cat under one elbow and forearm, holding it close to your side. Let the hindlegs dangle.

Rationale: The body is supported by the angle of your arm, but the hindlegs are unable to push the cat’s body up in order to make an escape. Watch out for the hindlegs getting caught in your side pockets.

2. Action: Hold the forepaws together between the fingers and thumb of the hand on that side.

Rationale: This controls the forepaws and prevents them from scratching you.

3. Action: Hold the scruff of the cat firmly with your free hand.

Rationale: In this position the cat feels secure and comfortable. If it tries to escape you have control of the head via the scruff and you can apply stronger pressure to the body with your elbow.

NB Avoid carrying aggressive or frightened cats around in your arms as such animals’ movements are unpredictable. They should be carried in a wire cat basket, which allows them to see out whilst providing you with clear visibility to assess their condition.

Rabbits

The rabbit is the third most popular pet in the UK and it is the most difficult to handle correctly. The rabbit has thinner bones than either the dog or cat and this makes it more prone to fractures of the legs and spine. The domestic rabbit has developed from the wild rabbit Oryctolagus cuniculus and its reactions are much the same, in that its instinct is to run and hide when threatened. There are around 50 breeds of domestic rabbit and they vary in size from dwarf breeds weighing around 1 kg to breeds such as the Flemish Giant, which can weigh up to 8 kg. This may be a significant factor in restraint and handling.

Procedure: To restrain a rabbit (Fig. 1.4)

Figure 1.4 Restraining a rabbit (A) Male. (B) Female.

1. Action: Observe the rabbit before attempting to handle it.

Rationale: This allows you to assess the nature of the patient – if it is aggressive you may need to ask for assistance. Restraint may cause respiratory distress.

2. Action: Rabbits should be handled gently but firmly.

Rationale: Rabbits have an innate fear of humans whom they perceive as predators.

3. Action: Talk quietly to the rabbit and approach from behind its head.

Rationale: The eyes of a rabbit are placed on either side of the head providing good lateral vision but very poor backwards vision. There is no need to offer a hand to sniff as you might do with a dog or cat and it may be mistaken for food!

4. Action: If the animal is fractious, grasp by the scruff and support the weight with one hand (Fig. 1.4) under the hindquarters.

Rationale: Never pick a rabbit up by the ears! The hindlegs must be supported at all times. Rabbits have a fragile skeleton and strong lumbar muscles, so they can easily dislocate or break their legs and spines by struggling or kicking.

5. Action: More docile rabbits may be restrained by placing one hand under the thorax, gripping the forelegs between the thumb and forefingers of that hand. Support the hind end with your other hand.

Rationale: Some rabbits may resent being scruffed. The back should be kept in a normal curved position to avoid spinal fracture.

6. Action: To carry the rabbit, tuck the head and front feet under your upper arm and support the body along your forearm (Fig. 1.5A).

Figure 1.5 (A) Carrying a rabbit with the head tucked under your arm. (B) A large towel wrapped securely around the rabbit can be very helpful for restraint.

Rationale: Keeping the rabbit close to your body avoids the risk of it kicking and scratching you. Keeping its head in the dark makes the rabbit relax.

7. Action: A large towel can be used as an additional means of restraint. Unfold the towel on a table. Place the rabbit on the towel with its head projecting from one side. Wrap the towel around the body, covering the feet and leaving the head exposed (Fig. 1.5B).

Rationale: Covering the feet protects the handler from injury while the head is available for examination and administration of medications.

8. Action: An excessively aggressive rabbit may be removed from a cage by throwing a towel over the animal and covering it completely. The rabbit can be unwrapped when it has been safely placed on an examination table.

Rationale: Aggressive rabbits can come at you as you open the cage and may growl and hiss in fury! Being in the dark may help to reduce the rabbit’s stress. Care must always be taken to prevent injury to you and to the rabbit.

Procedure: To differentiate the sex of rabbits (Fig. 1.6)

Figure 1.6 Sexing a rabbit. (A) Male. (B) Female.

1. Action: Hold the scruff of the rabbit and support its weight by placing one hand under its hindquarters.

Rationale: The rabbit must be held firmly to avoid possible injury to you or the rabbit.

2. Action: Gently lower the rabbit onto an examination table so that it lies in dorsal recumbency. Maintain your hold on the scruff and tilt the animal so that it is almost upside down.

Rationale: In this position the rabbit is almost hypnotized and will then be easier to examine.

3. Action: Using your forefinger and middle finger, apply pressure to the vent area just in front of the anus. With some rabbits you may find it easier if the examination is carried out by you while an assistant restrains the rabbit as described above.

Rationale: In both sexes the area will protrude when pressure is applied. Bucks under 5 weeks will show a blunt white tube without a central line, whereas older bucks will show a pink tube with a pointed end that resembles a bullet. The doe has central slit-like opening to the vulva with a band of pink tissue on either side.

NB Young rabbits are notoriously difficult to sex up to the age of 3 weeks – you will not be the first to make a mistake! Adult bucks have large scrotal sacks that are visible lateral and cranial to the penis. The adult testes can be retracted into the abdominal cavity. Adult does have a prominent fur-covered dewlap under the chin from which hair is plucked to line the nest prior to giving birth.