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.

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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 changeBody language communicated by the animal can demonstrate clearly how it feels toward other animals, people, and its surroundingsBody 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 forwardAmendable to being handledHowever, all veterinary staff should be alert to any change in behaviorBehavior 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 patientsStiff 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 groundSubmissive pets can react instinctively when they feel threatened

The Aggressive Animal

Shows Aggressive behaviors…growlingStiff stance, baring teeth, head lowered to the ground, staring, and tail raisedDominance aggression – “pack” animal instinct and social status within a groupFear aggression – defense reaction to being harmed and the instinct for an animal to protect itselfTerritorial 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 staffThis 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 proceduresSafety 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 environmentYoung animals must always be handled with care, as they can be very fragileOlder patients should also be handled with care, as they may be arthritic and have increased painThe safety of the patient and staff must be considered every time restraint is necessaryNever allow non-veterinary staff or an owner to restrain any animalThis can have potential legal repercussions

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Why Proper Restraint Techniques?

Prevents injuryNecessary for examinations and treatmentsMore comfortable for animal and handlerA First Aid Kit should be available for all bites and scratchesAll 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 litA plan should be discussed:Move any costly equipmentNonslip areaTemperature should be consideredWhat should be done if animal happens to get away from restrainerBack up plan (Plan B!)

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Rabbit Restraint & Handling

Picking UpGrab 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.HoldingUse 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 surfaceRabbit’s foot pads are covered with fur which causes a lack of tractionCan lead to dislocation of their hip or spinal fracture, when they try to move or hop

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Rodents & Ferret Restraint & Handling

Mice

Grasp the tail close to the body with one handUse 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 bitesHold in one hand, cup other over its headWrap thumb and index
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finger around neck and under chinDo not over tighten fingers around chest as this can impair breathing

Avian Restrai
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nt

Birds

Highly trained personnelCan stress easilyDo not squeeze thoraxSensitive to overheatingSmall to medium sizedGrasp from behind, finger and thumb on sides of head, others around bodyLarge birds require 2 handsTowel can also be used

Restraint Equipm
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ent

MuzzlesCommonly used for dogs, cats, and horsesMade of nylon, leather, wire, or basket materialsCan be made with gauze, tape, or leashesTowelsUsed to restrain small animalsUsed to wrap and containSwaddle fearful patients

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Cats Restraint & Handling

Cats tend to be one of the most difficult during restraint when they become upset and aggressive from stressSafely restrain and have control over headCat bags: control the limbs and headSqueeze cages: wire boxes with small slots that allow injections to be givenTo 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 catsWhen 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 restraintPlace one arm under the dog’s neck with the forearm, holding the headThe other arm is placed around the animal’s body to pull it close to the handlerCan be used on floor or tableUseGeneral ExamsSpecimen RetrievalNail TrimsSitting Restraint
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Same technique as standing restraint, but dog is sittingCan be against wall to keep dog from backing upUse:General ExamsCleaning earsBlood drawLateral RecumbencyBegin in Sitting RestraintCarefully place in lying position
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Hold legs that are on down side of table/floorprevents dog from standingPay attention of head of animal!Use:X-RaysBlood DrawNail trims (extreme)Sternal Recumbency
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Place dog in sitting positionUse light pressure to encourage dog to lie down on its chest“Bear-hug” dog to maintain restraintUse:Close examinationBlood drawDorsal Recumbency
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Will need more than one personPlace in lateral recumbency, then carefully roll dog to its backFront legs are pulled forward to headRear legs are pulled towards tailUse:X-RaysVenipuncture
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CephalicCephalic vein in front legSitting/Sternal RecumbencyJugularJugular vein on either side of neckSitting/Sternal RecumbencySaphenousInside of thigh in rear limbLateral recumbencyMuzzles
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prevent bitingcan be simple narrow strips of gauze or clothmake a loop in the materialLoop is then slipped over the dog’s nose and mouthThe ends are crossed under the jaw to bring them up behind the ears for tying in a bow

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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

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

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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 leashCaptures and restrains dogsPulling can cause severe head and neck injuries

Large Animal Restraint

Livestock, horses, cattle, sheep, goats, and swineInstincts of prey animals“Fight or Flight” instinct as part of reaction to restraintCapable of:KickingBitingRearing up into the airUsing 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.

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When Attempting to Restrain One Should:Use the least amount of restraint necessary for patient and staff safetyStay calm and relaxedBe firm but not aggressiveRemember that even very good dogs may bite/resist if something is painfulUse 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 breakAvoid handling injured areasUse caution with older or arthritic dogsAttempt to comfort the animal, either through petting and/or verbal reassuranceConsider 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 presentDo not allow an owner to restrain their own fearful or aggressive dog as this may lead to the owner being injured or bitConsider giving pain medication if the patient is painful or if pain is expected to be induced during a procedureConsider 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 handlerAlways remember that your safety is of the utmost importanceKeep 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 kennelChoker 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 painHarnesses – are very useful in small dogs or in dogs that have tracheal/neck problems as a “handle” by which the dog can be controlledMuzzles – 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 dogE -collar – very useful in brachycephalic dogs (pugs etc.) that are difficult to muzzle, will keep the mouth away from the handlerBlankets/towels – very useful for removing small dogs from kennels by wrapping the blanket around the animal and lifting them outCage door – can be used as a “squeeze cage” with extremely aggressive animals in order to sedate them, extreme caution should be used with this techniqueCapture 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 safetyStay calm and relaxedBe firm but not aggressiveOnly attempt when all participants are ready as some cats have a limited amount of time they will tolerate handlingClose all doors and windowsAllow the cat to leave its cage or carrier of its own volition if possibleWatch carefully for warning signs (beginning to growl, swishing the tail) as unlike dogs, cats rarely attack without warningDo not allow an owner to restrain their own fearful or aggressive cat as this may lead to the owner being injured or bitScruffing the cat by the neck is one way to control the cat without hurting itConsider giving pain medication if the patient is painful or if pain is expected to be induced during a procedureConsider 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 handlerAlways 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 legsCat 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 zippersProtective 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 glovesFlat leashes – can be used with caution when removing a cat from a lower cageMuzzles – useful to prevent bites but also to cover the cat’s eyes and reduce stressE-collar – will keep the mouth away from the handler though because cats are more agile, they are more likely to remove themThe most important restraint tool is an experienced veterinary professional, as cats are typically much more difficult to handle than dogs!

References

International Society for Applied Ethology (ISAE)International Association of Animal Behavior ConsultantsFowler M. Restraint and Handling of Wild and Domestic Animals, 3rd Edition. 2008. Ames: Wiley –Blackwell.Sonsthagen TF. Restraint of Domestic Animals. 1991. St. Louis: Mosby

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