Species

Dog and cat

Breed Predilections

Any

Mean Age and Range

Any

Predominant Sex

Any

General Comments

• Displacement behaviors (yawns, lip licking, grooming, panting).
• Offensive and/or defensive threat displays.
• “4 F's of behavior”: fight, flight, freeze, fidget.

Prior to Handling

Assess the environment, patient and yourself. What patients see, smell, feel, taste, and hear affect emotional state. Utilize assessments to ameliorate stressors and create a successful handling plan.

Assess the Environment: make it comfortable for the patient

• Eliminate exposure to patient's known triggers of fear or aggression.
• Reduce environmental stimuli (light, noise, movement, touch).
• Thermo-neutral comfort zone is 59–86°F, dogs; 86–100°F, cats.
• Ideal ambient sound level is 60 dB (stress at 85 dB).
• Provide pheromone support (Adaptil, Feliway).
• Mindfully manipulate owner presence; many do better with social support.
• Utilize highly palatable food for distraction and CC.
• Create a comfortable exam site (no slippery, shiny, cold surfaces).
• Provide a way for fearful patients to hide, feel covered, and protected.
• Ensure all supplies are readily available.

Assess the Animal

• Recognition of fear and impending aggression and interpretation of patient body language is critical.
• Anxiety, fear, and arousal are the motivations for aggression and other fractious behavior. Early recognition improves intervention efficacy and safety, and decreases handling time.
• Track body language, willingness to approach, interaction with the environment and people.
• Identify displacement behaviors to flag patients that are not coping well.
• Monitor continually. Changes in location (lobby vs. radiology), interactions (social petting vs. exam), procedures (auscultation vs. nail trim), and personnel (female vs. male) affect patients.

Assess Yourself: Avoid Perceived Threats, Track your own Body Postures and Behavior

• Avoid direct eye contact, bending over, or putting your face near a fearful patient.
• Bend at the knee, turn your body to the side, and squat down (when safe).
• Avoid reaching out, petting on top of the head, sudden grabbing of the collar or body, or reaching into a carrier. Encourage patients to approach you, or have the handler they feel safe with bring them to you.
  • Cat-encourage approach by patting the surface and using a soft voice. Remove carrier tops-do not pull or dump out patients. Allow time to sniff your hand. Gently scratch under the chin and pet the side of the head if postures indicate safety. Avoid petting beyond the shoulder as it is often arousing. Start exam at the head or middle and move back; save socially invasive or painful areas for last.
  • Dog-hold your hand at your side, patting your leg gently, soft verbal encouragement, hold your palm open with valued treats if the dog approaches, and allow the dog to sniff and investigate. Gently pet under the chin and neck area; slowly move into the desired examination position. Start exam at the middle or rear and move towards the head.
• Lack of patient approach in response to a non-threatening invitation indicates the animal is maintaining social distance. Anticipate that your approach may lead to an aggressive response.
• If you must approach, do so from the side; work from the side and from behind the point of the shoulder.
• Avoid front-facing interactions unless the patient's head is covered.
• Avoid loud talking and sudden movements.
• Work quietly, quickly, and effectively; often a narrow window of opportunity before fear and arousal escalate.
• Encourage handlers that are fearful of working with specific patients to stop and ask their team for help; reassess if and how to proceed. Fearful animals and fearful handlers are a dangerous combination, and often escalate each other's fear, arousal, and aggressive responses. Ensure the culture supports this and the safety of each team member.
• Monitor handler frustration. Adversarial and punitive language and interactions must be avoided.
  • Use language that is scientifically accurate and promotes patient empathy-fearful, painful, confused; and avoid choices that result in poor handling and may be offensive to clients-mean, bad, stupid, spiteful, evil, dominant. Handler language affects their actions as well as those of others.
  • Punishment (verbal, physical, leash corrections, “dominance maneuvers”) must be strictly avoided. Aversives increase fear, arousal, aggression, and are contraindicated. Behavioral signals of intent can also be blunted, making handling more dangerous. Negative experiences are likely to escalate fractious behavior during subsequent handling interactions at the hospital and possibly at home.
  • Create cultural norms that prohibit adversarial language and interactions.

Make a Handling Plan

Handling plans are unique to individual patients/working environment, and may require adjustments dependent on patient response. Initial planning may seem time consuming, but has a high payoff in staff safety, decreased future handling time, patient welfare, and client satisfaction. Chart information including what worked well and suggested changes to make the next visit even better.

Guidelines for a Patient Handling Plan

• Determine if and what the patient can eat; plan for CC that is appropriate and safe for the animal.
• Select appropriate level of restraint for the individual patient and the procedures.
• Select handling tools that increase safety and decrease patient fear and arousal.
• Critically consider what needs to be performed-must the procedure be done today, or at all? Consider multiple visits of shorter duration with fewer procedures.
• Place the required procedures in order of most important to least important in the event the patient is unable to tolerate all of them.
• Place those procedures in order of least aversive to most, so early difficult procedures do not inhibit ability to complete later ones. Trends among patients exist, individual differences also occur.
• Consider pain, invasiveness, number of procedures, and how the patient is coping with minimal handling. Consider sending the patient home with a plan for return (oral sedation prior to travel, avoidance of known triggers and environmental management, DS/CC to specific handling or tools). Use chemical restraint immediately when unlikely the patient will be able to tolerate all procedures.
• Have chemical restraint prepared and waiting for at-risk patients; use before patient becomes aroused to promote efficacy, handler safety, and to reduce further advancement of patient fear.

Utilization of Counter-Conditioning

• A form of classical conditioning where an animal's reflexive negative emotional response (fear) to a stimulus (veterinary setting) is changed to a positive one (pleasure). Palatable food is the easiest and most powerful means of establishing this association.
• Prevents and/or treats established fear of handling and environment.
• Most effective when food is first offered while the animal is relaxed and feels safe, then just before, during, and after the (aversive) procedure. Events may be aversive because they are painful (injections) or socially invasive (rectal temperature, nail trims).
• Stressed animals may need to be fed the duration of handling to prevent escalation of fear and arousal. Utilize food that can be broken up into small pieces, or use sticky, smearable options.
• Palatability must be high (meat baby food, liverwurst) to maximize the animal's interest in eating and increase the power of the positive emotional response. Petting and praise can be used additionally, but are far less powerful and may even be unpleasant for some pets.
• Food serves as a “barometer” for patient stress; many won't eat even highly palatable food. Rejection should cue the handler to reassess patient comfort level, safety and handling plan.

Safe and Effective Restraint

Once the itinerary of procedures has been organized, a restraint plan should be coordinated for each procedure. Avoid the tendency to over-restrain animals. Stress often revolves around the restraint, rather than the procedure itself. When patients are CC with food, and stressors are mitigated through environmental management and non-threatening interactions with staff, less restraint is needed.

Guidelines for restraint

• Use the least restraint required to allow the specific procedure(s) to be performed properly (AVMA Restraint Policy).
• When greater restraint is needed, provide firm, balanced pressure with global support around the patient. Prevent flailing by keeping control of head and rear end at all times.
• Reserve lateral recumbency in dogs only for procedures that require it (ex. orthopedic exams). It is a threatening position for many. Most can be performed in a stand or sit position. Some dogs will assume this position when lured with a treat or asked to perform a “down.” If required, prevent flailing and hitting the head; move the patient slowly and steadily with full body support.
• Reserve scruffing and/or stretching only for cats comfortable with this technique, and only when the procedure requires the cat to be in lateral recumbency.
• Slide your hands along the patient's body, rather than releasing and grabbing when moving your hands or adjusting your position.
• If the pet struggles longer than 3 sec., stop, reposition, and try again. Wait until relaxed, and preferably starts eating, before beginning the procedure. If after 2 or 3 attempts the patient does not relax and/or starts to get fractious, stop altogether and consider whether the procedure is essential.
  • Essential: make a plan for chemical restraint.
  • Non-essential: send the animal home and create a plan for return.

Handling Tools

Designed to expedite veterinary procedures and increase safety. Handling tools also reduce the need for physical restraint and the stressful social interaction. The key is using them correctly, often, and early in the handling plan.

Chemical Restraint

• Allows safe effective handling, blocking further distress. Avoid allowing patients to become fractious/agitated before considering; reduces the efficacy, allows learning to occur, advances fear responses.
• Desired plane of sedation-animal requires little to no restraint to accomplish all desired interactions, is unaware.
• Injectable forms of sedation IM are the most effective means of safely handling a fractious or highly fearful patient; protocol selection based on age, temperament, degree of health/disease.
• Manage environment to achieve and maintain desired sedation (white noise, music, dim lights, owner support, avoid triggers, Thunder cap, cotton balls in ears).
• Muzzle sedated patients for added safety.
• Oral administration of sedative/anxiolytic medication prior to arrival so experience is less fear-provoking, safer, and requires lower doses to achieve effect.

Oral Sedative/Anxiolytics

Administer 90 min. prior to travel to relieve mild to moderate fearful/fractious behavior or help patient cope with injectable sedation. Doses should be repeated Q8-12hr PRN for inpatients.