Fundamentals of Restraint

Restraint
 The limitation of a patient so a medical procedure can be performed safely and
efficiently
 Psychological: least physical restraint type that is often used in combination with other
types; methods include commands the animal already responds to, matching the
animal’s energy, and keeping a calm/soothing voice while stroking the patient
 Physical: primary type of restraint which involves the use of the handler’s hands or body
along with muzzles or ropes
 Chemical: type of restraint that utilizes drugs such as sedatives, tranquilizers and
anesthesia to alter the patient’s mental state; this allows animals to become more
docile and easier to restrain, or renders them completely unconscious so they are
unaware of their surroundings; used if the patient is hard to restrain, is in pain, will be
undergoing an invasive procedure or will be having a surgical procedure
Fundamental factors
 Behavior: relies on several factors
o Species: different methods of restraint are used for different animals
o Breed: some breeds are sweeter than others; large breeds are harder to restrain
o Sex: spayed/neutered animals are usually calmer; intact are more territorial
o Age: older animals may have arthritis and therefore need more consideration
when restrained; older animals may have had a lifetime of either good or poor
experiences at the vet determining how easy they are to restrain
o Territory: animals are usually uncomfortable in a clinic because of unfamiliar
surroundings
o Hierarchal position: animals that are alphas of their pack may be more
aggressive toward a handler while a beta may show fear aggression- some
researchers think this theory is outdated
o Prior experience: if a patient has had negative experiences in the past, they may
be harder to restrain; if a patient has never been to the vet they may be anxious
o Current health: injured patients may be in shock or in pain and bite the nearest
person; patients that have been injured in the past might still be healing and may
require modifications to restraint
 Procedure: the type being performed determines the type of restraint needed
o Pain level: how much pain is the patient experiencing; has the pain lasted for a
long time or is it due to an acute injury
o Duration: length of procedure determines type of restraint; surgery requires
chemical restraint while vaccinations require physical
o Body location: if the injury is close to a sensitive part of the body (eye) then
chemical restraint may be needed
o Degree of immobility required: surgeries require the patient to become fully
immobilized which is done by chemical restraint; less serious procedures don’t
require complete immobility
 Handler: the technician or assistant responsible for restraint
o Level of expertise: the level of training the handler has will determine the type of
restraint possible
o Physical strength: more strength is required to restrain larger animals; multiple
handlers may be required
o Availability: some methods of restraint require more than one handler
o Owners should not restrain their own pet
o Vets or vet techs decide what type of restraint should be used
 Available equipment: certain tools may be required for certain restraint types
o Ropes/leashes
o Towels and cat sacks
o Leather gloves
o Cages/carriers
o Commercial muzzles
o Gauze muzzles
o Quick release pole
o Panels/barriers/squeeze cages
 Physiological Restraint
Factors
 This type of restraint is used in conjunction with other types of restraint
o On its own, this restraint is the least limiting and very undependable
 The animal-handler relationship is the foundation for this restraint type
o This relationship needs to be established quickly because they most likely will
not have an already established trust with the patient
 Trained animals will respond to pre-determined auditory and visual commands but not
every trained animal will respond to every handler, and may only respond to owner
o Clinics prefer for owners to be present during examinations to calm their pet as
well as answer questions about their health
 Some dogs are abnormally fearful due to genetics or lack of socialization, rather than
the popular belief of abuse
o Fear can be gender specific (men but not women or vice versa)
o Some owners omit the fact that their pet is aggressive at veterinary clinics due to
fear that their pet won’t be seen, embarrassment, or belief that their
aggressiveness was due to mistreatment
o Ask how clients think their pet will react to being handled by strangers
o Have the owner muzzle the dog if they are trained in aggression tactics or have
displayed aggression in the past
o Police dogs require their officer to stay with them at all times, even during
treatment in the back of the hospital- most need tranquilized
 Both sound and touch are utilized in this type of restraint to subdue and calm the
patient
o Let the patient sniff the handler and become familiarized with their scent by
standing near them- do not stick out your hand because it can be seen as
threatening
o Avoid direct eye contact to not show dominance and use a low-pitch tone
o For cats, stroke behind their ears and under their jaw before restraining or
treating them to calm them
o For dogs, let them smell your hand by your side and then stoke them under the
jaw and along the throat
o Approach animals from the side instead of straight-on
Positive reinforcement
 Most humane and effective method of training an animal
 Reward the animal for performing the desired behavior
Negative reinforcement
 Punish the animal for performing an undesirable behavior
 Has adverse effects by possibly causing the animal to shut down and not perform
behaviors in fear of doing the wrong thing
 Diverting the animal and preventing them from performing the wrong behavior is
sufficient in eliminating it
Do
 Become familiar with the patient
 Allow the patient to become familiar with your scent, voice and touch
 Be prepared for the procedure and have all tools/equipment ready before starting
 Carry a leash in your pocket an apply your own leash when needed
 Make sure all doors and windows are locked before starting
 Limit distractions
 Move slowly/quietly and confidently & use a soft “baby talk” voice
 Stay calm and attempt to keep the patient calm also
 Talk to the patient and refer to them by name
 Keep physical contact with the patient & keep your face away from them
 Make the visit a positive experience for everyone involved
 Praise the animal when finished if they submitted to being restrained, don’t praise if
they struggled/growled/snarled
Don’t
 Never handle an unknown patient without supervision
 Never take the owner’s word regarding the patient’s obedience level
 Never handle a trained police/guard/attack dog
 Never begin the procedure without allowing the patient to become familiar with your
scent
 Never scramble for supplies after the exam/procedure has already begun
 Never trust the owner’s collar or leash
 Never leave the door to the exam/procedure room open
 Never move quickly or sporadically & never make loud noises
 Never yell or talk in a high-pitch tone & never lean your face into the patient
 Never break physical contact with the patient
 Never remove the leash until the patient has been discharged at the front desk and the
owner’s leash has been securely placed
 Ropes and Knots
Ropes
 A length of fibers that are twisted/braided together to increase strength for pulling and
connecting, but not pushing
 Should be flexible and not stiff
 Can be made of natural fibers such as hemp, linen, cotton, sisal, jute, coir
 Can be made of synthetic fibers such as polypropylene, nylon, polyesters, aramids
 Anesthetized patients undergoing surgery can be restrained using thin cotton ropes
 Active patients need to be restrained with thick nylon ropes
Types of knots
 Halter tie: quick-release knot used for securing conscious animals to immovable objects;
tightens when pulled on by patients but releases when the handler pulls on the other
end
 Half hitch: ties around a patient’s limb to extend it or used to secure one end of a rope
to a cleat under the surgery table; temporary and used when tension is applied to the
other end of the rope
 Square knot: used whenever tension is applied as it causes the knot to tighten; used
when slippage must be prevented
 Reefer’s/reef knot: a common, simple knot based on the square knot with a half bow to
secure two lengths or rope/gauze together; can be quickly untied by pulling on the free
end of the bow; used when tying two ends together that will need to be rapidly released
 The bow: similar to the reefer’s knot as it is based on the square knot and binds two
ropes together; includes two bights tied together to form loops; tightened when the
ropes are pulled and released when one of the free ends is pulled
 Placement and Removal of Patients from Enclosures
Memory
 Veterinary environments are high-pressure and high-flow so identification of patients
cannot be left to memory
 Guessing can cause frequent mistakes such as treating the wrong patients or the escape
of a patient
 Identification collars and cage cards are used to prevent mistakes
Identification collar
 Paper collar with plastic reinforcement
 Sticky on one end which serves as a clasp
 Cut on the non-sticky end to fit the patient’s neck comfortably
 Identifying information is written on the collar, and then applied in dark ink
o Owner’s name, patient’s name, date admitted, reason for hospitalization,
veterinarian in charge of patient, allergies/warnings/special instructions
Cage card
 Commonly pre-formatted to be specific to each practice
 Kept in cardholders attached to the front of the kennel/cage of each patient
 Contains the same information as identification collar plus physical observations
o Food given, amount eaten, amount of water consumed, urination log, defecation
log, body temp with time recorded, meds to be administered with administration
log, observations during hospitalization
Placing a patient in a cage
 Check that the kennel/cage is clean, sanitized, and prepared
 Place the patient’s cage card in the cardholder that is attached to the cage, and then fill
out the identification collar and place it on the patient
 Open the cage door completely
 Use psychological restraint to calm the patient with a soft, nice tone and carefully place
the patient inside on their feet; if the patient is a jumper, place them inside head first in
a bottom cage
 Begin closing the door while keeping one arm inside to stabilize the patient, ensuring
they don’t escape
 If the patient is attached to a leash, gently slip it off by loosening and pulling it over their
head; pull the leash out of the enclosure
 Close the kennel/cage door and securely latch it; double-check the latch to make sure it
is fully shut and secure by tugging on the door; use locks if available
Removing a small patient from a cage
 Make sure all windows and doors are shut & remove the patient’s cage card if they are
being discharged
 Use psychological restraint to keep the patient calm
 Hold a looped leash in one hand and stand in front of the door to keep them from
jumping out
 Swing the cage door open slowly just enough to fit your hand with the leash inside
 Slip the loop of the leash over the patient’s head and tighten it gently while continuing
to speak in a soothing voice
 Open the cage door completely and grab the patiently gently; remove them slowly and
pull them close to your body
 Pass your free hand over their back and under their chest ensuring that the palm of your
hand is up, holding the patient’s chest area
 Keeping a slight tension on the leash and firmly holding the patient, lift them up over
your hip; their body should be against yours while being supported by your forearm
 Insert your index finger between their front legs keeping your thumb and middle finger
on the outside of their legs; gently squeeze these three fingers together to hold their
legs together securely
 Slip your arm holding the leash over the patient’s upper back and bring it around to
cradle their head and neck on your arm close to your chest; don’t let go of the leash
Removing a large patient from a cage
 Make sure all windows and doors are shut and remove the patient’s cage card if they are being
discharged
 Hold the leash tightly in one hand with the loop open
 Open the kennel door slowly and stand in front of the open door to prevent the dog from escaping;
make sure you place your foot on the outside of the kennel door so it does not swing open too far
 While speaking to the patient in a calm and soothing voice, try to persuade them to come towards
you
 Slip the loop of the leash over the dog’s head and tighten it gently
 Walk to the dog’s left side and keep them close to you
 Leave the kennel using your left foot first and keep the leash taut, but not tight.
Bird restraint
 The biggest concern when handling birds is applying to much pressure to their chest
leading to suffocation
 Large birds are handled with towels or leather gloves
 The thumb and middle finger of the hand restraining the bird should encircle their head
at the mandibular joint (jawline)
 The index finger should rest on top of their head without covering the nares (nasals)
 The other fingers should encase the bird’s wings
Removal of a small bird
 Ask the owner about the bird’s level of training and if the bird is trained to “hop up”;
small birds don’t require you to wear gloves but you should always be cautious
 Make sure all doors and windows are shut and secure
 Slightly open the cage door and remove all objects from the cage
 Dim the lights and have a small cloth in one hand in case you need it
 If the bird is trained to “hop up,” stroke the underside of the chest and give them the
hop up command, then continue as directed; if the bird is not trained, skip this step
 Before removing the bird from the cage, place your free hand over the bird’s back; Drop
the small cloth over the bird and around their body for extra restraint and to prevent
them from seeing the handler if they are nervous
 Gently wrap your thumb and middle finger around the bird’s head at jaw level and rest
your index finger on top of the head
 Wrap your other fingers around the bird’s wings and body, restraining the wings by
pinning them gently against the bird’s body
 Allow the bird’s feet to rest on your pinky finger and pull your finger close to the bird’s
body making sure to hold the bird gently
 Slowly remove the bird from the cage; hold them almost completely in perching position
during the procedure and tip them slightly onto their back when needed while paying
attention to respiratory function.
Returning a small bird
 Make sure all doors and windows are shut and secure
 Open the cage door completely
 Put the bird inside the cage on the floor and release their feet
 Let go of the bird slowly and immediately close the cage door
 Return all objects one-by-one to the cage by opening the door just wide enough to slip
each item in
Handling large birds
 Make sure all doors and windows are shut and secure
 Open the cage slightly and remove all obstructions from the cage
 If using a cloth, place it over the bird’s body
 Place your left hand over the bird’s body and secure their head with your thumb and
middle finger on either side of their head with your index finger on top
 Place your right hand under the abdomen and in front of the legs, pinning their wings
carefully to their body
 Lift the bird from the cage using both hands, keeping the head and wings immobile
 Turn the bird so their belly is slightly facing up but still maintaining perching position
 For heavy/large birds, lay them on your forearm to support their weight
 Lifting Heavy Animals
Heaving lifting
 Use slow, smooth movements as hurried/jerky movements can strain muscles
 Face the patient with your body while getting into a squatting position; keep your face
clear of their head in case they snap or bite; lift them while keeping your back straight
 Always use both arms when lifting
 Keep the patient close to your body to avoid unneeded tension by reaching out
 Lift with your legs instead of your back; bend your knees to pick up the patient while
keeping your back straight
 Carry the patient between your shoulders and waist, using your torso to support their
weight
 Stretch your legs and back before the lifting the patient to warm up your muscles
 If you have to strain to carry a patient, they are too heavy so you need to ask for help
 Make sure you have enough room to safely lift the patient; make sure you can see
where you’re walking and know where you’re placing them before you pick them up
 Check the floor for uneven or slippery surfaces before lifting the patient
Moving large unconscious patients
 Use a stretcher, large blanket, or gurney- these methods require two or more handlers
 Patient is placed on their side (lateral recumbency)
o Stretcher/blanket: slipped underneath the patient who is then rolled onto it
o Gurney: patient is picked up and placed on it
Lifting medium-sized patients
 Usually only one handler is needed
 One arm should be cradled behind the dos’ rear legs underneath the tail
 The other arm should be placed around the dog’s chest and front legs
Lifting large/active patients
 The patient should be standing parallel to the surface that they will be placed on
 Both handlers should stand on the same side with the patient between them and the
surface
 The handler standing at the patient’s head should slip one arm under the patient’s chin
and around their neck to secure the head; slip the opposite arm under the patient’s
chest and as far around it as possible; pull the patient tightly to your chest
 The handler standing at the patient’s tail should slip one arm under the patient’s belly
and as far around it as possible; position the opposite arm behind the patient’s tail and
legs at knee level; push the hind legs forward slightly toward the patient’s body; pull the
patient tightly to your chest
 Both handlers should coordinate with each other to lift the patient simultaneously and
place it on the designated surface
 Release the arm restraining the patient’s head after they have settled onto the surface
and you’ve been told it’s okay
 One handler should stay with the patient while the other returns to their other duties
Handling the Fractious Patient
Complaining cats
 Irritable patients need to be approached with care
 Fractious cats should be handled briefly and only for the length of time it takes to finish
the procedure or until chemical restraint is administered
Types of holds
 The stretch hold:
o Grab the cat’s scruff in one hand and both hind legs in the other hand at the
hock (heel)
o Insert one finger between the cat’s hocks to separate them and stretch the cat
outwards with both hands while keeping your forearm close to the cat’s back
o If the cat is no stretched far enough, this hold will not restrain them
o Most cat’s do not resist this hold
 Scruff hold:
o Grab the loose skin behind the cat’s ears
o This hold mimics the maternal authority of a mother and may calm the cat
o The closer you hold to the ears, the less likely they are to turn and bite
 Hide and seek:
o Double-fold a towel and toss it over the cat’s entire head and body inside the
cage
o Place your hand on top of their neck and shoulders and push down gently
o Use you or other hand to wrap the towel underneath the cat’s body
o Remove them from the cage while holding them close to your chest and set
them on the exam table
o This prevents them from seeing the handler so they cannot scratch or bite
 The kitty burrito:
o Lay a towel down on the exam room table & open the cage/carrier
o Slide the cat towards you while slipping your arm under their body and lift them
out while keeping a hand at their scruff
o If leaving the cat’s head exposed, immediately place the cat on top of the towel
and wrap is securely around their neck; snuggle them into the towel all the way
down their body, wrapping one side of the towel first and then the other side
o If including the cat’s head in the wrap, wrap the entire cat in the towel
o Hold the cat snugly against your body until the vet/vet tech exposes the back
area
o When finished, place the cat back in the cage/carrier and allow it to come out of
the towel on its own
 The fish net:
o Open the cage/carrier slightly and slip the net over the cat’s body while pulling
the ring out from under them & then place a towel over their head
o Once the vet/vet tech has administered meds through the net, put the cat back
in the cage before removing the net if it’s still fractious
 The scratch shield:
 o A wire screen or plexiglass used to immobilize cats against the back of a
cage/carrier
o Injection are administered through holes in the shield using one hand while the
other hand pushes the shield towards the cat
 The cat muzzle:
o Covers both the mouth and the eyes which can calm the cat and also give the
handlers/vets/vet techs an advantage so the cat doesn’t see them coming
o Made of mesh, nylon, or leather with a Velcro clasp
o Needs to be removed when a cat is anesthetized in case they vomit
 The cat sack:
o Canvas or nylon sack with zippers that allows selective exposure of a cat’s body
parts while the cat’s head remains exposed
o Place the cat inside the bag from the top where the zipper opens and fasten the
neck closure under the chin while leaving enough room to breathe
o Close the zipper along the back after all the cat’s limbs are inside
o The head stays exposed while the feet are restrained in the sack so medication
can be administered
o Leg zippers may be opened to expose each leg as needed
Trimming a cat’s claws
 Styptic powder or silver nitrate helps control bleeding from the quick
 Polydactyl cats have more toes than normal cats
 Benefits of regular trim:
o Reduces the risk of cat scratches to family and friends
o Reduces the risk of damage to the owner’s property from scratching
o Reduces the chance of injury from scratches to other household pets
o Cats can become accustomed to the procedure
 Procedure:
o With the cat on the exam table, hold one toe between your thumb and index
finger and press to allow the nail to protrude from the toe
o Find the quick of the nail which will be pink and easy to see in white nails
o Use scissor-style trimmers but if using guillotine style, hook the blade of the nail
clippers underneath the nail between the straight portion and curved portion
o Cut the nail from underneath with a quick and precise stroke while avoiding
squeezing the nail slowly, as it causes discomfort
o If the cat is resistant, take a break between nails to soothe them; stroke and
praise them when they behave; scruffing them can also calm them
o If the quick begins to bleed, apply powder or nitrate and add pressure
Disgruntled dogs
 Look in the patient’s file for warnings about aggression or biting
 The vet staff should be mentally alert and observant of a canine patient’s behavior and
body language
  Offensive threat posture: dog is aggressive
o Tail up and stiff & hackles up (hair along back)
o Ears forward & nose wrinkled
o Corners of mouth forward & stands tall and forward on toes
 Defensive threat posture: dog is self-protective
o Tail tucked & hackles up
o Ears back & nose wrinkled
o Corners of mouth back & body lowered
o Pupils dilated & teeth showing
Restraint types
 The leash:
o Most common is a slip lead
o Placing the circle-end over the patient’s head and around their neck creates a
leash that tightens whenever it’s pulled
o Can be effective but also dangerous as applying too much or constant pressure
on a dog’s throat can cause tracheal damage and other injuries
 Leash restraint- barriers:
o One handler restrains the dog while the other administers injections
o The first handler opens the cage/kennel door slightly and slips the loop of the
leash over the dog’s head
o The handle of the leash is now slipped through the bars of the cage/kennel & the
dog is coaxed out of the enclosure
o The handler should pull the dog’s head up against the bars while holding the
leash outside of the of the door so the dog can’t move their head
o The second handler should now grab and extend the hind leg and administer the
injection
o For regular doors, the first handler should pull the leash handle through a crack
in the door and apply pressure from the opposite side to cause the dog’s head to
be pulled tightly against the door
o The second handler should remain on the same side of the door as the dog and
administer the injection
 Leash restraint- cross-tying:
o Requires two slip leashes and three handlers
o Place both leashes around the dog’s neck with one handler standing on each side
of the dog, each holding a leash
o Apply tension to the leashes to limit movement while the third handler
administers the injection to the hind leg
 Canine muzzles: gauze/leash/basket
o Brachycephalic dogs (short wide heads) require special muzzles
o Fabric muzzles include leash, metal/basket, nylon
o Non-aggressive dogs can smell their muzzle before it’s applied but aggressive
dogs should not be allowed
 Corner the dog with one handler straddling them while the other applies
the muzzle
o Gauze muzzles: easy, efficient, and don’t require choosing a proper size; cut a 3’
length of gauze and tie knots at the bottom of the loop & slip the loop under the
dog’s nose & tie the top- not used for brachycephalic dogs
o Leash muzzles: less common and secure but good for emergencies; used only
briefly when needed on short notice; wrap the leash around the snout many
times
o Metal & basket muzzles: allows dogs to still pant and drink water; can be left on
a dog for long periods of time; large and difficult to store
 Quick-release pole:
o Used to retrain a dog when needing to keep distance
o A cable forms a loop where the dog’s head is restrained and swivels so it doesn’t
tighten harmfully around the dog’s neck- still must use caution so the cable
doesn’t strangle the dog
o When giving an injection, one handler should slip the loop over the dog’s head
and tighten it securely but not enough to strangle the dog
o The handler should push to end of the pole to the floor to pin the dog’s head
down while the other handler extends the dog’s hind leg and administers the
medication
o Lead the dog back to their cage/kennel and release the knob to free the dog
 Recumbency (lying down)
Sternal recumbency
 A patient is lying chest down on their stomach (sternum= breastbone)
 Preferred position for procedures involving spinal or head examinations
 Place the patient on the table and give the “down” cue
 If the patient doesn’t respond to the cue, place your hand on top of their hips and apply
downward pressure while sweeping their rear legs under them to coax them into sitting
 Now place your hand on top of their shoulders and apply slight pressure while using
your other hand to sweep their front legs forward to guide them into a down position
 Wrap your arm under their neck and cradle their head against your chest
 Use your other arm to encircle the patients shoulder to hold them close to your body
Lateral recumbency
 A patient is lying on their side (lateral= side)
 Preferred position for exams involving limbs or shoulders
 Patient should be placed on the opposite side of the affected area
 Place the patient on the exam table & stand on the side they will lay on
 Reach both arms over their back with one at chest level and the other over the
abdomen
 Wrap your arms underneath their belly and grab the front and rear leg closest to you
 Pull the legs outward away from your body to flip them on their side while making sure
they don’t slam their head down- the flip should be smooth and controlled
 Keep both arms in position while keeping pressure on the shoulder and flank with your
forearms- keep their head down and keep holding the legs
 Can use your forearms to apply pressure to the patient’s neck to help restrain the head,
but avoid the trachea
 For large patients, use your entire body to hold the patient down but don’t lean on their
chest
Dorsal recumbency
 A patient is lying on their back (dorsal= back)
 Preferred position for procedures involving the abdomen or thorax; used for x-rays
 Patients with respiratory distress should only be placed in this position under direct
orders from the veterinarian
 Place the patient in lateral recumbency and grasp the front and back legs using a three-
finger hold
 Roll the patient onto its back while preventing their head from slamming down
 Extend the legs with the front legs reaching over their head and the rear legs stretched
out, parallel to each other towards the tail
 Keep their head between their front legs and use a muzzle if necessary
 Anesthetized patients can be held in this position by being placed in a “V” trough or
putting sandbags against their sides
 For surgery tables, two half-hitch knots would be used on each leg to extend the limbs
 Restraint during Physical Exam
Principles
 Be responsive and effective:
o Once the exam has begun, restraint is maintained throughout the entire exam
o Should be well versed in restraint and be able to anticipate the vet/vet tech’s
actions as they move around the patient
o Remain alert and observant of their behavior to assist in evaluating the patient’s
mood and need for restraint
o Apply both physiological and physical restraint
 Become familiar with anatomic vocabulary:
o Cranial: toward the head
o Caudal: toward the tail
o Ventral: toward the sternum
o Dorsal: toward the spine
o Medial: toward the midline (middle of body; spine)
o Lateral: toward the side; away from the midline
o Proximal: part of limb closer the body
o Distal: part of limb farther from the body
o Rostral: toward the tip of the nose; used in reference to the head
o Anterior: toward the front of the body; used in reference to the limbs
o Posterior: toward the back of the body; used in reference to the limbs
 Take the essential steps:
o Make sure the exam room is cleaned and sanitized
o Instruments should be laid out in the correct order
o Receptionist should check-in the patient and then the vet assistant takes them to
the exam room
o Place the patient on the exam table or floor with their left side facing the
veterinarian to facilitate auscultation (listening to the heart/lungs/abdomen with
stethoscope)- heart sounds are clearer on the left side of the body
 Begin the examination in basic position:
o Place the patient in a standing or sitting position or sternal recumbency
o Stand to their side with the arm closest to the head wrapped around their neck
& the other arm wrapped under or around the belly, or over the back/shoulder
while tucking close
o Keep your head/face away from the dog’s head/face & pull them close to your
body
o Use your hands to keep their muzzle closed- some professionals don’t
recommend this due to the risk of biting
o During an otoscopic (ear) exam, the vet may ask you to lift the pinna (earflap)
and point the head down; use the arm cradling the chest to lift the left ear; the
right ear may require you to switch sides of the exam table or rotate the patient
Thorax examination
 Slip your left arm under the abdomen instead of around the chest
 For the right side, move back away from the patient to allow the veterinarian to fit the
stethoscope between you and the patient; you may also rotate or switch sides
Abdomen examination
 If the patient is sitting, replace your left arm around their chest and push upward so
they stand up
 Release all pressure on the abdomen when the veterinarian is palpating the organs
Anus/perineum examination
 Anus: terminal opening of the digestive system
 Perineum: the pelvic floor and structures associated with the pelvic outlet
 The patient should remain standing and your left arm should be under the abdomen to
support them during this uncomfortable examination
 Hold them close to your chest for extra support
Limbs examination
 The patient may need to be in lateral recumbency
 While on their right side, the vet will exam the left front and back limbs as well as the
shoulder and hip joints
 Flip the patient to the other lateral side so the vet can exam the opposite side
 The patient may also remain in a standing position while the veterinarian examines the
limbs
Exam completed
 Help the patient get off the exam table & don’t allow them to jump down
 When the owner and patient leave the room to be discharged, clean the equipment
Reminders
 Always stand on the opposite side of the veterinary staff member during the exam
 Maintain restraint from the time the patient is placed on the exam table until the time
the examination is completed; do not let go at any time
 Use your entire body to restrain the patient to provide extra strength and support
 Be alert and observant at all times; try to anticipate the movements of the vet/vet tech
 Be observant of the patient’s attitude and body language; tell the vet/vet tech you need
to increase your level of restraint or change positions if they become fractious
 Move your body and arms accordingly so the patient can be examined without
interruption
 Use firmer restraint when the specific procedure is delicate or dangerous such as those
involving the eyes or ears
 Restrain the patient’s mouth accordingly as the examiner’s face is often close to it
 Use less restraint for short procedures such as vaccinations; use psychological restraint
 Notify the veterinary team if you are ever losing control of a patient so they can help or
move out of harm’s way
 Memorize directional vocabulary
 Restraint for Venipuncture
Venipuncture
 The introduction of a needle into a vein, or the placement of a needle/catheter into the
blood vessel to administer drugs/fluids or to take a blood sample
 Very sensitive and requires dependable restraint from the vet assistant
 If the patient moves during this process, bruising can occur around the vein and a new
one will need to be used
 For something small like a glucose test, only one drop of blood is needed so a 1 cc
syringe with a 25 gauge needle is typically used
 Blood obtained closer to the heart is more reliable than blood farther from the heart
Jugular
 The vein chosen to extract large amounts of blood from in a small patient; chief vein of
the neck
 Once the needle is withdrawn, apply pressure to the puncture site to prevent
hematoma (buildup of blood due to leaking blood around a vein)
Cephalic
 The vein chosen for intravenous catheters; vein on anterior surface of the forearm
 Occluding: creating a tourniquet by using your fingers to apply pressure to the leg to
block circulation and causing the blood to pool in the vein, making it more visible
o Can use either thumb or index finger
Use of other vessels
 For canines, lateral (outside) saphenous venipuncture may be used; hind leg
o Occlude the vein by holding the leg at the stifle (knee)
 For felines, medial (inside) saphenous venipuncture may be used; inner thigh
o This puncture site bleeds easily causing large hematomas
Prepared items
 Patient’s medical record
 Alcohol bottle & cotton balls
 Adhesive tape
 Clippers with #40 blade
 Catheter’s and/or syringes with needle of correct size
 Blood tubes for each blood test that is needed
 Tourniquet & peroxide
 Restraint during the Administration of Injections
3 factors
 Manufacturer’s directions/recommendations:
o May include how and where to administer the drug
o May have several options such as intramuscular or subcutaneous
 Desired absorption rate:
o Pre-anesthetic drugs may need to take effect quickly but routine vaccinations
don’t
o Relies on injection method, blood supply at injection site, and absorption rate of
the active and adjunct ingredients in the drug
o Adjunct- non-active ingredient in a drug
o Subcutaneous- drug is injected just under the skin; slowest method
o Intramuscular- drug is injected into the muscle
o Intravenous- drug is injected into the vein; fastest method
 Patient comfort and pain level:
o The size of a needle may dictate how much discomfort a patient feels
o Certain medications cause more pain than others
o The location and type of injection also determines the amount of discomfort
 Restraint during Vaccination
Vaccination
 The inoculation with a vaccine
 Vaccine- weakened or killed pathogen
 Administered subcutaneously, intramuscularly, or intranasally
Administration of oral medications
 Oral medication comes in pills, capsules, or liquids
 Allows owners to continue their pets’ medication without constant injections or hospital
stays
Administering liquids
 Gastric tube- descends through esophagus and into the stomach; used for emergencies
(bloating, poisonings) to administer large doses of medications
 Nasogastric tube- passes through nose, then esophagus, and down into stomach
 Mouth speculum- instrument used to expose the interior of a body passage if the
patient is under anesthesia; aids in insertion of the tube
 White tape- holds the tube in place if the patient is still conscious
 Biggest concern is the patient biting the tube and breaking it into pieces
 Administer the liquid using an eyedropper or dispensing syringe & then rinse the
patient’s mouth with plain water to make sure all the medication has been consumed
 3 ways:
o Place your hand under the patient’s chin and tilt their head backwards with their
nose up; with one finger, pull the corner of one lip outward and open to form a
pocket between the cheek and teeth & slowly pour the liquid into this place;
keep the nose upwards to allow them ample time to swallow
o Open their mouth and squirt the liquid medication straight into the back of their
mouth and not the tongue while keeping the nose upwards
o Tilt their closed mouth upwards and lift the upper lip behind the canine tooth;
place the syringe with the liquid or tube of paste right behind the tooth, pointing
it towards the roof of their mouth; slowly squeeze all of the medication into the
mouth and hold the head upwards
Opening a cat’s mouth
 Hold the upper jaw with your fourth finger and thumb, which should wrap around the
back of their head, and your fingers should rest on top of the canine teeth pointing
upward
 Hold the pill/syringe in the other hand and use one finger to pry the bottom jaw open
 If it’s a pill, drop it as far back in the cat’s mouth as you can without letting it fall to the
sides
 Close the mouth immediately and hold it shut while stimulating swallowing by either
swiping their nose of massaging their throat
 Check their mouth to make sure they swallowed the pill or rinse it with a syringe full of
water
 To limit salivation due to bad-tasting pills, be quick and rinse their mouth afterwards
Opening a dog’s mouth
 Hold the upper jaw with your thumb and index finger behind the top canine teeth while
using the other hand to hold the medication and open the bottom jaw
 Drop the pill as far back as you can
 Allow the head to return to normal position so they can swallow, then repeat the
process with a syringe full of water
 If the dog is resistant or aggressive, hide the pill in food
Opening a bird’s beak
 Small/medium birds:
o Place one hand behind the bird’s head with the thumb and middle finger on
either side
o Your index finger should be resting on top of the head without covering the
nares (nostrils)
o Using the other hand, grab a paper clip and wedge it between the upper and
lower beak; then proceed to rotate it to pry the beak open
o Insert the tip of the feeding tube into the beak slightly to the left where the
esophagus is
o Remove the paper clip and move the syringe to the center of the beak, widening
the opening in the beak
o Slide the feeding tube down the esophagus until you reach the crop and then
slowly push the plunger
o You can feel the esophagus to make sure the feeding tube is in the right spot
o Once the syringe is empty, withdraw the tube & re-open the beak using a paper
clip to rinse the mouth with a syringe full of water
o Crop- pouch inside the esophagus of birds; where food is held for later digestion
or regurgitation
 Large birds:
o Same procedure as small/medium birds
o All birds should be wrapped in a towel
o For large birds, approach the mouth from the left to make sure the medication
enters the esophagus instead of the trachea
Restraint during the Healing Process
 Head restraint- Elizabeth collar/E collar:
o Name comes from the ruffled collar worn in Elizabethan times
o Durable and reusable; stops animals from scratching their wounds or sutures
o Animals may get stuck in small spaces or bump into things; food and water need
to be elevated for the animal to reach
 Head restraint- Cervical collar/Neck brace:
o Keeps patients away from their back end
o Restrains the neck to limit movement of the head while still allowing access to
the front legs
o Rarely used
 Leg restraint- Hobbles:
o Restrains a patient’s legs so they can walk by using small steps but cannot
scratch their face/body
o Mainly used in large animal medicine such as horses to facilitate more rapid
healing and limit movement
Restraining rabbits
 Sociable, trainable and affectionate animals
o Can be trained to use a litter box, come when called, and play games
 Biggest hazard when restraining rabbits is the rabbit injuring itself when struggling to
free themselves from the handler
o Worst injury that can happen is dislocation of the vertebrae or breaking its back
 Process:
o Remove the rabbit from its carrier by grabbing the scruff of the neck gently and
sliding them forward to the front of the carrier & use your other hand to lift
them from under their body
o For long distances, set the rabbit on the forearm of the hand that is not holding
the scruff and wrap the hand under the hind legs & tuck the rabbits head under
this arm; let go of the scruff and move the according hand around the rabbit’s
body for added support
o For short distances, maintain the hold on the scruff as you move your other hand
underneath their hind limbs
o Place the rabbit on top of a folded towel on the exam table during exams
o If they are scared, modify the kitty burrito technique to fit a rabbit’s needs
o Before the examination begins, make sure to ask the owner if the rabbit has
gotten any injuries in the past or is used to being handled by different people
o One the patient is on the exam table, continue to hold the scruff of the neck
while placing your other hand on top of their hips an applying light downward
pressure to prevent them from kicking out its back legs