2022 AAFP/ISFM Cat Friendly Veterinary Interaction Guidelines: Approach and Handling Techniques

Abstract

Practical relevance: The '2022 AAFP/ISFM Cat Friendly Veterinary Interaction Guidelines: Approach and Handling Techniques' (hereafter the 'Cat Friendly Veterinary Interaction Guidelines') support veterinary professionals with feline interactions and handling to reduce the impact of fear and other protective (negative) emotions, in so doing enhancing feline welfare and In implementing these Guidelines, team satisfaction and cat caregiver confidence in the veterinary team will increase as the result of efficient examinations, better experience, more reliable diagnostic testing and improved feline wellbeing. Veterinary professionals will learn the importance of understanding and appropriately responding to the current emotional state of the cat and tailoring each visit to the individual.

Clinical challenges: Cats have evolved with emotions and behaviors that are necessary for their survival as both a predator and prey species. A clinical setting and the required examinations and procedures to meet their physical health needs can result in behavioral responses to protective emotions. Cat friendly interactions require understanding, interpreting and appropriately responding to cats' emotional states and giving them a perceived sense of control while performing the required assessment.

Evidence base: These Guidelines have been created by a Task Force of experts convened by the American Association of Feline Practitioners and the International Society of Feline Medicine, based on an extensive literature review and, where evidence is lacking, the authors' experience.

Endorsements: These Guidelines have been endorsed by a number of groups and organizations, as detailed on page 1127 and at catvets.com/interactions and icatcare.org/cat-friendly-guidelines.

Keywords: Cat Friendly Clinic; Cat Friendly Practice; anxiolytic; behavioral needs; chemical restraint; cooperative care; feline emotions; handling; non-physical interactions; physical interactions.

Figure 1

Examples of places and opportunities for cats to hide during their visit. (a) High-sided cat weighing scales, (b) blankets and towels, (c) igloo beds or (d) high-sided beds, with or without an added blanket/towel, are all excellent options and items that can easily be washed and dried in the veterinary practice. (e) An additional towel or blanket ‘roll’ draped over the neck can also give cats a sensation of being hidden. Images courtesy of Kelly St Denis (a,b,e) and Ilona Rodan (c,d)

Figure 2

(a,b) A veterinary team member approaching a cat in their carrier with a soft hand; note the curved fingers. Images courtesy of Ellen Carozza

Figure 3

Feline facial glands are preferred areas of touch for the head region. Image courtesy of International Cat Care

Figure 4

Example of an inhibited cat. The cat is passively gathering information, with eyes half-shut and ears rotated laterally. Image courtesy of Sarah Heath

Figure 5

Splayed whiskers is one of the signs a cat may display when experiencing protective emotions. Image courtesy of Ilona Rodan

Figure 6

Behavioral responses to protective emotions are shown in images (a-c), while image (d) shows a behavioral response to engaging emotions. If avoidance and inhibition responses have not been successful for the cat, this increases the probability that repelling responses will then be selected. In this case, an anxiolytic within a treat was offered passively and the cat was left alone for 2 h, which was successful (see image d). The alternative would have been to sedate the cat for the procedure to be carried out, or send the cat home with advice for the caregiver to carry out carrier training and administer anxiolytic medication (eg, gabapentin) before the next visit. Images courtesy of Ilona Rodan

Figure 7

Young cat becoming frustrated in relation to their desire-seeking system due to confinement and the presence of the soft collar. Strategies to prevent frustration aim to increase fulfillment of the desire-seeking system; for example, through providing social interactions at consistent times by one or two veterinary team members and, for some patients, allowing the caregiver to visit. Consistency in the timing of feeding and playing is also helpful; remove the soft collar for feeding. If the cat is hospitalized for more than 24 h, ensure that all environmental needs are met, either in the cage or a small room environment (see the accompanying Cat Friendly Veterinary Environment Guidelines). Image courtesy of Sam Taylor

Figure 8

Images from Couture et al provide evidence to support the benefit of minimal feline handling (a,b) over restraint. Blinded observers reviewed video clips and pictures, including those shown here. The methods of restraint illustrated in images (c-e) resulted in increased objective indicators of fear and aversion.^, Images courtesy of Lee Niel

Figure 9

Carrier training case study, providing a clear example of how prior negative experiences can influence veterinary interactions, and how the veterinary team can support caregivers to train cats, of any age, to voluntarily enter the cat carrier. Note the facial expression indicating discomfort, which was due to musculoskeletal pain not being well controlled. Image courtesy of Ilona Rodan Watson was presented as a 12-year-old who was highly fearful during veterinary visits due to a painful experience as a kitten at the practice he then visited. Carrier training was recommended and successfully resulted in a calm and content cat during veterinary visits. At home, Watson readily entered the bottom half of the carrier lined with his favored bedding. As a food-motivated cat, he then entered the carrier with the top added when coaxed with food treats. At 14 years of age he starred in a carrier training video, ’Cats & carriers: friends not foes’ (Box 6) filmed in the practice he had been so fearful in prior to carrier training.

Figure 10

Example of cooperative care. This cat was trained to be comfortable with weighing scales to prevent fear of the equipment and to allow weight to be monitored at home on a routine basis for early detection of obesity or weight loss. Image courtesy of Ilona Rodan

Figure 11

(a-e) Clinical examinations being performed in the cat’s chosen location. Images courtesy of Ilona Rodan (a-c) and the Feline Healthy Ageing Clinic, University of Liverpool, UK (d,e)

Figure 12

(a-e) Examples of towels and blankets being used to loosely wrap (rather than tightly restrain) anxious cats to facilitate the examination. Images courtesy of Ilona Rodan (a,b), the Feline Healthy Ageing Clinic, University of Liverpool, UK (c), Sam Taylor (d) and the AAFP (e)

Figure 13

(a,b) Massaging over the facial glands. These produce pheromones used in facial rubbing and are the preferred areas of touch in the head region (see Figure 3). In both these images, massage is over at least two of the facial glands. Images courtesy of Ilona Rodan (a) and the AAFP (b)

Figure 14

Open the carrier door and allow the cat to come out on their own accord. Treats can be offered passively in front of the carrier to encourage the cat to exit. Image courtesy of Ilona Rodan

Figure 15

Approach the cat from an angle when examining the head, to avoid direct eye contact. Image courtesy of Ilona Rodan

Figure 16

Combine abdominal palpation with head and neck petting and massage to make the experience more positive. Image courtesy of the Feline Healthy Ageing Clinic, University of Liverpool, UK

Figure 17

Palpation of the spine for degenerative joint disease. Image courtesy of Ilona Rodan

Figure 18

(a,b) Oral examination. Note the examiners are avoiding pulling on the cat’s fur to raise or lower the lips. Images courtesy of the AAFP (a) and Feline Healthy Ageing Clinic, University of Liverpool, UK (b)

Figure 19

Cat sitting on a warm blanket on weighing scales. The scales are zeroed after placing the blanket and before the cat is enticed onto them. Image courtesy of Kelly St Denis

Figure 20

Coccygeal blood pressure measurement being taken while the cat remains relaxed in a cat bed. Image courtesy of the AAFP

Figure 21

Radial blood pressure measurement being taken while the cat is relaxed in the base of their carrier. Image courtesy of the Feline Healthy Ageing Clinic, University of Liverpool, UK

Figure 22

Cats having a jugular blood sample collected with (a) no physical handling and (b) only minimal handling, including no restraint of the forelimbs. Note the use of a liquid treat to distract the cat in image (a). Images courtesy of the Feline Healthy Ageing Clinic, University of Liverpool, UK (a) and Ilona Rodan (b)

Figure 23

Medial saphenous venipuncture with the cat in a semilateral position. Image courtesy of Eliza Sundahl

Figure 24

Cephalic venipuncture with a 25 G butterfly catheter. The patient remains comfortable within the bottom half of the carrier. Image courtesy of Ilona Rodan

Figure 25

Standing cystocentesis. The cat is held gently against the body of the assistant, who is slightly retracting the hindlimb, holding at the thigh. Image courtesy of Kelly St Denis

Figure 26

Cystocentesis in lateral recumbency. Note the hindlimbs are not being held at the joints or feet. Image courtesy of Ilona Rodan

Figure 27

(a,b) Examples of a cat having an ultrasound examination in the bottom half of their carrier. Images courtesy of Sam Taylor

Figure 28

Pediatric cradle hold. Neonates may be held by placing one hand over the dorsum, holding the base of the jaws with thumb and forefinger. The other hand holds the lower half of the kitten and helps control the animal’s movement. Image courtesy of Ellen Carozza