As we all know, cats can be very unpredictable in the hospital setting. Here are some tips to avoid bites and scratches in fractious cats. 

1) Take a proper history:

• Why is this cat coming into the hospital today? 
• Does the history suggest the cat could be in pain? Cats in pain may be more fractious or resistant to examination and treatment. A wellness visit may be less stressful and shorter than a visit for a sick cat that may need labwork or diagnostics. Cats often have a threshold for what they will tolerate, so plan accordingly for what may need to be done so the stress doesn't escalate. 
• Ask new clients if their cat is usually friendly at the vet's office. (This is not always a guarantee, but owners of fractious cats will often tell you they can be difficult or may act fearful when you are getting ready to remove the cat from the carrier.)
• Keep good notes in the medical records about what certain patients do or do not like! Some cats are great with minimal restraint, even for vaccinations, but some may do well with basic restraint such as appropriate scruffing if needed for an injection or exam. Consider ear thermometers for well cats, I have found them to be accurate and most cats do not enjoy rectal temperature taking.

2) Read the cues the cat is giving you:

• Ears back, hissing, tail swishing are signs of agitation. Increased vocalization may be a sign of stress. Don't ignore their communications and be cautious.

3) Be alert: Don't let your guard down at any time. Be relaxed but prepared. Sometimes cats may be doing very well for examination or treatment, until they have had enough and may suddenly become fractious. Always make sure your restraint is adequate and minimize chance for injury.

4) Use sedation if needed: For extremely fractious cats, I always use sedation. It is just simply not worth the stress on us or the cats to try and wrestle with them to do a blood draw or provide treatment.

5) Implement Fear Free tactics when possible: Dr. Marty Becker has been speaking about Fear Free techniques and has pioneered the movement. Things to consider are:

• Pheremone spray in the exam room may be calming.
• Separate entrance or exam room for cats vs. dogs if possible
• Quiet area for exam: loud noises and barking dogs can be very stressful for cats
• Fear-free starts at home! If you know a particular patient is stressed when they come in, offer tips to the owners for the next time they come in.
• Minimize waiting time. For stressed patients, sitting in the lobby or waiting for a lengthy amount of time causes more anxiety to build.

6) Proper restraint techniques:

Be sure to check out this great video from atdove.org with Megan Brashear, CVT, VTS (ECC) that shows various restraint techniques for a fractious cat. It is a must watch!

• If a cat is fractious, always have help, don't try to retrieve a fractious cat or restrain alone without backup.
• Never let go before other restrainer if more than one person is holding and communicate with each other. If one person has the scruff and one person has the limbs, it could result in a bite or scratch if one person lets go before the other. If the cat is really this stressed and fighting, then sedation is needed. It is not worth the stress on the cat or the staff- or risk of injury to either.
• Use towels to wrap cats (burrito) to restrain their limbs if needed. This may only work in some cases. Sometimes cats like to hide under a blanket and may help them to feel safer and be easier to restrain their head and neck while doing the exam in parts (front and then back) without scruffing.
• Cat face muzzles can be helpful in some cases to eliminate bite risk while allowing the cat to breathe normally.
• Consider doing a quick courtesy nail time for cats that are indoor only and if the owner allows- before you draw blood or perform treatments (for cats that may be more difficult to handle). The scratch, if it were to occur, is not nearly as severe.

Fear-Free workshop notes: Fear Free feline handling, exam, and treatment by Dr. Ilona Rodan