Introduction

The first aim of any practice should be to stop the cats becoming fractious in the first place. A very good place to start is with the Feline Advisory Bureau's Cat Friendly Practice programme: http://www.fabcats.org/catfriendlypractice/.

If the cats can be kept calm in the first place then all handling becomes much easier. This requires 'thinking cat' at all times: i.e., from when advising clients how to bring their cats to the practice (e.g., having a secure cat basket that the cat is used to seeing, and spraying it with Feliway® [synthetic feline appeasement pheromone made by Ceva]), having a separate dog-free cat waiting area where cat baskets do not need to be placed on the floor, cleaning consult room tables thoroughly between patients so their anxiety pheromones from their sweaty paws are removed, having 'cat friendly' staff who understand cat ethology, and a cat-only ward.

Cats are generally more sensitive to unfamiliar people, places and situations than dogs are, and this can be even more extreme for cats that have been poorly socialised and/or cats that live indoor-only and meet very few people.

Handling

Careful 'cat friendly' handling is essential, and it can be taught. Below are some general tips from the FAB Cat Friendly Practice booklets:

 Adopt a 'less is more' approach to restraint as this will reduce the risk that the cat responds with aggression.

 Always approach a cat in a calm and soothing manner. Do not look the cat in the eye on first contact--look past it. Once the cat is relaxed you can make eye contact, but it is best to do so with semi-closed eyes--this is much less threatening. A slow blink can be an effective way of telling a cat you mean it no harm. Stroke and talk to the cat before lifting it from the cage or basket.

 Rub your hand over the cat's own pheromone centres (above the bridge of the nose and pre-auricular area). The cat will often put its head in your hands--very impressive for clients!

 After removing the cat from the basket, let it settle, stroke it while having a chat with it and its owner, or let it wander around the consult room for a few minutes.

 Avoid sharp or loud noises as cats are often very sensitive to these.

 Avoid very bright lights while the cat settles down. If the cat needs a retinal examination leave this to a little later in the consultation.

 Talk to the cat calmly and slowly with a relatively quiet tone; move slowly and quietly and do not make sudden movements. Some people find getting down on the floor with the cat can make it relaxed and so make handling easier.

 Perform some of the physical examination with the cat looking away from you.

 Start with the least invasive procedures first, ending those most likely to upset the cat, such as opening its mouth and taking a rectal temperature (for the latter remember to use plenty of lubrication). Cats often resist having their mouths opened wide and it can be easy to miss things, see http://www.fabcats.org/catfriendlypractice/ for tips on oral examination.

 Have items such as thick towels to hand for calm use if required.

 Being moved around on a slippery surface can be stressful. A towel or rubber mat which gives the cat something to grip can help. Consider using the cat's own blanket from its basket.

 Felifriend® (Ceva) (in addition to Feliway®) can be useful. However a paradoxical increase in aggression has been noted in cases where the cat is faced with a human or feline with which it associates hostility. The cat appears to panic at the conflict between what it sees and the appeasing scent signal. Remember no amount of synthetic feline pheromone will replace good handling techniques.

 Use cotton overalls as synthetic material can lead to electrostatic effects.

 Careful observation of cat behaviour will help predict when a cat is feeling threatened.

 If aggression does occur it is important to realise it is because the cat is fearful not dominant.

 Scruffing the cat should not be used routinely and certainly not for lifting. Grabbing and immediately scruffing a cat is intimidating and leaves the cat with no room to manoeuvre except for defensive aggression ('fight' may be necessary as 'flight' has been prevented).

 Be willing to use chemical restraint to decrease the stress which may be caused by physical restraint.

Drug Options

Drug options are many but the author finds that a combination of butorphanol (0.3mg.kg) and ACP (0.05mg/kg) IM is often sufficient to calm a cat sufficiently for physical examination, ultrasound examination or blood sampling. Ketamine (5mg/kg) plus midazolam (0.25mg/kg) IM provides a heavier sedation and is generally a good way of sedating fractious cats for procedures such as radiography, ultrasound examination or blood sampling. However, this combination can occasionally lead to increased agitation and hyper-excitation, particularly in Oriental-type and Bengal cats, particularly when they are young. Some authors like to use low doses of medetomidine, however the author is not keen on this drug and the resulting vasoconstriction can then make blood sampling difficult. In very fractious cats some authors would consider squirting 2ml of ketamine into the cat's mouth (in the hope that 0.5 to 1.0ml will be swallowed). However, ketamine tastes offensive so the cat will salivate heavily. Ketamine also causes corneal ulcers so care is needed when squirting it at the cat. For very fractious cats it can be safest to chamber induce them.

Tips for Blood Sampling

 Handle the cat quietly and gently in a quite area with a limited number of people and no dogs.

 Use a handler who is good at handling cats gently and likes to work with them.

 Observe the cat's behaviour to determine the exact approach to take. Not all cats that are hissing or growling cats are likely to strike. They will often calm down with a slow gentle approach (remember not to make eye contact). These cats can usually be handled with a heavy towel. Once the cat is wrapped in the towel it will often calm down, especially if its face is also covered, either with part of the towel or, if necessary, with a cat muzzle. Always try to use the least aggressive form of restraint.

 Some cats, particularly young cats, maintain the kitten 'scruff reflex'. While the author does not like to see this used routinely, some authors do apply it, in the form of pegs or clips applied to the scruff area of the cat, and they find they can then undertake minor procedures such as blood sampling, radiography and ultrasound examination. However, this appears most likely to work successfully when the cat is calm before the clips are applied. Ref: Pozza et al. (2008) Pinch-induced behavioural inhibition ('clipnosis') in domestic cats. JFMS 10(1): 82-87.

 In a fractious cat, unless the blood sample is essential prior to sedation/anaesthesia for further procedures, then wait until then to collect the samples--it will be simpler and less stressful for all concerned.

 When preparing the skin prior to taking a blood sample always use either small cat friendly clippers (narrow blade and very quiet) or scissors. Then apply EMLA local anaesthetic cream so the skin overlying the vein is numbed (this takes 10-20 minutes).

 When collecting blood via the cephalic vein make sure not to over-extend the cat's elbow as this can be uncomfortable for them, particularly if they are older as this is a very common site for osteoarthritis. Causing pain in this manner will make the cat more fractious. The holder should back the cat against their stomach, rather than holding it under their arm--the cat will feel more secure and is less likely to struggle.

 When collecting blood via the jugular vein in a fractious cat it can be helpful to place it on its back on a thick towel on the table, then have the holder place their fore-paw-holding arm between the cat's hind-limbs, placing gentle pressure on the cat's pelvis to hold it still. http://www.fabcats.org/catfriendlypractice/.

 Collecting blood via the saphenous vein can be a particularly useful technique in fractious cats as there is generally less risk of getting bitten. The cat is held on its side with the upper hind-limb held up, and the blood sample is taken from the saphenous vein of the lower leg http://www.fabcats.org/catfriendlypractice/.

 Using butterfly needles can be helpful as they allow for more movement, and for small blood samples insulin needles/syringes can be sufficient.

References

1.  More helpful information can be found in the American Association of Feline Practitioners (AAFP) Behavior Guidelines: http://www.aafponline.org/resources/guidelines/Feline_Behavior_Guidelines.pdf