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The handler has positioned herself so that the cat is in front of them, with their body leaning over the cat’s body and their forearm tucking the cat’s hindquarters in towards them. The cat is facing away from the handler. This makes the cat feel secure and prevents it from walking backwards, without any restraint as such. Leaving the cat’s limbs unrestrained may be possible in some cats. Often gentle stroking on the top of the head or bridge of the nose can also help to keep cats relaxed during blood sampling.

The cat’s body is covered with a towel and the cat held gently so that its limbs are still relatively unrestrained, rather than being firmly wrapped in the towel.

The handler places their right arm around the hindquarters of the cat and uses their right hand to slowly take hold of its forelimbs. The forelimbs are approached from the caudal aspect of the limbs, with the thumb wrapping around the right forelimb, index finger between the limbs, and second finger wrapping around the left forelimb. The forelimbs are held midway along the radius and ulna, as too close towards the paws will irritate the cat. The cat’s feet should be allowed to rest on the table, as this will give the cat a greater feeling of security than placing its feet over the table edge. The handler’s left hand is used to hold the cat’s head by placing the index, middle and ring fingers under the cat’s mandible and the thumb behind the cat’s skull.

The handler’s body and right shoulder are rotated slightly over the top of the cat’s body, whilst using the right elbow to tuck in the cat’s hindquarters towards the handler’s body. This should be close and in line with the cat’s back, but no pressure should be put on the back. The cat’s head is elevated slightly to allow access for the blood sampler. When the blood sample is about to be taken, the middle and ring fingers may need to be lifted slightly to allow the blood sampler better visualization of the vein. It may also be necessary to increase the grip around the mandible with the index finger, to ensure better control of the head.

Lifting the cat up and towards the body; the cat should rest on the forearm.

The cat is turned over slowly and smoothly, letting go of its head so that the cat then moves on to the handler’s left forearm. They should still be holding the cat’s forelimbs with the right hand.

The cat is placed gently on to the blanket, wrapping the right arm around its hindquarters whilst still holding the forelimbs with the right hand.

The left arm is slid out from the back of the cat’s head, and the head taken hold of again by placing the thumb across the mandible and the fingers around the top of the cat’s head. The blood sampler may prefer the handler to continue to hold the cat’s head whilst they raise the vein and take the sample.

Alternatively, the blood sampler may wish to take hold of the cat’s head themselves, allowing the handler to raise the jugular vein with their left hand.

The handler takes hold of the cat’s head from above the skull with the left hand. The thumb and index finger can grip around the cat’s zygomatic arches and then tilt the head slightly upwards. This restraining technique will not feel as controlled as the others described, but it will allow the cat to breathe effectively, making it less stressful for it and thereby facilitating blood sampling by increasing the likelihood of staying still.

The handler wraps their right arm around the cat’s hindquarters and extends the cat’s right forelimb by placing fingers behind the cat’s elbow and the thumb over the dorsal aspect of the cat’s radius. The left hand should hold the cat’s head by holding its mandible with the index finger and placing the thumb behind the head. Ideally the cat’s left forelimb should be placed on the table unrestrained.

If there is risk of injury due to not restraining the left forelimb, this can be held by the little finger on the right hand, hooking the left forelimb underneath the right forelimb.

The cat can be held as for cephalic catheterization (above), but more relaxed restraint can be used and the cat’s forelimb does not need to be extended as far forward. Some cats prefer their forelimb to be left down on the table and unrestrained; this method should be tried if they react to their forelimb being held off the table. The cat’s head also does not need to be restrained; the cat can be prevented from moving forward by gently supporting its chest.

The handler’s hands can be placed gently over the cat’s shoulders and hindquarters to prevent sudden jumping or movement, though even less restraint may be needed in very relaxed cats. Placing the cat on a comfortable bed always encourages it to settle more than when placed on a bare table.

The cat should be turned with the cat standing across the body of handler 1, who should take hold of the forelimbs with one hand and place their other hand under the cat’s chin for support and safety. Handler 2 should take hold of the hindlimbs.

The cat is gently turned over into lateral recumbency. If tolerated, handler 1 can adjust the restraint of the legs by holding them separately and allowing the cat to rest its head on their arm. Both handlers should always hold the cat’s legs midway along the limbs, as cats are often very sensitive to having their paws touched.

If the cat is less cooperative or there is a risk of injury to the handler, the forelimbs can be held in one hand whilst the other hand is gently placed across the cat’s neck and fingers under the mandible.

When less restraint is required, cats will often be more relaxed if they are able to have some free head movement, as this allows them to feel more in control and therefore more relaxed. It is possible to restrain a relaxed cat effectively with a single handler. However, it is preferable to have two handlers to allow gentle restraint whilst also being able to provide comfort by gently stroking the top of the cat’s head and bridge of the nose; stroking in this way will often even result in cats going to sleep during ultrasonography.

Handler 1 can hold the forelimbs in one hand leaving the other hand to restrain the head as necessary. Handler 2 should hold the hindlimbs separately, ensuring that the uppermost hindlimb is either flexed or extended slightly caudally to allow good visualization of the medial aspect of the lower hindlimb. To extend the leg and raise the medial saphenous vein, handler 2 must hold the lower hindlimb above the stifle and take a careful but firm grip around the femur. An alternative is for a single handler to allow the cranial part of the cat to remain in sternal recumbency (see Figure 1.17), whilst the person placing the catheter extends and holds the hindlimb.

The cat should be lying across the handler’s body so that they can use their body to support the cat and aid restraint. One hand should be placed across the shoulders of the cat whilst using the fingers to gently slide and keep the forelimb forward. The other hand should be used to support the hindlimbs and to keep the cat close to the handler’s body. It may be useful for the handler to lean over the cat slightly for further restraint so that it does not jump as the needle is inserted.

Performing cystocentesis (see QRG 4.11.4). The handler uses her hands across the shoulders and around the hindquarters to keep the cat’s body close to her. Very little pressure is put on the cat but having the handler’s hands in this position does help to prevent the cat from jumping as the needle enters the abdominal cavity. If needed, the handler’s left hand can also be used to hold the cat’s left hindlimb caudally if access to the bladder is not easy.

Performing cursory thoracic ultrasonography on a cat with respiratory difficulties, looking for signs such as the presence of pleural fluid. Here the handler uses her hands across the cat’s shoulders and around its hindquarters to gently keep the cat’s body close to her. Very little pressure is put on the cat, so that stress and further respiratory compromise are avoided.

Clockwise from left: direct ophthalmoscope; Finhoff transilluminator; condensing lens; forceps.

Disposables for ophthalmic examination.

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A large round white lens occupies the majority of the anterior chamber, due to a cataractous anterior lens luxation. A bright green crescent of tapetal reflection is present within the visible pupil above the ventrally positioned luxated lens; this aphakic crescent is pathognomonic for lens luxation.

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Technique used to lift the lips; here gingivitis with calculus accumulation is present.

Canine malocclusion: the upper canine is too rostral; the lower canine is therefore occluding more lateral and distal than its normal position, resulting in the cusp catching the upper lip and causing ulceration.

Soft tissue trauma to the gingival tissue of the mandible has resulted from a premolar malocclusion (common in British Shorthairs); the cusps of the maxillary premolars have caused ulceration of the mucosa. Note also the fractured upper left canine tooth.

Swelling of the buccal mucosa resulting from contact of the maxillary fourth premolar on a non-healing extraction site.

Calculus accumulation and gingivitis affecting the maxillary premolars.

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Inflamed lateral glossopalatine folds and caudal mucosa. Pus accumulation can be seen between the mandibular molars and buccal mucosa.

From left to right: infant, paediatric, Master Classic II, 3M electronic stethoscope.

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S1 (‘lub’): first heart sound: occurs at the start of systole; associated with closure of the atrioventricular (mitral and tricuspid) valves.S2 (‘dub’): second heart sound: occurs at the end of systole; corresponds to closure of semilunar (aortic and pulmonic) valves but is due to vibrations produced by opening of the AV valves, early muscular relaxation and acceleration of blood in the great vessels.

S3 (‘dub’): third, but abnormal, heart sound: heard as a gallop sound immediately following S2 (dub), i.e. lub (S1)-pause-dub (S2) dub (S3). Sound is caused by early diastolic filling and cannot be heard in normal cats. An audible S3 implies poor compliance (as in restrictive cardiomopathy), mitral regurgitation or an accelerated filling velocity (as seen with high atrial pressures).

S4 (‘le’): fourth, but abnormal, heart sound: produced by atrial systole. It is heard if the atrium contracts against a distended or non-compliant ventricle (as in volume overload). Therefore, it is audible as a gallop sound occurring immediately before the first heart sound (i.e. lelub-pause-dub). In addition, cats may present with combination gallops, in which both S3 and S4 can be heard.

The majority of murmurs auscultated in cats are systolic (‘lub-shush-dub’); they may be dynamic (present only at higher heart rates) or static. Generally the ‘shape’ of the murmur cannot be described, as the cat’s heart rate is too high.

Diastolic and continuous murmurs are rare and typically represent severe and/or congenital disease. The most common cause of an early diastolic murmur is aortic regurgitation. Continuous murmurs are typically associated with congenital diseases such as patent ductus arteriosus.

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The withdrawal reflex is best performed with the cat in dorsal recumbency between the thighs of the examiner.

Testing the patellar reflex using the handles of artery forceps to tap the patellar ligament. As with the withdrawal reflex, it is best performed with the cat in dorsal recumbency between the thighs of the examiner. This position allows the stifle to be slightly flexed, and the two sides to be compared.

Evaluation of extensor tone in the pelvic limb. The ability to support weight on the tested limb is determined while the contralateral limb is lifted off the ground.

The menace response is elicited by making a threatening gesture towards the eye of the cat with one hand while blindfolding the contralateral eye.

Each eye can be tested separately by covering the eye contralateral to the one being tested. This response requires intact visual pathways, mentation and postural control of the thoracic limbs.

The palpebral reflex is elicited by touching the medial canthus of the eye and observing a reflex closure of the eyelids. The afferent arm of the reflex is mediated by the trigeminal nerve (CN V sensory) while the efferent arm is mediated by the facial nerve (CN VII motor).

Response to stimulation of the nasal mucosa; the cat’s eyes should be masked, as described above.

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(Courtesy of The Feline Centre, Langford Veterinary Services, University of Bristol)

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