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Manual Restraint of the Avian Patient

RESTRAINT

Restraint is defined as a restriction of an animal's activity by verbal, physical, or pharmacological means so that the animal is prevented from injuring itself or others. Pharmacologic restraint is applied through sedation and/or anesthesia and is covered in Chapter 24.

Note: Restraining a bird forcibly is stressful for the bird and potentially dangerous to both the bird and the handler. Most domestically raised pet birds can be safely restrained by trained personnel with gentle handling and minimal manipulation. During all restraint, care must be taken not to restrict breathing - no pressure should be on or around the body itself, which prevents the movement of the sternum. Birds breathe essentially like a bellows system and must be able to move the body walls.

Pharmacologic agents are recommended to assist in proper restraint for (see Chapter 24)

• Procedures that are painful.
• Procedures requiring the holding of an animal in a position that may compromise respiration or where prolonged complete immobility is needed (such as for radiographs).
• With extremely frightened, aggressive, or if pain is already present.

Purposes of Restraint

1. To facilitate the physical examination, including oral and ophthalmic examination.
2. To administer medications: oral, injectable, and topical.
3. To apply bandages or splinting.
4. To perform certain procedures such as oral gavage, culturing of orifices, recording of blood pressure, electrocardiograph, and ultrasonography.
5. To prevent self-mutilation, such as placement of a collar.

Complications

• Stress.
• Overheating (hyperthermia).
• Dyspnea.
• Tissue trauma including muscle strain and feather damage.

Equipment Needed

• Various sizes of towels. It is recommended to avoid red-colored towels - some birds are stressed by the color.
• Various sizes of restraint straps:
• Various types and sizes of collars, including padding materials and fasteners
• Sedation/anesthesia (see Chapter 24)

Procedure

Removing the bird from a cage or carrier

Purpose

In order for a bird to be physically examined, it must be removed from the cage or carrier. It is preferable for the bird to come out on its own; however, many frightened or ill birds will not.

Technical Action

1. Most birds will come out of a cage on their own, either on a perch (stick) or to a hand. Small passerines are usually flighted, and so are usually caught within their cage or carrier.
2. Only reach into a cage to catch a bird if it will not come on its own.
3. Move slowly. Have an appropriately sized towel that is slowly introduced into the cage.
4. Allow the bird to watch and talk softly to it.
5. Depending on the size of the bird or if the bird latches onto the cage bars, you may slowly place the towel over the bird (on the side of the cage or the bottom of the cage).
6. Find the bird's head and gently use your thumb and fingers to restrain the mandible, and while moving the towel around the body, use your other hand to help secure the feet and shoulders.
7. Gently lift the bird out of the cage and reposition the towel. It is preferable to have the bird's head exposed.
8. Take care not to inhibit movement of the body wall.

Rationale/Amplification

• Towel color may have associations for particular birds. You may want to talk to the owner about previous interactions with the veterinarian or other experiences if it involved particular colors, movements, and sounds.
• Assoc with #4: Birds that are not used to being handled may be frightened by someone entering their cage. Dimming the lights in the exam room may help calm them. If a bird frantically starts trying to fly around the cage, back out and allow the bird to calm down. Go more slowly the next time entering the cage, and then you may need to move very swiftly to drop the towel and grasp the mandible.
• Assoc with #5: if the bird goes to the bottom of the cage or into a cage corner, the towel can be slowly dropped over the bird, and then you can manually find the mandible for restraint.
• If the bird is clenched to the bars and side of a cage, you may need to slowly lift the toes and get them under control with your other hand. To get the bird to let go of the cage, sometimes a few drops of sugar water dribbled on the rhinotheca so they enter the mouth will get the bird to release as it tastes the water.
• Assoc with #8: Restraining the head and the feet; allowing the body free movement takes practice with many types of pet birds. Usually the shoulders of the bird are also restrained by the hand holding the mandible.

Procedure

Using a towel to manually restrain a bird

Purpose: Manually restrain a bird by grasping the mandible through the towel, cupping the shoulders with that hand. The towel can lightly wrap around the bird, preventing flapping and grabbing with the feet - the bird could potentially injure itself or the handler. Small birds can be restrained with one hand.

Technical Action

1. The bird is out of the carrier or cage.
2. Approach the bird slowly, talking to it.
3. If you are right-handed, you will want to restrain the bird's mandible and head with your left; if you are left-handed, you will use your right hand.
4. With the towel in the left hand, slowly surround the bird with your hand and a towel, and then slowly with the toweled hand, secure the bird's head and mandible from behind, while bringing the rest of the towel across its body with your right hand.
5. Once the towel is draped around, you can lift the bird off the perch or surface.
6. Secure the feet - let them grasp the towel or your jacket/scrub top. Very small birds like budgies can have their feet clasped between your fourth and fifth fingers.
7. The bird is frequently held at an angle with the feet against your body, and the head is elevated to an easy visual position for the examination.

Rationale/Amplification

• Following Dr. Brian Speer's approach as you drape the towel, often the wording is "Mr. Towel is going to greet you, and wants to hold you" . etc. Talking softly to the bird often calms it as they usually know their name. Do not show fear - be gentle, but not hesitant.
• #5,6,7: Depending on the size of the bird and the type of examination or medication administration or other procedures, you can reposition the towel as needed and adjust the angle you are holding the bird. Be sure the bird does not overheat in the towel. If the bird struggles and vocalizes, you may need to consider the addition of some sedation to decrease the stress.

Procedure

Using a restraint strap

Various sizes of restraint straps

Purpose

With a bird in a towel restraint, the use of the strap allows the bird lay in the towel and strap, usually chewing on the towel, and frees the hands of the clinician to do the examination or procedures. Birds are usually calmer in this restraint than just manually in a towel, struggle less, and in the author's experience, are less likely to overheat. Restraint straps are usually unnecessary with small passerines such as canaries and finches. Larger passerines such as starlings and crows can be restrained, similarly to a psittacine.

The original design of the strap was done by Dr. Robert Shelley, Washington State University Class of 1980. Both authors worked with him. The straps are in four sizes made from stitched vinyl with three straps made of hook and latch fastening material. They can be washed and disinfected.

Technical Action

1. Lay the appropriately sized restraint strap on the exam table, with all straps laid out.
2. With the bird wrapped in the towel, lay the bird down on the restraint strap, positioning it so that the first horizontal straps will go approximately across the shoulders. Bring the two sides of the straps across the bird and secure them. It should be snug, but because of the towel, it is not constricting.
   
   
3. The middle straps are then brought across the body and secured.
4. The bottom straps are then brought across - these usually are just cranial to the bird's feet, and often the feet are within the towel.
   
   
5. To examine different parts of the bird's body, the straps in the area are opened and the towel sections lifted.
   
6. Some birds may wiggle down and must continue to have an assistant secure their mandible from behind the head (cradle the head in the hand).
7. Straps often need to be adjusted.
8. When finished, manually secure the bird's head and usually continue to hold the bird in the towel while each set of straps is being released. The bird then is just in manual restraint with the towel for placement back in the cage, carrier, or onto a perch.

Rationale/Amplification

• 2: many birds are not used to being...