Cat Friendly Guidelines_CFVE_ASt2.

qxp_FAB 29/09/2022 18:18 Page 1133

Journal of Feline Medicine and Surgery (2022) 24, 1133–1163

PRACTICE GUIDELINES

2022 ISFM/AAFP Cat Friendly

Veterinary Environment
Guidelines

Practical relevance: The ‘2022 ISFM/AAFP Cat Friendly Veterinary Environment Guidelines’
(hereafter the ‘Cat Friendly Veterinary Environment Guidelines’) describe how the veterinary clinic Samantha Taylor
BVetMed(Hons), CertSAM,
environment can be manipulated to minimise feline patient distress. Many components of a DipECVIM-CA, MANZCVS,
veterinary clinic visit or stay may result in negative experiences for cats. However, much can be FRCVS*
done to improve a cat’s experience by making the veterinary clinic more cat friendly. Exposure to Co-Chair
International Society
other cats and other species can be reduced, and adjustments made with consideration of the feline of Feline Medicine,
senses and species-specific behaviour. Caregivers can prepare cats for a clinic visit with appropriate advice. International Cat Care,
Tisbury, Wiltshire, UK
Waiting rooms, examination rooms, hospital wards and other clinic areas can be designed and altered
to reduce stress and hence encourage positive emotions. Changes need not be structural or expensive Kelly St Denis
MSc, DVM, DABVP (Feline)*
in order to be effective and make a difference to the cats and, in turn, to cat caregivers and the veterinary Co-Chair
team. Moreover, by improving the all-round experience at the veterinary clinic, there are positive effects St Denis Veterinary
on preventive healthcare, identification of and recovery from illness, and compliance with treatment. Professional Corporation,
Powassan, Ontario, Canada
Clinical challenges: Good feline healthcare necessitates visiting the veterinary clinic, which, simply
Sarah Collins
by being outside of a cat’s territory and familiar surroundings, may lead to negative experiences. Such
DipAVN(Medical), RVN,
experiences can trigger negative (protective) emotions and associated physiological stress, which can VTS (ECC), Cert CFVHNut,
result in misleading clinical findings, patient distress, prolonged recovery from illness, further difficulties ISFM DipFN
International Society
with handling at subsequent visits and potential veterinary personnel injury. There may be a mistaken belief of Feline Medicine,
that veterinary clinics must undergo significant renovation or building work to become cat friendly, and that, International Cat Care,
if species cannot be separated, then clinics cannot improve their care of cats. These Guidelines aim to Tisbury, Wiltshire, UK
dispel any such misconceptions and provide detailed practical advice. Nathalie Dowgray
BVSc, MANZCVS, PgDip,
Evidence base: These Guidelines have been created by a Task Force of experts convened by the
MRCVS, PhD
International Society of Feline Medicine and American Association of Feline Practitioners, based on International Society
an extensive literature review and, where evidence is lacking, the authors’ experience. of Feline Medicine,
International Cat Care,
Endorsements: These Guidelines have been endorsed by a number of groups and organisations, Tisbury, Wiltshire, UK
as detailed on page 1161 and at icatcare.org/cat-friendly-guidelines and catvets.com/environment.
Sarah LH Ellis
BSc (Hons), PGDip, PhD
Keywords: Cat Friendly Clinic; Cat Friendly Practice; waiting room; examination room; hospital wards; International Cat Care,
cat friendly equipment; treatment room; ICU Tisbury, Wiltshire, UK
Sarah Heath
BVSc, PgCertVE,
Introduction provoke.1 By promoting positive and minimis- DipECAWBM(BM), CCAB,
FHEA, FRCVS
ing negative experiences in the veterinary clinic, Behavioural Referrals
The iSFM Cat Friendly Clinic (catfriendlyclinic. we can enhance feline wellbeing,2 improve team Veterinary Practice,
org) and AAFP Cat Friendly Practice safety3,4 and positively engage cat caregivers. Chester, UK
(catvets.com/cfp) programmes celebrate their Each area of the clinic, and the home and trans- Ilona Rodan
10-year anniversary in 2022 and have made a port environment prior to the visit, can be con- DVM, DABVP (Feline)
Cat Behavior Solutions,
positive contribution to feline health and well- sidered with the cat in mind, to optimise both Cat Care Clinic, Madison,
being during this time. Being ‘cat friendly’ the cat’s physical health and mental wellbeing. WI, USA
means considering the cat’s experience of their These Guidelines aim to provide all veteri- Linda Ryan
environment in the veterinary clinic and during nary teams with practical information on how, VTS (Behaviour, Oncology),
DipAVN, KPA-CTP,
the veterinary team’s interactions with the cat. and why, the veterinary clinic environment RVN, CCAB
These Guidelines have been written to provide can be altered, often inexpensively, to become Inspiring Pet Teaching,
a practical guide to adjusting the clinic environ- cat friendly. Fordingbridge, Hampshire,
UK
ment and equipment to improve the experience
*Corresponding authors:
of feline patients. To do this we need to [email protected]
understand how cats perceive and interact with proclawveterinarians@
their environment and the emotions this can gmail.com

doi: 10.1177/1098612X221128763
© iSFM and AAFP 2022 JFMS CLINICAL PRACTICE 1133
Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:18 Page 1134

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

CONTENTS page Cat Friendly Guidelines

< Introduction 1133 The ‘2022 ISFM/AAFP Cat Friendly Veterinary Environment Guidelines’
< Feline behavioural needs 1134 are published together with the ‘2022 AAFP/ISFM Cat Friendly Veterinary
– Sensory system 1136 Interaction Guidelines: Approach and Handling Techniques’ in this special
– Emotions 1136 issue of JFMS dedicated to optimising the veterinary visit for cats.
< Fundamentals of a cat friendly Cats’ emotional health and wellbeing is intricately related to both the
environment 1138 environment they find themselves in and the interactions they experience.
– Cat friendly physical environment 1138 As such, the two Cat Friendly Guidelines go hand in hand, and are intended
– Additional fundamental principles to be read closely in conjunction with one another.
to consider 1138 A number of important principles underpin the cat friendly approach,
< Preparation to reduce stress prior and these are described in an additional article in this special issue:
to the clinic visit 1140 ‘ISFM’s Cat Friendly Principles for Veterinary Professionals’.
< Pre-consultation period and
waiting area 1142 All three articles, and related content, are available at:
< The cat friendly examination room 1145 bit.ly/JFMSCatFriendly
– Cat-only 1145
– Minimise movement 1145 Further information:
– Optimise for cats’ sense of smell 1146 < ISFM Cat Friendly Clinic
– Other considerations 1147 programme: catfriendlyclinic.org
< Creating a cat friendly ward 1149 < AAFP Cat Friendly Practice®
– Noise in the ward 1149 Program: catvets.com/cfp
– Cage positioning 1150
– Cage size and construction 1150
– Furnishing the cage 1152
– Beds and bedding 1153
– Provision of food and water 1153
Feline behavioural needs
– Litter boxes/trays 1154
– Cleaning of cages 1155
The domestic cat is unique as the only solitary
< Other clinic areas 1155 hunter able to live amicably with humans.5
– Preparation/treatment rooms 1155 Many of the self-protective behaviours of their
– Induction of anaesthesia and recovery 1155 ancestor, Felis silvestris lybica, are retained in
– Theatre/operating room 1156 domestic cats including predatory behaviours,
– Imaging areas (radiography, territoriality and avoidance of threats. one
ultrasound, advanced imaging) 1156 exception exists; where Felis silvestris lybica is
– Isolation and intensive care areas 1156 solitary by nature, the domestic cat is a social-
< Cat friendly equipment 1157 ly flexible species, with individuals displaying
– Needle gauges 1157 varying degrees of sociability, both to other
– Clippers 1157 cats and to other species, including humans.5
– Topical local anaesthetic cream/gel 1158 in free-ranging domestic cats with no care-
– Blood pressure machines 1158 giver, social grouping is dependent on
– Weighing scales 1158 predictable availability of resources such as
– Towels and blankets 1159 shelter and food, as well as on relatedness,
– Hiding places within cat cages 1159 particularly down the maternal line. How-
– Non-slip surfaces 1159 ever, in companion cats contact between cats
– Fluid pumps and syringe drivers 1159 is caregiver-determined. The ability to live
– Synthetic feline pheromones 1159 without distress alongside other cats and peo-
– Elizabethan collars and other ple in a home setting is dependent not only on
protective items 1159 availability of resources, but also genetic pre-
– Other useful items 1160 dispositions to sociability to people and cats,
< Equipment not recommended for and on relevant early, and ongoing, positive
a cat friendly environment 1160 social exposure.6,7 For behaviour towards
< Conclusions 1160 people, a sensitive period between approxi-
< Summary points 1160 mately 2 and 9 weeks has been identified as
< Supplementary material 1161 the time when cats are most receptive to learn-
< Endorsements 1161 ing about people.8–10 despite this social
< References 1161 flexibility towards cats and people, the legacy
of being a solitary survivor is retained, and
domestic cats naturally prefer to rely only
Each cat needs a sense of control and the ability on themselves for protection. Perceived
to find comfort and, if possible, pleasure in the safety comes from a behavioural need for
familiarity, control, predictability and
environment, even at the veterinary clinic. avoidance/displacement of all possible threats.

1134 JFMS CLINICAL PRACTICE

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:19 Page 1135

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

SYNONYMOUS TERMS DEFINITIONS

Many of the words used in the veterinary industry have the same meaning. These Guidelines Definitions for key terms used
are written in British English and use terms that are common in this language. The following in the Cat Friendly Guidelines
are synonymous terms that may be used and/or be more familiar in other countries. are included on page 1095
of the ‘2022 AAFP/ISFM Cat
< Clinic/practice/hospital < Cat carrier/basket Friendly Veterinary Interaction
< Appointment/examination/consultation < Loaner/for hire Guidelines: Approach and
< Examination room/exam room/consulting < Litter box/tray Handling Techniques’ (hereafter
room/consult room < Hospitalisation ward/kennel room the ‘Cat Friendly Veterinary
< Treatment area/‘the back’/preparation < Clinical examination/physical Interaction Guidelines’).11
area/prep area/‘out back’ examination
< Cages/kennels/condos < Operating room/theatre

Much of cats’ characteristic behaviour conveys protection strategies in the face of threats,
this. For example: including running away, getting up high and
< Regular assessment of their environment, hiding. in an unfamiliar environment or
including hypervigilance in novel or challenging situation, the preferred coping strategy for most
environments, such as a veterinary clinic.2 cats is to escape. When this option is unavailable,
< Regular chemical marking of the environ- as in the veterinary clinic, they attempt to hide or
ment to enhance familiarity. For secure to perch to increase perceived safety, choice and
individuals within homes, such marking sense of control. Hiding is critical to the cat’s
usually includes facial rubbing and scratching. coping ability to reduce distress.13–16
More confident and bold cats will facial rub < Perching, to enable cats to monitor the
in examination rooms and hospital cages. environment from above to detect perceived
outdoors, urine spraying may be witnessed. threats, such as approaching people and
in individuals feeling insecure within the indoor animals. Confident cats are more likely to perch
environment, urine spraying and increased on a flat surface, while more timid cats prefer
scratching may occur, and facial rubbing may some concealment, even when perched.17,18
be used to boost the cat’s perceived security.12 < Engaging in territorial behaviours such as
< Employing distance-increasing and self- chemical marking, and regular patrols and

The impact
of the
environment
on each of the
feline senses
should be
considered
when
developing
spaces in which
to interact with
and to
hospitalise cats.

Figure 1 A cat’s perception of their world. Cats have keen senses, which are used to identify threats as well as prey. Cats and
humans perceive the world differently, and these differences should be considered in a cat friendly veterinary environment.20–22
Image courtesy of International Cat Care

JFMS CLINICAL PRACTICE 1135

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:19 Page 1136

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

PERCEIVE
Utilising senses, perceive situation in the clinic
(eg, dog in proximity to carrier, strong chemical smells, loud noises)

Veterinary team reassess based COMPARE

on any new developments: current observations with previous experiences
triggers eliminated, POSITIVE – no threat perceived,
triggers minimised, and engagement and interaction warranted
positive reinforcements offered, etc NEGATIVE – potential or actual threat
perceived, leading to self-protective
emotional response

ENGAGING BEHAVIOURAL RESPONSES

POSITIVE (ENGAGING)
(eg, taking treats, exploring,
EMOTIONS
playing, human/social interactions)

PROTECTIVE BEHAVIOURAL RESPONSES NEGATIVE (PROTECTIVE)

(eg, inhibition, appeasement, avoidance, repulsion, EMOTIONS
non-repelling confrontational responses)

Figure 2 Experiences
at the veterinary clinic are
surveillance to aid avoidance of close contact with compared with previous Emotions
experiences, triggering a
unknown or known, but disliked, individuals. behavioural response that
Cats are thinking and feeling animals, and
< Consuming food within the safety of the can be engaging or their behaviour reflects the situations they
protective.26,28 Veterinary
territory. Even if a meal involves prey or team members have the
experience and the cognitive capabilities and
scavenged food from outside of the territory, opportunity to initially emotional motivations they possess. Cognitive
it will often be brought back to the safety of the assess and subsequently
reassess any new
and emotional health (together, termed mental
central area of the territory (core territory) to developments in the cat’s wellbeing) are therefore equally important to
be consumed.19 emotions and behaviours in physical health and should be addressed in
response to changes they
< Sleeping and resting within the core territory, have implemented. Diagram each feline patient.2 The physical and social
where perceived safety is highest. Secluded designed by Ilona Rodan; environment of the home and clinic must meet
image courtesy of Kelly St
locations within this area are often used. Denis the cat’s needs in order to optimise cognitive,
< Toileting on the periphery of the territory in emotional and physical health.2 Cats have
soft rakeable substrates where burying of faeces long-term memory,23–25 and learn from both
is optimal. Such behaviour is thought to help positive and negative experiences. in some
maintain territory cleanliness, minimise parasite cases, learning from a single experience can
burden and spread of disease, and prevent Many of the influence future behaviour substantially.
chemical detection by possible predators. self-protective What the cat sees, hears and smells at the
Together, these behaviours serve to prevent veterinary clinic will be compared with, and
conflict, and potential injury and illness that behaviours of processed based on, previous experiences
could impact the cat’s survival, and they need (Figure 2).26–28 This creates an emotionally
to be taken into account when considering the
their ancestor, motivated response to their situation which,
veterinary environment. Felis silvestris in turn, triggers a behavioural response of
either engaging with the environment or
Sensory system lybica, are displaying self-protective behaviour. Fear–
The cat’s keen senses primarily function to anxiety, pain and frustration may all con-
detect prey and possible threats, continually
retained in tribute to a protective emotional response.28
monitoring the potential for an environment domestic cats, When short-lived, these protective emotions
to be either beneficial or detrimental to their are adaptive and lead to physiological and
survival. Promoting positive and minimising including behavioural responses that allow the cat to
negative stimuli within the veterinary clinic predatory keep themselves safe. However, when
environment will help to increase the cat’s experienced over long periods of time, or
perception of it as being a beneficial rather behaviours, frequently, these emotional motivations can
than a threatening environment (Figure 1).20–22 become maladaptive and lead to distress
As the cat’s senses differ from those of territoriality and potential suffering. The environment
humans, they perceive the world differently. and avoidance should always be assessed for triggers that
The impact of the veterinary environment on threaten the cat’s safety and, where removal
each of the feline senses should be considered of threats. is not possible, these triggers should be
when developing spaces in which to interact minimised and counteracted with positive
with and to hospitalise cats. experiences.

1136 JFMS CLINICAL PRACTICE

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:19 Page 1137

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

The five pillars of a healthy feline environment

Five pillars
in the veterinary clinic

Pillar Pillar Pillar Pillar Pillar

1 2 3 4 5

Provide a Provide Provide Provide Provide an

safe place multiple and opportunity positive, environment
separated for play and consistent that respects
key predatory and the cat’s
environmental behaviour predictable sense of
resources human–cat smell and
social other senses
interaction

Figure 3 The five pillars illustrate the essential needs of cats in any environment, including the veterinary clinic. Utilising these pillars as a guide,
the clinic environment can be optimised to meet these needs during all facets of veterinary care. Modified, with permission, from Ellis et al1

PILLAR 1 PILLAR 3
Providing a safe place for cats to hide increases their coping Object play and predatory behaviour are very important
ability.13–16 Safe spaces should be created in all areas of the clinic, for cats and can be triggered by a positive emotional
including waiting areas, examination rooms, and hospitalisation and state. Cues for these desire-seeking motivated
boarding areas. The goal is to increase the sensation of safety for behaviours, such as toys, food and treats, can therefore
the cat, and safe spaces can also function as resting areas. When increase positive emotional bias during the physical
providing hiding and resting areas, also consider vertical space. examination, diagnostic tests and hospitalisation. This is
This can enable the clinic to expand the overall size and complexity particularly important for cats boarding or hospitalised for
of the environment and increase the cat’s ability to perform their more than a short period.
normal behaviours of jumping, climbing and monitoring the
environment from above. PILLAR 4
The ‘Cat Friendly Veterinary Interaction Guidelines’11
PILLAR 2 address positive, consistent and predictable human–cat
Cats housed in the veterinary clinic, especially for more than interactions.
a short period, require all their essential needs to be met;
food, water, resting areas, perches, scratching areas, litter PILLAR 5
boxes/trays and play opportunities (if appropriate) should be The veterinary environment should respect the feline
provided. Resources should be appropriately distributed within the senses, including smell, sight and hearing, as information
available space so that the cat’s preference to use resources gathered during the clinic experience can influence a cat’s
separately is respected. emotional health.

JFMS CLINICAL PRACTICE 1137

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:19 Page 1138

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

in certain situations, the cat’s emotional Environmental adaptations that are neces-
response to unavoidable triggers can be modi- sary to enhance feline physical health and
fied using anxiolytic therapy, and the cat’s mental wellbeing during the veterinary visit
ability to identify and respond to triggers can are described on page 1137 according to the
be altered using sedation.29,30 it is essential that five pillars framework.
use of either of these approaches is based on
an accurate assessment of the situation and Additional fundamental principles
a diagnosis of the emotional motivations to consider
involved. Sedation alone will not alter a cat’s < Scents and chemical signals Where
perception of the environment and interac- possible, use cat-only examination rooms and
tions they are experiencing, but may be neces- thoroughly clean away the smells of other
sary in some clinical contexts to limit the patients in preparation for the next appointment.
potential damage that could be done by expos- Remember that cats can leave feline-specific
ing the cat to unavoidable triggers. This will olfactory cues, such as alarm pheromones,
help to prevent emotional arousal that might Cats’ perceived which can be distressing for other cats.2 if
alter emotional responses at future visits. safety comes multispecies rooms must be used, pay particular
Pleasurable experiences are desirable to the attention to removal of potentially challenging
cat, and the emotional motivation system from a scents from other species, particularly those
known as the desire-seeking system drives the considered as potential predators. For example,
cat to seek out positive experiences such as
behavioural dog hair should be swept up and bins emptied
food, warmth (or coolness) and companion- need for if they contain strong-smelling waste such as
ship (in certain circumstances, with specific faeces, urine or anal gland secretions. Synthetic
individuals). Promotion of positive (engag- familiarity, feline pheromones in diffusers or sprays can
ing) emotions is as important as the removal control, help to create a more reassuring pheromone
of triggers for negative (protective) emotions, environment from a feline perspective.32–34
as both measures may improve the cat’s predictability, Avoid chemical smells, perfumes and other
response to what they are experiencing, rescu- strong scents that may be overwhelming to the
ing a potentially problematic situation. and avoidance/ cat. Use unscented or minimally scented
displacement cleaning products and replace rubbing alcohol
Fundamentals of a cat friendly with dilute chlorhexidine solution, when
environment of all possible possible, such as for venepuncture and
intravenous (iV) catheterisation. Familiar
Cat friendly physical environment threats, and positive smells are also important. Educate
The cat’s veterinary clinic experience has much of their caregivers to enhance the cat’s sense of control
many components, including their journey to and security by bringing (unwashed) bedding
the clinic, their interactions with team mem- characteristic and favoured treats from home where
bers, the social environment (eg, other animals appropriate. if the cat is to be hospitalised,
in waiting and hospitalisation areas) and the
behaviour provision of their familiar diet and litter can also
physical environment. Providing an environ- conveys this. be beneficial.
ment that minimises negative emotions, such < Sounds in both animal shelter and
as fear–anxiety, and promotes behaviours that veterinary clinic settings, cats have been found
cats find rewarding or comforting enhances to demonstrate more fear behaviours when the
feline wellbeing.31 For example, normal environment is noisy when compared with a
species-specific behaviours, such as hiding in quiet environment.35,36 Consideration of noise
an unfamiliar situation, scratching or finding levels is thus relevant to the veterinary
tasty food treats, can help minimise negative experience, as cats find sounds that we accept
emotions and/or promote positive emotions. as normal challenging. Therefore, a quiet
Each cat needs a sense of control and the abili- physical environment with sound barriers
ty to find comfort and, if possible, pleasure in in walls and ceiling tiles can be beneficial,
the environment, even at the veterinary and cats should be kept away from noisy
clinic.31 The ‘AAFP and iSFM Feline Environ- equipment, such as centrifuges and washing
mental Needs Guidelines’ describe the essen- machines. Likewise, cat carriers should be
tial needs for cats in any environment in terms taken apart, and cage doors opened and closed,
of five pillars (Figure 3).1 The fifth pillar, for quietly. The social environment throughout the
example, refers specifically to the cat’s senses, clinic should also be as quiet as possible. Team
including the sense of smell, which must be members should use soft voices at all times and
addressed in the clinic context where sensory cats should be kept away from barking dogs
input can be challenging. Sensory stimuli can and other vocal patients. if a cat housed in the
trigger an emotional state, either positive or clinic is vocal, move them to a different area
negative, leading to a behavioural response. to prevent negative arousal of other cats; for
Ensuring that these stimuli are positive is example, house the cat in a covered collapsible
important to enhance the cat’s wellbeing. cage in an examination room.

1138 JFMS CLINICAL PRACTICE

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:19 Page 1139

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

< Sights Visual threats, such as may be perceived as threatening,

seeing unfamiliar or disliked and even the motion of ceiling or
animals, can lead to increased room fans can negatively arouse
levels of fear–anxiety and/or a cat. Reducing visual stimulation
frustration. Even pictures of to a minimum is beneficial; if it is
animals can be perceived as not possible to keep all necessary
threatening,37 and so images equipment within the exam-
(including silhouettes) of cats and ination room, it is important to be
other animals should be avoided. prepared and bring whatever is
interactions with people can also needed into the room in advance,
lead to a perception of threat to avoid movement in and out
and it can help if veterinary team of the room. Use of visual cues
members come down to the cat’s Figure 4 Food treats can for positive emotion, such as
be used to induce positive
level, while approaching from the side and emotions and thereby
interactive (wand) toys, can be considered but
avoiding making direct eye contact, rather than cue wanted behavioural can cause high levels of arousal for those cats
towering over them from the front. Equipment responses, such as
movement, which enables
who engage in play, which can make
within the room that is unusual in appearance the clinician to move the cat examination difficult.
to a desired location (eg, < Tastes Although most veterinary clinics
when leaving the carrier).
Image courtesy of Ellen Carozza have treats for dogs, many still do not offer
them for cats. if there is no medical reason to
withhold treats, they can be considered as a
tool for inducing positive emotions. They can
also be used to help manoeuvre cats by laying
a food trail or holding a treat (eg, tube of paste
or liquid sachet) in order to entice the cat to
a desired location (Figure 4). Keep treats
available in all clinic locations, including a
variety of soft, dry and liquid treats and other
food options. However, if cats are highly
fearful, their protective emotion may override
the motivation to eat, leading to emotional
a conflict and risking creating negative
emotional associations with the food. There-
Figure 5 Warmed towels and fore, always assess the emotional state of the
other bedding are excellent
options to ensure thermal patient before treats are offered. it can also
comfort in the conscious help to offer treats in ways that enable the cat
patient. (a) A commercial towel
warmer. (b) Heated grain bags to retain a sense of control and avoid social
(in pink) with a towel wrapped proximity or interaction – for example, by
around are a low-cost option
for mobile patients. These can scattering treats on the consulting room
be sprayed in advance with table or floor or presenting a length of
synthetic feline pheromones
and tucked into an lickable tube rather than offering directly from
examination room drawer the hand.
or other small space to stay
warm. Images courtesy of b
Kelly St Denis

a b

Figure 6 (a,b) Covering the

consulting room table with
non-slip materials such as
rubber mats or yoga mats,
topped with soft blankets
or towels, increases patient
comfort and security.
Images courtesy of Creature
Comforts Veterinary Centre,
Hong Kong (a) and Village Vet
St Helens, UK (b)

JFMS CLINICAL PRACTICE 1139

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:19 Page 1140

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

Box 1
Examples of single or compounding stressors
potentially experienced prior to a clinic visit
< Physical confinement (within the home or within the carrier) < Transportation (by car, public transport, bike or on foot)
< For cats with outdoor access, restrictions or changes causing variable and unpredictable movement of different
to the predictable outdoor access routine (eg, locked intensity and duration (eg, the carrier swinging while being
cat flap) transported on foot, long car journeys, etc)
< Physical interactions that may be required to get the cat into < Unfamiliar sights, sounds, smells and tactile sensations
the carrier (eg, being confined to one room and/or lifted into associated with the changing external environment during
the carrier); the carrier may itself be an unfamiliar object transit
< Pre-procedure/sampling fasting, leading to hunger and < Possible nausea and/or pain (eg, due to chronic conditions
frustration or motion sickness) during transit

< Temperature Warmed towels and other Preparation to reduce stress

bedding, safe heating devices and heated cages prior to the clinic visit
are excellent options to ensure thermal
comfort. Towel warmers have become a Many factors relating to the cat’s environment
relatively inexpensive addition to many clinics may induce distress (frustration, fear–anxiety,
and can be placed adjacent to cat examination pain) prior to a veterinary visit, including
room(s), as well as in recovery areas (Figure novelty, unfamiliarity, unpredictability, restric-
5a). Towels and bedding can be sprayed with A cat’s coping tion, exposure to perceived threats, previous
synthetic feline pheromones in advance of learning and loss of autonomy, all of which
warming. Alternatively, a blanket or towel
ability is cats find difficult. See Box 1 for specific
sprayed with synthetic feline pheromones can influenced examples.
be wrapped around a warmed grain bag and A cat’s coping ability is influenced by both
stored in an examination room drawer to stay by both the the number of stressors and the exposure time
warm for the patient (Figure 5b). Cold surfaces number of to them, as shown in Figure 7, which illus-
such as metal tables and pet weighing scales trates the concept of ‘stressor stacking’.
should be covered with non-slip rubber mats, stressors and Stressors can begin to accumulate during
or similar, topped with warmed towels or preparation for the veterinary visit at home,
blankets (Figure 6). the exposure and continue to accumulate throughout the
time to them. physical examination, and during any sample
collection, treatment and hospitalisation.
Further stressor stacking can occur when the
patient returns home; other cats in the house
may, for example, have an adverse response
to the patient on return and/or the caregiver
may need to continue treatments at home.
How negatively impacted cats may be by
exposure to stressors also depends on a range of
factors related to the individual. For example:
< The cat’s physical health illness and/or
pain can predispose cats to, or exacerbate
existing, anxiety and a negative emotional bias
when exposed to potential stressors they may
normally cope with.38
< The cat’s early learning history (cognitive
and emotional health) Early and appropriate
exposure to environmental experiences
encountered during veterinary visits is
necessary to create neutral (habituation) or
positive (non-social environmental learning)
Figure 7 ‘Stressor stacking’ associated with a visit to the veterinary clinic. A cat’s coping emotional associations with the veterinary
ability is influenced by both the number of stressors and the exposure time to them.
For example, cats may cope with being temporarily confined in their carriers at home, environment. if this does not happen, or the
but when compounded by enforced confinement, fasting, non-consensual handling, experience is not consistent, cats may develop
possible pain/illness/discomfort, removal from their territory and transport, stressor stacking
is experienced, often resulting in cats being unable to cope and consequently showing signs distress when visiting the clinic.
of negative (protective) emotions on arrival at the clinic. Stressor stacking will continue not < The cat’s ongoing experiences Each
only during the cat’s visit (eg, in response to sample collection, treatments and hospitalisation),
but right up until the cat is settled back at home. Image courtesy of International Cat Care
experience informs the next. For example,

1140 JFMS CLINICAL PRACTICE

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:19 Page 1141

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

Box 2
Features of a cat friendly carrier
< Large enough for the cat to be able to stand up smell, as well as by sight and touch) bedding,
and turn around comfortably to aid comfort; bedding should not slip or roll
– but not so large that the cat can slide about < Ventilated with slats or similar
or roll around (particularly important for kittens < Designed ideally to allow floor level entry,
so the cat can walk in
Placing treats,
or older cats – eg, those with degenerative joint
disease [DJD]) < Removable top half (important for both catnip or toys
< Made of a material that is easy to clean, strong, carrier training and for enabling cat friendly
supportive and prevents escape examinations to be conducted in the bottom in the carrier,
< Lined with deep, supportive and familiar (by half)
and spraying
bedding used
in the carrier
with feline
synthetic
pheromones
15 mins prior to
the cat needing
to enter,
are helpful
a b in creating a
Figure 8 Carrier
positive
design and preparation
can improve the cat’s association
comfort and
the veterinary for the cat.
professional’s cat
friendly approach.
(a) Example of a cat
friendly carrier with
comfortable and
favoured bedding.
(b) The same carrier
showing how the top
can be removed,
allowing the cat to be
examined within the
carrier base lined
with soft blankets.
(c) Features of a cat
friendly carrier. Images
courtesy of Kelly St Denis
c (a,b) and International
Cat Care (c)

cats may be motivated by fear–anxiety when Reducing the impact of potential stressors
placed in carriers due to a perceived threat to prior to the clinic visit is essential and
their security, combined with frustration at the includes:
inability to escape. These emotional responses < Providing long-lasting, positive activities
will result in negative associations, which may for cats, if and when confined at home in
be reactivated on exposure to the cat carrier preparation for the veterinary clinic visit.
on subsequent occasions. Thus, learning will For example:
impact future events. – toys for self-directed play;
< The cat’s individual nature (temperament)  – puzzle feeders for food acquisition (if food
How confident or timid the individual is, is allowed).
impacts how well cats cope and influences < Giving appropriate advice regarding pre-
their selection of behavioural strategies.28 admission fasting. if fasting is necessary

JFMS CLINICAL PRACTICE 1141

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:19 Page 1142

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

(procedure- and case-dependent), < Advising clients with cats likely

veterinary teams should give caregivers to experience nausea, pain or anxiety
clear information about timings, so that during transport to discuss the use
cats are not fasted for unnecessarily of timely pre-event antiemetics/
long periods. The ‘AAFP Feline antinausea drugs, analgesics and/or
Anesthesia Guidelines’ recommend that anxiolytics, which the clinic can
a 3–4 h fast after a small meal of wet prescribe (see the accompanying ‘Cat
food is sufficient.39 Friendly Veterinary interaction
< informing caregivers about suitable Guidelines’).11
cat carrier styles (Box 2 and Figure 8)
and how to manage transportation in a Pre-consultation period
cat friendly and safe manner (car, public and waiting area
transport, bike, on foot).
< Encouraging caregivers to have in addition to helping caregivers and
an inviting carrier present in the their cats prepare prior to clinic visits,
home environment permanently and the design of the entrance and reception
placed in a location where the cat likes areas can help to create a positive clinic
to be. The aim is for the carrier to be experience.40 ideally, cats should have a
accepted as part of the cat’s furniture Figure 9 Carriers are separate waiting area, which is away
best maintained as a
(Figure 9), rather than being viewed as novel permanent feature of the from the sight, sound and scent of dogs and
or predictive of aversive experiences. cat’s daily environment,
in a place that the cat likes
other species. it may be possible to be creative
< Using visual covers (eg, blanket or towel) to be. The carrier should with unused space; for example, a blind-ended
over carriers to mask and muffle aversive be inviting and comfortable, or long, quiet hallway may be able to accom-
allowing it to be a familiar
sights and sounds during transportation. item associated with modate a chair and table as a cat-only waiting
Consider air flow and the ambient positive experiences. area. Where possible, a separate entry/exit to
Image courtesy of Sam Taylor
temperature, to prevent overheating. the building, with a cat-specific reception desk
< Advising clients to consider spraying or (or section of the reception desk) and examina-
wiping the cat carrier/bedding/covers with tion rooms, will ensure there is no risk of inter-
synthetic feline pheromones 15 mins in advance species encounters and will reduce awareness
of the cat going into the carrier for a veterinary of other species.
visit, to aid familiarity and reduce anxiety.32,34 However, if such adaptations are not
< Educating caregivers on respectful possible, simple adjustments to the available
placement of cats in carriers. ideally, longer- Being unwell space and processes can still be effective in
term, positive reinforcement training can help mitigating stress in a multispecies waiting
cats to voluntarily enter and enjoy being and
and/or in pain area (Box 3 and Figure 10).
travelling in their carrier, as well as prepare while confined There are also a number of ways in which
them for veterinary interactions. Practical the waiting room, regardless of whether it is
guidance and videos are available at to a small multispecies or segregated, can be made more
catfriendlyclinic.org/cat-owners/getting-your- space in an cat friendly, as outlined below.
cat-to-the-vet and catfriendly.com/cat-carrier. < Ensure that the waiting room is a calm,
Additionally, guides for caregivers on taking unfamiliar unhurried and quiet area, maintained at a
their cat to the veterinary clinic are available comfortable ambient temperature. ideally, it
in the supplementary material. setting can be should be as spacious as possible to allow cats
< Providing advice on correct carrier handling very stressful and caregivers to be at a good distance from
and manoeuvring. For example: others.
– Never carry by the handle or strap, and for cats and < Play calming classical music, or cat-specific
always support carriers top and bottom. music,41 to reduce acoustic stimuli and create
Limit sudden or erratic movements, and aim result in a a more relaxed atmosphere.
to maintain consistent/predictable motion. variety of < Remove ringing practice phones from the
Consider using a buggy/stroller or trolley to waiting area if it is possible for external calls to
transport the carrier if carrying steadily is emotions be answered elsewhere in the practice. if not
difficult and the surface is not too uneven. possible, ringer volume can be reduced.
– Plan to transit smoothly, minimising as
including Calm and quiet discourse in the waiting area
much exposure to perceived threats on the fear–anxiety should be encouraged by the reception team
journey to the clinic as possible (eg, noisy and reinforced in signage and posters.
people, animals or traffic). and frustration. < Mute or turn off any door entry bells and
– if travelling by car, identify a safe, stable area alerts to reduce additional unwanted noise.
for the carrier, which will allow the cat to feel < Train the veterinary team to use and model
secure. The recommendation from the Center for calm behaviour – talking quietly, moving
Pet Safety is that most carriers be placed on the slowly and minimising noise or hurry.
floor behind the front seats (centerforpetsafety. < Consider the cat’s sensitive olfaction and
org/pet-parents/pet-travel-tips). pheromone detection abilities:

1142 JFMS CLINICAL PRACTICE

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:19 Page 1143

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

Box 3
Minimising stress in multispecies waiting areas
If segregation is not possible, and multispecies entry/exit points and waiting areas are unavoidable,
consider:

< Scheduling cat-specific clinic times, where < Proactively offering to reschedule

only feline patients are seen, ideally when the appointments if there are excessive
clinic is quieter and the waiting room will not disturbances in the clinic that day (eg, a very
be busy noisy, distraught dog)
< If cats need to be seen urgently, informing the < Directing caregivers to an empty examination
veterinary team so the cat can be brought room in which to wait
straight into the examination room, or straight < Arranging furniture and barriers to help prevent
through to other clinic areas contact (including visual contact) between
< When booking or confirming the appointment, patients (Figure 10); these may also serve Arrange
and if weather conditions are appropriate, as information boards
offering caregivers the option to wait in their < Using clear species-specific signage to furniture
car with their cat, with the plan to call them direct caregivers to the appropriate area and barriers
in individually when the team is ready to see and reinforcing this with direction from
them. Following the appointment, consider the reception team. Signage should invite in waiting areas
having cats remain in the examination room or caregivers to give each other space at
returned to the car while the caregiver is at the entry/exit points, and at the reception
to help prevent
reception desk following their appointment desk contact
(including
Figure 10 (a–d)
Arranging furniture
and barriers in
visual contact)
creative ways can
help prevent contact between
between patients
without necessitating patients.
waiting room
renovations or other
costly modifications.
Barriers can
comprise of branded
screens, information
a b boards, potted plants
and shelves, and can
be as inexpensive as
corrugated cardboard
or fabric. All manner
of approaches is
possible – home-
made, tailormade,
foldable, slidable, etc.
Whichever option is
used, the individual
areas of the waiting
room should be
clearly labelled.
Images courtesy of
Neighborhood Pet
Clinic, USA (a),
Redmond Veterinary
Clinic, USA (b), Bålsta
Smådjursveterinärer,
Sweden (c) and Davies
Veterinary Specialists,
UK (d)

c d

– disinfect regularly with unscented or – Use synthetic feline pheromones, both

minimally scented cleaning products, environmentally (ensuring adequate plug-ins
promptly cleaning away patient-related for the size of the room) and applied to
odours (eg, urine) as they occur; towels/blankets for covering carriers.
– Avoid perfumes/colognes, deodorants, < Cover cat carriers, preferably with a
air fresheners, smoke (on clothing), etc. pheromone-sprayed towel or blanket, to

JFMS CLINICAL PRACTICE 1143

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:19 Page 1144

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

Figure 11 (a–d) Cat carriers

should be covered to decrease
visual and auditory stimuli.
Blankets pre-sprayed with
synthetic feline pheromones can
either be provided by the clinic
and returned when the cat leaves,
or brought into the hospital with
the cat, if admitted, to stay with
that patient. The decision to cover
(partially or completely) the cat’s
view of the surroundings should
be based on the individual cat’s
needs, previous experiences and
temperament. Images courtesy of
Sam Taylor (a), KatUnique, Belgium
(b), Village Vet Longstanton, UK (c)
a b and Asahi Pet Clinic, Japan (d)

c d

Carriers can be covered to facilitate hiding,

facilitate hiding and decrease visual and
auditory stimuli (Figure 11). For those cats who and decrease auditory and visual stimuli; or partially
prefer some visual access to their environment, covered, for those cats who prefer some visual
the front of the carrier can remain uncovered
(Figure 11a,c) or be partially covered. Towels access to their environment.
and blankets can be provided by the clinic in
the waiting area and returned as the cat leaves.
Covering the carrier can also help to keep the
cat warmer than ambient room temperature;
warmed blankets could potentially be used.
(See ‘Creating a cat friendly ward’ for
information on the thermoneutral zone of cats.)
< Provide elevated surfaces to place carriers
on while caregivers are either waiting or at the
reception desk following their appointment,
to avoid carriers being put on the waiting room
floor and/or where they can be sniffed by dogs
(Figure 12).
< Ensure that there is no contact between
feline patients and any resident or team
members’ pets, including visually from a a b
distance. Restrict access of clinic cats to
patients, whenever possible.
< Train the reception team to be instrumental
in implementing cat friendly principles in the
waiting area (Box 4).

Figure 12 (a–c) Provision of elevated surfaces for carriers

to be placed on prior to the appointment gives cats a sensation
of safety from potential predators and harm in a strange
environment. This could be a chair, table, shelf or specially
designed ‘cat parking’. (d) Also include an area at reception so
the cat carrier remains elevated when caregivers are speaking
with the receptionist and/or settling their bill. Images courtesy
of Dierenartspraktijk Nieuwkoop-Noorden, Netherlands (a), Abbey
House Veterinary Hospital, UK (b), Village Vet Highbury, UK (c) and c d
Joy Pet 24-hour Animal Hospital, China (d)

1144 JFMS CLINICAL PRACTICE

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:19 Page 1145

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

Box 4
How the reception team can help
Reception personnel should be viewed as part of the cat friendly team and trained as such. They should feel empowered to implement
cat friendly principles and to advocate for the cats coming into the clinic. In particular, receptionists should make every effort to:

< Ask questions about temperament and past veterinary catfriendlyclinic.org/cat-owners/getting-your-cat-to-the-vet)

experiences when making an appointment for a cat, ideally – How to place a cat gently and respectfully in a carrier
via a questionnaire to collect as much information as possible (see guides for caregivers on taking cats to the veterinary
– Send questionnaires to new clients prior to their visit, to clinic at icatcare.org/advice-cat-carer-guides and
improve individualised advice and care. Include questions catfriendly.com/cat-to-vet [also available in the
about the cat’s comfort and experience with the carrier, travel supplementary material])
and other relevant previous experiences. Example new client – Hiring/loaning out scrupulously clean, appropriately
questionnaires are included in the supplementary material designed carriers, if needed
– Inform the clinical team of any concerns so that, < While caregivers and cats are waiting for their appointment,
if necessary, medication such as anxiolytics or ensure that:
antiemetic/antinausea drugs can be prescribed pre-visit – Cats are always in carriers
< Remain calm and approachable, empathetic and supportive – Carriers are elevated
< Prioritise attention to patients and clients in the waiting area, – Caregivers are offered large towels/blankets or translucent
ensuring, for example, that caregivers are sitting in the material to cover carriers. Materials such as sheer fabric
correct areas provide the cat with the sensation of being hidden while
< Provide advice on preparing for clinic visits and travelling, still allowing a view of the cat, when needed, to assess
directing to further information as needed, and ensure their status
smooth logistical arrangements for arrival at the clinic; for – Dogs and cats are separated
example, send an advice sheet on booking an appointment – The waiting area is calm and quiet (Figure 13)
or direct caregivers to the clinic webpage, with links to – A synthetic feline pheromone diffuser is plugged in,
guides for caregivers on taking cats to the veterinary clinic switched on and in date, and placed where it can diffuse.
(icatcare.org/advice-cat-carer-guides and catfriendly.com/ Additionally, using canine pheromone plug-in diffusers may
cat-to-vet [also available in the supplementary material]) help dogs feel calmer and more settled, thus helping cats
< Relay concerns or observations related to the cat’s behaviour – Caregivers with unsettled, boisterous or loud dogs are
in the waiting area, and/or caregiver concerns, to the veterinary politely asked to wait elsewhere (dog-specific advice sheets
team and note in the appointment diary and medical record can also be helpful)
– Be prepared to step in to advocate for cats, help – Cars are used as ‘waiting rooms’, where necessary – this is
caregivers and quickly prevent escalation of potential particularly beneficial for highly aroused or distressed patients
problems; for example, direct anxious or (of any species). Advise caregivers to
disruptive patients elsewhere, and inform avoid scented in-car air fresheners and
the veterinary team overly loud radios/music, and ensure the
< Improve opportunities for cat friendly care car is climatically comfortable and parked
by booking longer appointments whenever in a quiet/low-traffic area
possible (ideally 20 mins or longer), with < Arrange and maintain the waiting area so
more time allocated for anxious cats as as to provide ample space and separation
well as sick or ageing cats and/or cats <  Ensure there is good communication
with concerned caregivers and as much efficiency as possible to
< Provide advice, or direct caregivers to minimise waiting times and reduce
Figure 13 The reception team should be caregiver frustration or anxiety
sources of information, on: trained and feel empowered to implement
– Appropriate carrier choice and use cat friendly principles, ensuring, for <  Seek feedback following a visit on how
– Positive and pre-emptive carrier training example, that waiting areas are calm
and quiet, and that carriers are elevated.
the experience was for caregivers and
(eg, catfriendly.com/cat-carrier and Image courtesy of Oxford Cat Clinic, UK their cats, and how the clinic can improve

The cat friendly examination room not used for any other species (Figure 14). if
the clinic does not have space available for a
Planning and preparation of the examination cat-only examination room, try to schedule
room can – as with all areas of the clinic – certain periods of time where the examination
improve the clinic’s handling of feline room space can be single species. For exam-
patients.2,42 ple, offer cat-only appointments on one or two
afternoons each week.
Cat-only
Where space in the clinic allows, a cat-only Minimise movement
examination room should be established and Where possible, the clinic layout should allow
clearly labelled as being cat-only, and strictly direct access from the car or cat-only waiting

JFMS CLINICAL PRACTICE 1145

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:19 Page 1146

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

area to a cat-only examination room, bypassing

any dog waiting areas or the busy reception
area. The room should have spaces where the
cats can potentially hide that are easily accessi-
ble (Figure 15). difficult-to-access areas under
cabinets and seating should be blocked off
down to floor level. A stool for the consulting
veterinarian, rather than a chair, and a wall-
mounted computer monitor reduce access to
awkward hiding spaces. All equipment that is
likely to be required during feline examina-
tions should be present in the room or brought
in at the beginning of the appointment to
a minimise patient arousal as a result of exiting
and re-entering of team members during
Figure 14 (a,b) Cat-only consulting rooms are ideal.
If not available, consultations should be timed to avoid the examination (Box 5; see also ‘Cat friendly
exposure of cats to other species’ scent. Images b equipment’). When it is not possible to have
courtesy of Lumbry Park Veterinary Specialists, UK (a)
and the AAFP (b)
dedicated equipment for each examination
room and/or there is a lack of storage space,
portable caddies containing everything that
might be needed are ideal (Figure 16).

Optimise for cats’ sense of smell

Clean the room thoroughly between patients.
Cats have an excellent sense of smell,12 and
even non-visible material from the previous
patient may be alarming and cause increased
arousal. Use lint rollers to remove hair from
soft furnishings and clothing. Special atten-
tion should be paid to places where cats may
b have marked with
pheromones (eg,
corners of cabinets,
human legs, sweaty
paw prints on the
a examination room
table) and plug-in
synthetic feline
pheromone diffusers
should be in use.
Consider the smell
of disinfectants used
in the examination
room and utilise
those that are
c d unscented or only
minimally scented.
Figure 15 (a–e)
Within the
examination room,
spaces should be
In an unfamiliar environment,
provided where cats
can potentially hide the preferred coping strategy
or perch that are
easily accessible.
Any difficult-to-
for most cats is to escape. When
access areas under
cabinets and client this option is unavailable, as in
seating should be
blocked off down to the veterinary clinic, they attempt
floor level. Images
courtesy of KatUnique,
Belgium (a), Anicura
to hide or perch to increase
Kleintierzentrum
Weingarten GmbH, perceived safety and
Germany (b), Ilona
Rodan (c,e) and
Occi’Cat Bessières, e
sense of control.
France (d)

1146 JFMS CLINICAL PRACTICE

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:20 Page 1147

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

Box 5
Equipment for the cat friendly examination room
< Two towels/blankets per appointment light, Schirmer tear test strips, tonometer, topical anaesthetic
< Synthetic feline pheromones in plug-in diffuser format, for eyes, mydriatic drops
and/or spray for towels/blankets < Dermatology kit (Figure 16c): microscope slides, scalpel
< A high-sided cat bed, basket or other vessel to examine the blades or sterile spatulas, adhesive tape, mineral oil, UV light,
cat in (as the cat’s own carrier may not facilitate examination) toothbrushes for fungal assays, collection tubes
< Towel warmer or a drawer designated for heated grain bags < Laboratory caddy (Figure 16d): sample collection materials,
for warming towels/blankets including small gauge needles, syringes, collection systems
< Non-slip mats (eg, yoga mat) for examination surfaces and and butterfly catheters (eg, 25 G), EMLA cream or lidocaine
weighing scales gel plus occlusive dressings,43,44 bandaging material,
< A variety of treats, including liquid/tube treats, pill pouches, syringes and needles for cystocentesis, appropriate
canned food and dry cat treats collection tubes (serum, plasma, faeces, urine, etc)
< Paediatric or small pet weighing scales < Dilute chlorhexidine solution or suitable equivalent for
< Nail trimmers appropriate for cats venepuncture and IV catheterisation, instead of rubbing
< Quiet clippers alcohol, to avoid strong offensive odours
< Stethoscope (small diaphragm/bell size for cats) < Doppler or high-definition oscillometry to measure blood
< Thermometer and lubricant pressure
< Ear kit (Figure 16a): otoscope, appropriately sized ear cones, < Necessary vaccines and associated syringes and needles,
saline, cotton-tip swabs, gauze, microscope slides and or a fridge containing all vaccine options
mineral oil. Note that scented ear cleaners should be
Unless insurmountable barriers exist, outpatient procedures
avoided as the smell can be offensive to cats and they
should also be performed in the examination room. This
may cause otic and pharyngeal irritation
increases the accuracy of certain diagnostic tests, reduces
< Eye kit (Figure 16b): ophthalmoscope, 30 dioptre lens,
sensory arousal and exposure to unfamiliar animals, and
fluorescein stain, sterile eye saline, blue or ultraviolet (UV)
avoids separation of cats from their caregivers.45

a b c d

Figure 16 When insufficient equipment is available for each examination room, portable caddies containing everything that might be needed
are ideal. This minimises movement in and out of the room by veterinary team members, which can lead to patient arousal. (a) Ear kit, (b) eye kit,
(c) dermatology kit and (d) laboratory caddy. Images courtesy of Kelly St Denis

Other considerations if the cat remains in the carrier or a cat bed,

Surfaces can be unpleasantly cold and slip- weigh them within and then weigh the item
pery for cats. Use veterinary examination alone when the cat needs to be removed (for
table mats or yoga mats as well as warmed admission, diagnostic tests, etc). Recording the
towels or blankets on the surface of the exam- weight of the carrier and contents (blankets,
ination room table (Figure 6). Place a towel or toys, etc) on a sticker on the carrier and/or in
blanket on the weighing scales (tare to zero the medical record can facilitate future weigh-
before weighing the cat) to reduce fear of the ing; recommend to the caregiver that they
slippery surface and to keep the cat warm. include the same contents at each visit.

JFMS CLINICAL PRACTICE 1147

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:20 Page 1148

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

a b

Figure 17 Hiding is
a self-preservation
response that can be
accommodated during
the physical examination.
Give cats the opportunity
to express normal
behaviour by allowing
them to remain (a,b) in the
bottom of the carrier,
in a high-sided cat bed or
basket, and/or (b–d) under
towels or blankets. Images
c d courtesy of Kelly St Denis
(a,c,d) and Sam Taylor (b)

All cats need the ability to hide if blankets (Figure 17).2 Be prepared to work Figure 18 Examine cats
where they are comfortable.
desired,12,16,42 and much or all of the examina- where the cat chooses to be, thus allowing This may be (a,b) on the
tion can be performed while allowing the cat them a sense of control. Some cats prefer floor, (c) in the caregiver’s
or veterinarian’s lap, (d–f) on
to have the sensation of being ‘hidden’, be it perching to monitor the environment; having a chair or windowsill, for
in the bottom of the cat carrier, in a high-sided shelves or windowsills in the room may also example, or (g) in their carrier
or bed. Images courtesy of
cat bed or basket and/or under towels/ allow assessment of their mobility and move- ISFM (a), the AAFP (b,c),
Sam Taylor (d,f), Ilona Rodan (e)
and MyVet Maynooth, Ireland (g)

a b c

d e f g

1148 JFMS CLINICAL PRACTICE

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:20 Page 1149

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

ment. Ensure that any perch options provided Noise in the ward
for the cat are safe and easily accessible for The cat ward needs to be in a quiet setting that
veterinary team members. Safe perching areas has minimal disturbances, including sounds
can be made desirable with beds, including from other patients (eg, vocalising dogs or
those with sides to provide concealment while cats) and noisy hospital equipment (eg, cen-
perching. other cats may prefer to settle on trifuges). increased noise levels that may be
the floor, on a chair or bench next to their care- detrimental to patients have been recorded in
giver or in their caregiver’s lap (Figure 18). veterinary intensive care wards,49 and high
For further discussion see the accompanying levels of background noise may elicit physio-
‘Cat Friendly Veterinary interaction logical stress responses during examination.35
Guidelines’.11 Telephone ringers should be muted or turned
  to the lowest setting and team members need
Creating a cat friendly ward to communicate in soft, quiet tones and min-
imise conversation; case discussions can occur
The hospital/clinic cat ward and associated elsewhere. All doors in and out of the area,
cages provide housing for sick cats, and cats as well as cage doors, should be squeak-free
in perioperative care (pre-/post-surgery), and and close quietly, with door silencers
may also be used for boarding in some installed.
circumstances. Being unwell and/or in pain The ideal room for a ward is one that is
while confined to a small space in an unfamil- separated from other areas of the clinic
iar setting can be very stressful for cats and and incorporates sound proofing. A window
can result in a variety of emotions including into the room allows visual assessment of
fear–anxiety and frustration.2,46,47 Con- patients and a one-way intercom will alert the
sideration for patients’ sense of safety and nursing team to the sounds of cats in distress
comfort in the cat ward is critical. it has been or iV fluid pump alarms. Video monitoring
shown that cats housed in a quiet, predictable devices can also be useful for monitoring
environment are more tolerant of an approach hospitalised cats. Certain types of music
by an unfamiliar person,48 so the aim should are reported to reduce stress in several
be to create as quiet and predictable an envi- species, including cats. Studies have shown
ronment for hospitalised patients as possible. that cat-specific music reduces stress, both
ideally cats are kept in a separate ward. if this at home41 and in the examination room.50
is not possible, efforts should be made to Cat-specific and classical music also seemed
reduce the impact of the presence of dogs on to have benefit in a recent study of hospi-
the hospitalised cats (Box 6). talised cats.51
The thermoneutral zone for cats is 30–38°C Quiet periods are essential to facilitate prop-
(86–100.4˚F), so the ambient temperature in er rest and recovery, including periods of dim
cat wards should be higher than in other parts light or darkness. in human medicine, sleep
of the hospital. Heated cages are used in some deprivation in the intensive care setting
clinics, or additional warming devices may be contributes to fear and anxiety as well as
supplied for each cat.18 sensitivity to light, noise and activity;52 more-
over, periods of both light and darkness are
The cat ward needs to be in a quiet setting that has important to avoid disruption to circadian
rhythms, which can negatively affect recovery
minimal disturbances from vocalising dogs or cats from illness.53
and noisy hospital equipment.

Box 6
Improving feline welfare in multispecies wards
< Avoid the sight of dogs and other cats by: in the ward; for example, perform cat surgeries in the
– Covering or partially covering the front of each cage morning and discharge patients as soon as it is safe
(eg, with a towel) to reduce or eliminate visual contact to do so
– Using room dividing screens, blinds or curtains < Monitor cats recovering from procedures closely in
– Housing cats in a mobile bank of cages on wheels that carriers/collapsible cages or mobile cages in areas with
can be rotated away from dogs no dogs, if separation within the hospital is not possible
< Position cats as far away from dogs as possible (eg, < Set up a collapsible cage or mobile cage in a consulting
opposite end of the ward) room or other location free of dogs, to house cats that have
< Ensure each cat has somewhere to hide within their cage high fear–anxiety
< Remove noisy animals to alternative locations, if possible < Prevent clinic cats from interacting with patients in the ward,
< Schedule procedures to minimise time with both species either directly or visually from a distance

JFMS CLINICAL PRACTICE 1149

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:20 Page 1150

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

Cage positioning
Cages need to be oriented facing in one direc-
tion to avoid visual contact with other cats
(Figure 19a), rather than facing one another
or at an angle that allows visual contact.
Treatment tables where other cats are examined
should be out of view of the cages, to avoid
unnecessary stress to the cats (both observer
and observed);54 if necessary, mobile screens,
room dividers, blinds and curtains can be used
when a cat is on the table (Figure 19b,c).
Cages should be elevated from the floor to
reduce stress due to perceived dangers lurk-
a
ing at floor level, or lower cages used only as
a last resort when higher cages are full. Cage
elevation from the floor should take into
account ease of use for the veterinary team,
the cat’s ability to survey their surroundings,
and the safety of the patient (eg, risk of a fall).
Cages that are too high up or too low down
can make interactions with the patient diffi-
cult. Step stools should be provided where
necessary to keep the patient and veterinary
team level during any interactions.

Cage size and construction

The cat ward cages should be constructed of b c
materials that are non-permeable, easy to clean
or disinfect, and not likely to bend or make Figure 19 (a) Cages should
be oriented facing in one
noise during use. Consider low gauge stainless stainless steel and matt finish surfaces are direction (rather than facing
steel, laminate or moulded plastic construction preferred. if shiny surfaces are unavoidable, one another or at an angle),
thus avoiding all visual
materials. Shiny surfaces may reflect the cat’s high-sided cat beds may reduce reflection.46 contact between cats.
face and lights, causing potential alarm, so Minimum dimensions for ward cages are Treatment tables should
equally be out of view, to
non-reflective materials such as brushed noted in Box 7, and depend on whether the cat avoid patients observing
is hospitalised for up to 24 h or more than 24 h. other cats being examined.
(b,c) If necessary, a room
Box 7 Consider expanding the space provided by divider, curtains or mobile
connecting portholes between cages or utilis- screen can be utilised
around the treatment table
Minimum dimensions ing vertical space with shelves to allow perch- or between the treatment
for cat ward cages ing (Figure 20). The goal is to provide ample table and cages. Images
space to have core resources spread out and courtesy of Lumbry Park
Veterinary Specialists, UK (a),
The ISFM’s Cat Friendly Clinic (CFC) and AAFP’s allow the cat to engage in normal behaviours Narae Animal Medical Center,
Cat Friendly Practice (CFP) programmes stipulate (stretching, grooming, etc). South Korea (b) and
Sam Taylor (c)
the following: Cage doors should operate quietly, and be
easy to clean/disinfect and to open and close,
Cats hospitalised for up to 24 h: remaining securely latched when closed.
< Minimum floor space: Additional security may be required for
– CFC: 2700 square centimetres (eg, 45 cm overnight care, particularly with clever, active
x 60 cm) or frustrated cats who may unlatch the door.
– CFP: 432 square inches (eg, 18 in x 24 in) doors may have bars (stainless steel, alumini-
< Minimum height: um) or a more solid but transparent (plas-
– CFC: 39 cm tic/acrylic [Perspex or Plexiglas]) design.
– CFP: 21 in opaque or semi-transparent door structures
are not recommended generally, due to lack
Cats hospitalised (or boarded) for longer of patient visibility and potential frustration
than 24 h: for the cat in being unable to see their
< Minimum floor space: surroundings. doors with bars or air holes in
– CFC: 3600 square centimetres (eg, 60 cm solid-fronted cages provide air flow, which
x 60 cm) reduces the build up of odours within the
– CFP: 576 square inches (eg, 24 in x 24 in) cage, improves air quality for the patient and
< Minimum height: allows the patient to view and smell their
– CFC: 55 cm surroundings. Solid transparent doors may be
– CFP: 22 in required for oxygen therapy and have the

1150 JFMS CLINICAL PRACTICE

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:20 Page 1151

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

a b

c d

Figure 20 Cage space can be expanded with options such as (a,b) portholes connecting between cages and (c,d) shelves. This maximises the space, allowing
appropriate distribution of resources. Images courtesy of Clinique Vétérinaire de l’Estuaire, France (a), Tierklinik Hofheim, Germany (b), Clinique Vétérinaire du Grand Large,
France (c) and Affinity Veterinary Center, USA (d)

The goal is to provide ample space within

the cage to have core resources spread out
and allow the cat to engage in normal behaviours
(stretching, grooming, etc).

benefit of reducing external sound transfer

into the cage. disadvantages of doors with
bars include the potential for entrapment of
limbs (a particular consideration for kittens –
ensure bars are appropriately spaced in rela-
tion to patient size), contact between patients
in neighbouring cages, and splattering of
spilled food, water, litter, urine or faeces.
occasional patients may become distraught
and potentially cause self-harm when con- Figure 21 Occasional patients may become distraught
fined, necessitating other options including when confined to a cage, necessitating other housing options.
This cat would become frantic when housed in a hospital
being housed loose in a separate room (eg, cage, causing self-trauma while trying to escape, but was
office or examination room; Figure 21). relaxed and settled when housed loose in a separate room.
Image courtesy of Kelly St Denis

JFMS CLINICAL PRACTICE 1151

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:20 Page 1152

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

Figure 22 Cage layout and

a furnishings. A variety of core
resources including bedding,
a hiding place, perch, food,
water and a litter box/tray
will be required in the cage.
(a) Double-compartment
caging is ideal, but (b) in
small or single-compartment
cages, the feeding and water
vessels and litter box/tray
should be placed as far
apart as possible. Images
courtesy of Kelly St Denis (a)
and Sam Taylor (b)

b
Furnishing the cage
Within the cage, and depending on the state
of health of the patient, a variety of core
resources will be required, including bedding,
a hiding place, food, water and a litter box/
tray. Additionally, a vertical space or perch is
desirable,14 particularly for patients hospi-
talised or boarding for longer than 24 h.
ideally, resources are separated,47 with food,
water and litter boxes/trays placed in different
areas of the cage. double-compartment hous-
ing is optimal but, in small cages, these three
resources should be placed as far apart as pos-
sible, and/or at differing levels (Figure 22).46

a b c

d e f
All hospitalised
cats should be
provided with
an area in
which to hide,
and ideally also
to perch.

Figure 23 All hospitalised cats should be provided with an area in which to hide, and ideally also to perch. Many options are
available that are low cost and readily accessible. Examples include (a) a covered litter box/tray repurposed as a bed; (b) Cats
Protection Hide & Sleep; (c,d) modified plastic stool or plastic bucket; (e) a simple cardboard box; and (f) the cat’s own carrier.
The choice of bed may depend on the patient’s clinical status (eg, it may not be desirable for orthopaedic patients to perch) and
temperament (bolder cats may like to perch and have a view out of the cage). Images courtesy of Sam Taylor (a,b), Wicstun Veterinary
Hospital, UK (c), Village Vet Kensal Green, UK (d), Anicura Jeløy Dyresykehus, Norway (e) and Aireworth Vets, UK (f)

1152 JFMS CLINICAL PRACTICE

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:20 Page 1153

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

Beds and bedding

Cages without blankets, or with only paper lining, Soft bedding may include layers of fleece blan-
are not considered cat friendly. kets or soft towels, and these items can be
placed over the top of a cushioned surface,
such as convoluted foam or a mattress. Cages
All hospitalised cats should be provided without blankets, or with only paper lining,
with an area in which to hide, as hiding is an are not considered cat friendly. The addition of
important coping mechanism for cats and familiar items from home may increase patient
can reduce stress during confinement.2,14,15,55 emotional comfort;56 caregivers should under-
Linens draped over perches creating tents stand that these items might become soiled or
underneath, cardboard boxes, beds or the lost, although a labelling and recording system
patient’s carrier provide easy and inexpensive can avoid this. Warming devices in cages are
opportunities for the patient to hide, and in beneficial for sedated, recovering or unwell
some cases also an option to perch (Figure 23); patients to avoid hypothermia (taking care to
Figures 23c,d illustrate how other household avoid overheating or burns).39
items can be adapted for this purpose.
Additional options might include draping Provision of food and water
sheer fabric over the cage door, allowing the Cats are likely to have food preferences and
team to still see the cat, yet giving the cat the may have feeding/water vessel preferences as
sensation of being hidden and protected, or well. Consider a pre-admission questionnaire
partially covering the cage door with a towel, requesting details of these prefer-
giving the cat the option to look out. Each cat ences from the caregiver (an
Clinics that hospitalise cats should
needs to be assessed individually in this example ‘dietary history ques-
ensure their ward is cat friendly
regard. Covering the whole cage front can lead tionnaire’ is available in the
in order to optimise a patient’s
to an increased sense of security for some cats, supplementary material). if nec-
physical recovery and to safeguard
and to frustration for others because their visu- essary, the caregiver can supply
the cat’s emotional state. A
al access is obscured; covering just half of the items and food to maintain famil-
species-appropriate hospital
cage front gives cats the choice over whether to iarity. ideally, the hospitalised
environment will improve the
stay hidden or look out. Perches – whether as patient should have access to
cat’s experience of confinement,
part of the resting space options, as noted their preferred diet, and new
as well as make caring for patients
above, or provided as additional shelving – diets should be introduced slowly
a rewarding experience for the
expand the cage space and offer a higher when the patient has returned
veterinary team.
vantage point. home.46,57

In terms of
their core
resources,
every patient
should be
assessed as an
a b
individual and
their personal
preferences Figure 24 (a–d) Feeding
and water vessel
catered for, preferences will vary
with temperament,
age, breed and patient
whenever mobility/wellness. Wards
should stock a variety
possible. of bowls for hospitalised
cats. Flatter, low-sided
bowls, plates or saucers
are generally preferred.
Images courtesy of Kelly
St Denis (a,c), Sam Taylor
c d (b) and Summercourt
Veterinary Centre, UK (d)

JFMS CLINICAL PRACTICE 1153

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:20 Page 1154

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

Box 8
Recording information on hospitalised cats
Recording and sharing of information can improve patient safety and health, as well as providing a
legal record of the patient’s care.59 For example, accurate recording of vital signs, food and water intake,
urination and defecation ensures early detection of abnormalities, which can prompt intervention.
A cat friendly hospital chart is included in the supplementary material. Information that should be
recorded on the chart includes:

< Patient signalment ‘2022 ISFM Consensus Guidelines on

< Current date and date of admission to the Management of the Inappetent Hospitalised
hospital/clinic ward Cat’57)
< Five vital signs: temperature, pulse, respiration, < Outputs: urine frequency and volume; bowel
pain assessment and nutritional assessment60 movements, including frequency, volume and
< Body weight: updated at least daily and more faecal score; vomiting
frequently depending on the cat’s clinical < Date of IV catheter placement (it is good
condition practice to use only one colour of dressing
< Pain scoring, if indicated for IV catheters to avoid inadvertent discharge
< Medications (dose, frequency and route, along of a patient with a catheter in place)
with actual time given) < Scheduled checks/procedures (eg, IV catheter
< RER in calories and grams of diet fed flushing/unbandaging, feeding)
< Food offered and accepted (in grams); < Scheduled diagnostic testing (eg, electrolytes,
food consumed as a proportion of RER imaging, surgery)
should be calculated daily as part of < Fluid therapy data (fluid type, rate, start time,
the patient’s nutritional assessment. reassessment plan)
(Tube feeding information should be recorded < Information on normal patient demeanour
elsewhere – an example feeding record and behavioural responses to interactions
for a patient with a feeding tube is available < Assessment of current emotional state
within the supplementary material of the (eg, showing fear–anxiety, frustration)

Feeding and water vessel preferences will urine. Wood shavings and wood or recycled
vary with temperament, age, breed and paper pellet litters can have a strong scent,
patient mobility/wellness (Figure 24). Many with some cats also finding the pelleted
cats will prefer familiar foods, warmed and varieties painful to stand on (particularly
presented in low-sided bowls, with one recent
study demonstrating that cats over 7 years of
a b
age prefer wet food warmed to 37˚C (98.6˚F).58
Hospitals should have various food and
feeding vessel options available to meet
a range of patient preferences. See the ‘2022
iSFM Consensus Guidelines on Management
of the inappetent Hospitalised Cat’ for more
information.57
Food consumed should be monitored and
calculated as a proportion of the daily resting
energy requirement (RER) of hospitalised
patients (Box 8).

Litter boxes/trays
Litter boxes/trays should be 1.5 times the c d Figure 25 Litter
length of the cat (from nose to base of tail) in boxes/trays should be
appropriately sized and
size, if cage dimensions allow,2 and preferably preferably low-sided for
low-sided, or with high clear walls and a low ease of use. (a–c) Many
options are available,
entry door, to make them easy for the unwell including seed trays,
cat to access and exit. Seed trays and other baking trays and building
products, such as concrete
large flat trays (eg, builders’ concrete mixing mixing trays. (d) Various
trays) can be used as an alternative (Figure types of litter should be
stocked, or caregivers
25). Unscented clumping litters are generally asked to bring in familiar
preferred by cats and should be provided at a litter from home. Images
courtesy of Kelly St Denis
sufficient depth to allow burying of faeces and (a,b) and Sam Taylor (c,d)

1154 JFMS CLINICAL PRACTICE

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:20 Page 1155

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

Areas of the clinic where cats are sedated personnel and using ‘do not disturb’ signs.
Always ensure that all equipment is set up,
or anaesthetised, and where they recover, ready and in good working order, and that all
consumables appropriate for the patient size
should be kept quiet, with minimal staff movement, and procedure are readily available; this saves
and no (or minimal) exposure to the sight, time and reduces noise and movements back
and forth of personnel.
sound or smell of other animals.
Preparation/treatment rooms
General preparation/treatment rooms can be
a busy environment, especially when used
cats with dJd), so these may be best avoided. for multiple species and purposes (eg, proce-
As with all resource provision, every patient dures, treatments, examination and induction
should be assessed as an individual and their of general anaesthesia). The loud sounds of
personal preferences catered for, whenever equipment and scents of other patients may
possible. if a cat’s familiar litter is not stocked cause significant fear–anxiety for feline
in the ward, caregivers can be asked to supply patients. Consider whether this is an appro-
some; and for cats accustomed to passing priate place to provide the quiet, calm envi-
urine and faeces outside, it may be necessary ronment required for reducing stress in cats.
to fill a litter box/tray with soil or sand to if these requirements cannot be met, then it is
encourage use while hospitalised. preferable to move the cat to another room
(an unused examination room can be a good
Cleaning of cages alternative). Careful scheduling of patient
A full daily clean is rarely required and will treatments and procedures will assist with
remove pheromone markings and familiar this, and time spent planning can create a
reassuring scents. ideally, the cat remains in more relaxed cat who is easier to handle and
the same cage during hospitalisation and, if allow a more efficient treatment or procedure.
moved, the bedding is moved with the cat.
Layering two blankets/towels can allow Induction of anaesthesia and recovery
removal of the top layer, if soiled, minimising Physiological stress associated with protective
disturbance to the patient and maintaining the emotions leads to release of catecholamines
familiar scent profile. ‘Spot cleaning’ of soiled and, in turn, to physiological changes that can
areas, with minimal disruption of other areas, increase the risks of anaesthesia in cats.39 Cats
is preferable to a full clean for hospitalised exposed to a less stressful transport protocol
patients.46 took less time to reach sedation and needed a
lower dose of propofol than control cats in one
Other clinic areas study.61 Meanwhile, research in humans and
rat models suggests exposure to stress and
Examination rooms and hospitalisation wards low mood perioperatively can increase com-
are not the only areas of the clinic that should plications62 – for example, affecting wound
be cat friendly. during the journey of the healing,63 and both postoperative and chronic
veterinary visit, some feline pain62,64 – and the same may be
patients may require certain true in cats. Therefore, areas of
procedures (eg, imaging or the clinic where cats are sedated
surgery), often necessitating or anaesthetised, and where they
sedation or anaesthesia. Hence recover, should be kept quiet,
all areas should be designed and with minimal staff movement,
used in a way that reduces the and no (or minimal) exposure to
impact of fear–anxiety and con- the sight, sound or smell of other
siders the principles of a cat animals, as impacts may be far
friendly environment. ideally, reaching for each patient. Calm
dedicated cat-specific areas interactions and gentle handling
should be available in every part of the patient are essential to
of the clinic. Where this is not optimise outcomes as well as to
possible, consideration should minimise negative emotional
be given to the timing of pro- impacts (see the accompanying
cedures (prioritising feline ‘Cat Friendly Veterinary inter-
patients first so there is no scent action Guidelines’).11
from dogs), thorough cleaning A side room or other quiet area
Figure 26 The option of a side room or other quiet area for
of the areas between patients/ sedated and recovering cats can reduce anxiety and stress. can be used for cats in the peri-
species, having only one patient These areas should be warm, have minimal staff movement, anaesthesia period (Figure 26),
and no or minimal exposure to the sight, sound or smell of
in an area at a time, minimising dogs. Image courtesy of Lumbry Park Veterinary Specialists, UK or procedures timed for quieter

JFMS CLINICAL PRACTICE 1155

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:21 Page 1156

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

or dedicated cat-only periods, as described Imaging areas (radiography, ultrasound,

earlier. A similar approach applies during advanced imaging)
recovery, where cats should be kept in a Cats should be sedated or anaesthetised, as
warm, quiet area without dogs or visual con- appropriate, for imaging.30 Conscious radiog-
tact with other cats, but still with the required raphy and ultrasonography rarely provide
facilities to maintain monitoring in order to results of diagnostic quality and may result in
avoid complications that can occur during this exposure of veterinary team members to radia-
period.65 Recovery can occur in the ward, if tion. Moreover, the restraint required for radio-
adequate personnel, monitoring and warming graphic positioning is likely to result in distress
devices, for example, are available and if litter due to triggering of fear–anxiety and/or pain,
boxes/trays and water bowls are removed the latter particularly in older cats where exten-
from the cage. Consider expressing the blad- sion of limbs may cause significant discomfort
der prior to recovery to decrease postopera- given the prevalence of dJd in this age group.68
tive discomfort, and manage dysphoria and imaging areas, like other clinic regions, should
pain as indicated.39,66 Litter boxes/trays and be cleaned to remove the scent of dogs and
water bowls should only be put back into the other animals before being used for cats, and
cage when the cat is fully recovered. kept warm, quiet and fully stocked to avoid
excessive personnel movement.
Theatre/operating room
The small size of feline patients increases the Isolation and intensive care areas
risk of hypothermia during surgery and Cats with infectious diseases may need to be
measures to prevent this should be employed hospitalised and facilities should be available
(Figure 27).39 Heat sources during anaesthesia for this purpose. Similar considerations in
should be limited to warm air devices, medical terms of reducing distress apply as they do in
grade electric blankets, circulating water blan- other clinic areas, particularly in the light of
kets and/or warmed towels/blankets, and the fact that stress can also affect the immune
care should be taken with any warming device system.69 ideally, dogs are not housed in the
to avoid burns.39 Multimodal analgesia includ- same area and cages are furnished as recom-
ing local anaesthesia should be considered mended earlier for the main cat hospitalisa-
during and after surgical procedures.66 A study tion ward. if a specific isolation area is not
of anaesthetised cats showed that patients had available, unused rooms may be converted
reduced blood pressure, heart and respiratory into quiet areas to house cats with infectious
rates, and possibly lower anaesthetic levels, disease, noting that these patients may be sig-
when listening to classical music as compared nificantly unwell and so should be monitored
with other human music genres;67 hence, back- as closely as they would be on the main ward.
ground classical music can be considered in infection control must be optimum to avoid
the theatre/operating room. infection of other patients; for example, cats

Figure 27 Cats are prone to

hypothermia under sedation
or anaesthesia and
equipment should be
available to prevent its
development. (a) Booties
a c or infant socks placed over
the feet of an anaesthetised
patient to reduce heat loss
through the limbs; (b) bubble
wrap to prevent heat loss;
(c) a commercial warm air
under-blanket below the cat,
who themselves are covered
in a blanket, and there is an
additional heat-moisture
exchanger present between
the endotracheal tube and
circuit; (d) commercial warm
air blanket covering a cat
during dental surgery; and
(e) warm water circulating
mat. Images courtesy of Kelly
d b e St Denis (a,d,e) and Joanne
Michou (b,c)

1156 JFMS CLINICAL PRACTICE

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:21 Page 1157

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

Figure 28 (a) Cat-only ICU

with cage fronts partially
covered with blankets to allow
patients to hide and yet be
monitored by the veterinary
team via the transparent
doors. (b) Sheer draping
reduces the need for
disturbance, leaving the cat
visible while giving them the
sensation of being hidden.
Images courtesy of Lumbry Park
Veterinary Specialists, UK (a)
and Kelly St Denis (b)

a b

in isolation should be attended to last and not The aim is to provide an experience that is
removed from the isolation area.46 neutral, or even positive, for the cat, and
Larger clinics and hospitals may have an prioritises their security and comfort.
intensive care unit (iCU) and these facilities
can be a challenge to make cat friendly due to Needle gauges
the requirement for frequent interventions Where possible, use small gauge needles
and the severity of patient illnesses. Cats in (23–25 G) for all injections and sample collec-
the iCU may be very unwell, depressed or tion. Smaller gauge needles may be more com-
sedated, but their behavioural needs, includ- fortable for the cat, with a number of studies
ing cognitive and emotional health, still need showing no impact on clotting parameters
consideration. oxygen tents or incubators and or biochemistry/haematology readings.70,71
iCU cages should contain areas to hide, and Additionally, the human literature72 indicates
be partially covered with blankets/towels or that less pain is experienced when phlebotomy
covered with sheer draping material (Figure is performed using a smaller gauge needle,
28). Repeated lifting of opaque towels to view and the Task Force members’ experience is that
an anxious patient can escalate anxiety and the same is true in cats. Changing to a fresh
promote protective behaviour; sheer draping, needle after drawing up medication also
on the other hand, reduces the need to disturb ensures a sharp needle, reducing any pain that
the patient. Cats should not be in direct visual a blunter needle may cause.73
sight of other cats or other species, yet they
should be visible to the veterinary team to Clippers
ensure adequate monitoring. Lights should Cats can hear up to an octave above the
be dimmed at night, and even during the day, Figure 29 (a,b) Examples human hearing range, but they can also hear
of quiet clippers suitable for
to allow rest and sleep.53 The iCU should be feline work. Image (b) also lower pitched sounds.22 The sound of electri-
kept quiet, with case discussions held outside shows gentle handling for cal clippers is novel and frightening for many
blood sampling in the base
the ward. of a carrier. Images courtesy cats, and a quieter volume is likely to be
of Ellen Carozza (a) and better tolerated (Figure 29).
Sam Taylor (b)
Cat friendly equipment
a b
When looking for cat friendly equipment,
there are a few key things to take into consid-
eration. Most of this equipment is novel to
cats and hence will likely be met with mis-
trust, so any equipment that needs to be used
on a regular basis (eg, blood pressure moni-
toring equipment) should be introduced
slowly, prior to a time that its use becomes
essential. Time invested in cooperative care
(see later) will be beneficial in the longer term.
Secondly, take into consideration the noise,
smell and sensation the equipment may create
when used, and do what you can to minimise
these sensations. Finally, consider the emo-
tion(s) that use of the equipment may create.

JFMS CLINICAL PRACTICE 1157

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:21 Page 1158

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

Topical local anaesthetic cream/gel

Have EMLA cream or lidocaine gel and
occlusive dressings readily available in
advance of phlebotomy or iV catheter place-
Cooperative
ment and always allow adequate time for
effect (Figure 30).43,44,74,75 care is
Blood pressure machines fundamental
Blood pressure measurement is best per- to a cat friendly
formed in a place where the cat is comfortable
and relaxed, with all the equipment required environment.
housed in the room and ready to be used.
When using a doppler machine, use head- Any equipment
phones to minimise noise.76 that needs to a
< Doppler or oscillometric machine? Some
studies have not recommended oscillometric be used on a
machines for indirect blood pressure
measurement in cats,77 and have found
regular basis
doppler to be superior for ease and speed should be
of use, repeatability of results and diagnosis
of systemic hypertension.78 However, oscillo- introduced
metric technologies and studies comparing
slowly to cats.
indirect methods with gold standard direct
methods have indicated that high-definition
oscillometric readings can be used to gather and
interpret blood pressure readings.79,80 Veterinary
b
professionals trained and proficient with
oscillometric machines report them to be reliable Figure 30 (a) EMLA cream or lidocaine gel applied topically
and easier to integrate into a routine wellness in a sedated cat. The area is covered with occlusive dressings
in advance of phlebotomy or IV catheter placement and left
appointment. With an oscillometric machine, for at least 20–30 mins for effect,43,75 to reduce negative
the coccygeal artery is more comfortable for responses and pain from these procedures. (b) Products to
the patient;81 for some machines it is the dissolve adhesives on bandaging tape can reduce the pain
of the removal of dressings. Images courtesy of Kelly St Denis (a)
recommended, validated site. The relative and Sam Taylor (b)
comfort of the coccygeal artery may be due to a
reduced incidence of dJd in the lumbosacral
spine compared with the forelimb.68 Many cats will also tolerate this better than use of a doppler
machine, which requires more hands-on
interaction with the cat. in many cases, blood
a
pressure can be measured with oscillometry
without anyone holding the patient.
Blood pressure readings obtained by doppler
are not interchangeable with blood pressure
measured by oscillometric devices.82 There is a
need for reference intervals for cats specific to
oscillometric devices and possibly even specif-
ic to the oscillometric manufacturer.82 Never-
theless, consistent use of the same machine
allows monitoring of trends in the patient and,
along with evidence of target organ damage,
will support a diagnosis of hypertension. For
further details on feline hypertension see the
Figure 31 (a,b) Portable
b paediatric scales, or those ‘iSFM Consensus Guidelines on the diagnosis
designed for cats, should and Management of Hypertension in Cats’76
be available for weighing
feline patients, ideally with and the AAFP’s Hypertension Educational
a set in each clinical area. Toolkit (catvets.com/hypertension).
Various types are available.
Images courtesy of the
AAFP (a) and Ilona Rodan (b) Weighing scales
Accurate weight (and body condition score)
recording is important for feline health,83
and thus small portable weighing scales are
essential for all veterinary clinics (Figure 31).
Stainless steel surfaces can be cold, slippery

1158 JFMS CLINICAL PRACTICE

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:21 Page 1159

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

and stressful to stand on, and even plastic interaction Guidelines’,11 plug-ins should be
scales can alarm an anxious cat. The use of used in all rooms that cats may be in,
non-slip surfaces (eg, rubber mat), where including in the waiting area, to provide a
necessary, and a layer of warm blankets on the reassuring pheromone environment. Bedding
scales, tared to zero weight, can greatly or equipment may also be sprayed with
improve the cat’s acceptance of the equip- pheromones, where appropriate.
ment. Scales with slightly elevated sides also
provide a cat with a sensation of being pro- Elizabethan collars and other
tected and even hidden, and hence offer protective items
greater security; some cats choose to sit in Certain items such as Elizabethan collars may
such scales and can be examined in them, be needed to prevent the cat from pulling at
if comfortable. Alternatively, a box or high- catheters (iV, urinary, etc) or tubes (feeding
sided bed can be placed onto the scales (again, tubes, chest drains, etc), damaging or removing
tared to zero) to provide concealment for the bandages, or licking wounds (surgical or
cat when being weighed. otherwise). With consideration of appropriate
analgesia perioperatively (eg, local anaesthesia,
Towels and blankets postoperative multimodal analgesia), the need
Have a ready supply of soft towels or fleece for protection of surgical wounds may, howev-
blankets. it is important that these are large er, be lessened.66 The Task Force recommends
enough to provide a loose wrap, if required. that, if deemed necessary, only the soft variety
Equally, have a supply of smaller ones for of Elizabethan collar be used (Figure 32),
kittens and young cats. Where possible, have avoiding hard plastic or other materials unless
a way to warm these (either a commercial absolutely necessary. other possibilities
towel warmer or using heat pads or heated include the use of donut collars or recovery
grain bags) prior to the cat’s arrival (Figure 5). suits. it is important to recognise that any of
Consider spraying synthetic feline phero- these items will restrict the cat’s comfort,
mones onto the blankets or towels 15 mins movement and possibly peripheral vision, thus
prior to use, for added comfort. potentially triggering protective emotions
including frustration. Their use should be care-
Hiding places within cat cages fully weighed against these potential issues
The importance of providing a place to hide for and, if they are still deemed necessary, periods
cats being hospitalised (Figure 23) is well estab- Figure 32 Soft Elizabethan of supervised time without the item should be
lished,14,15,55,84 and is discussed above. A variety collars are preferred over
hard plastic versions, as they
permitted to allow the cat to eat, groom and to
of different types of beds that can facilitate allow cats to move and eat, perform other normal behaviours.
hiding, and can be easily cleaned, stacked and and are more comfortable.
Image courtesy of Sam Taylor
Where a potential need for an Elizabethan
stored, should be stocked. collar or other protec-
tive item is being
Non-slip surfaces anticipated, such as
Non-slip surfaces are important when exam- in the case of elective
ining cats to aid them in feeling more secure, surgery, cooperative
whether on the examination table, weighing care techniques can
scales or the floor (Figure 6). Non-slip mats be employed to accli-
can be used with a soft towel or blanket on top matise the patient to
to make them more comfortable. the item in advance.
Cooperative care is
Fluid pumps and syringe drivers fundamental to a cat
Cats are at risk of fluid overload if their iV friendly environment,
fluid therapy is not well controlled.39,85 The and further informa-
ability to give fluids and blood products at a tion on how it may be
controlled rate is very important and, conse- introduced is provid-
quently, fluid pumps should be serviced ed in the accompany-
annually and calibrated according to manu- ing ‘Cat Friendly
facturer’s directions. inaccurate fluid delivery Veterinary interaction
can risk not only fluid overload, but, in the Guidelines’.11
case of drugs administered by constant rate
infusion, potential overdose.
Elizabethan collars restrict the cat’s comfort,
Synthetic feline pheromones
Provision of synthetic feline pheromones has movement and possibly peripheral vision,
a beneficial effect for cats in the clinic.33 As dis- potentially triggering protective emotions
cussed earlier in these Guidelines, as well as
in the accompanying ‘Cat Friendly Veterinary including frustration.

JFMS CLINICAL PRACTICE 1159

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:21 Page 1160

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

EQUIPMENT NOT RECOMMENDED FOR A CAT FRIENDLY ENVIRONMENT

The Task Force does not recommend the use of any of the following pain, and increasing protective emotions and, in turn, the risk
equipment: clips used for Clipnosis, cat bags, gauntlets or gloves, of protective behavioural responses. By practising cat friendly
muzzles of any kind, Elizabethan collars of any variety (unless interactions and providing a cat friendly veterinary environment,
deemed necessary for the very specific purposes discussed earlier, these equipment items quickly cease to be a consideration.
but not for cat friendly interactions), anaesthetic induction boxes/ Note that the use of trap and restraint cages is also not
vessels, pillow cases, mesh cat ‘nabbers’, air muzzles or any other recommended, except in specific circumstances such as when
device placed over the cat’s head, cat tongs or rabies poles. It is the dealing with feral or street/community cats. In rare cases where
Task Force’s position that the equipment listed here is likely to be restraint cages may be needed to facilitate injection, they should
detrimental to the cat’s experience, potentially causing or worsening be used briefly, gently and without excessive force.

Other useful items Figure 33 A small

portable ultrasound
< Small blood tubes, so anticoagulant is machine can be very
correctly diluted without excessive sample useful, allowing cats
to be scanned in carriers
sizes being required.86 and cages with minimal
< Blood collection systems for direct collection stress. This cat is free to
move around and adopt
of blood into sample tubes. a comfortable position.
< Portable ultrasound machines, on hand in Avoiding stress for
dyspnoeic patients
the examination room or hospitalisation ward, is vital and point-of-care
so that quick diagnostic procedures, including ultrasound can
immediately identify
point-of-care ultrasound and ultrasound- effusions, for example,
guided cystocentesis, can be performed without restraint.
without moving the cat. This is particularly Image courtesy of
Sam Taylor
important for dyspnoeic cats, who are
vulnerable to decompensation due to stress
(Figure 33).
< Unscented surgical scrub and cotton
wool (cotton ball) or gauze, for skin cleaning
for phlebotomy.
< Cat-specific licensed medications. Where Conclusions
licensed products are not available, or dosing
does not fit the patient, pharmaceutical grade Achieving an optimal veterinary visit for cats
compounding is helpful to provide smaller depends on many factors, including the
tablet sizes (preferably with scoring to increase environment into which they are welcomed. As a
dosing options), flavoured liquids, flavoured prey species taken out of their natural home
treats and transdermal formulations. Note territory and transported to an unfamiliar setting,
that transdermal medications should only there is much that can be done to improve
be used where the specific medication has their experience by making the environment
been studied for transdermal efficacy cat friendly, as discussed in these Guidelines.
(eg, mirtazapine).87,88 The Guidelines should be used in conjunction
< Crash trolley, incorporating a chart of cat with the ‘iSFM’s Cat Friendly Principles for
doses of emergency drugs, and appropriately Veterinary Professionals’89 and the accompanying
sized endotracheal tubes. ‘Cat Friendly Veterinary interaction Guidelines’.11

SUMMARY POINTS
< Every clinic can benefit from the advice and recommendations set out in the ‘2022 ISFM/AAFP Cat Friendly
Veterinary Environment Guidelines’. While there is much to consider, as each clinic is unique, creation of a
cat friendly veterinary environment need not involve significant financial investment.
< Rather than being overwhelmed, each veterinary team is encouraged to look at even the smallest adjustments
they can make right away to their own veterinary environment, while starting to adopt other adjustments over time.
Small and incremental changes will improve the veterinary visit for cats, caregivers and veterinary teams alike.
< The nature of interactions with the cat is also fundamental to being cat friendly,
and is the focus of the accompanying ‘2022 AAFP/ISFM Cat Friendly Veterinary
Interaction Guidelines: Approach and Handling Techniques’.11

1160 JFMS CLINICAL PRACTICE

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:21 Page 1161

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

Supplementary material Ethical approval

The following files are available online at jfms.com and can also be This work did not involve the use of animals and therefore ethical
accessed at catvets.com/environment and bit.ly/JFMSCatFriendly. approval was not specifically required for publication in JFMS.

< Getting to know your cat: new client questionnaire (iSFM and Informed consent
AAFP versions).
< Example dietary history questionnaire for caregivers. This work did not involve the use of animals (including cadavers)
< iSFM/AAFP cat friendly hospital chart. and therefore informed consent was not required. For any animals
< iSFM guide for cat carers – ‘Taking your cat to the veterinary or people individually identifiable within this publication,
clinic’. informed consent (verbal or written) for their use in the publica-
< iSFM guide for cat carers – ‘Cat Friendly Clinic: cat friendly tion was obtained from the people involved.
veterinary care’.
< AAFP client brochure – ‘Visiting your veterinarian: getting your References
cat to the veterinary practice’.
< AAFP client brochure – ‘You and your cat deserve a Cat 1 Ellis SLH, Rodan i, Carney HC, et al. AAFP and ISFM feline
Friendly Practice®’. environmental needs guidelines. J Feline Med Surg 2013; 15:
219–230.
Acknowledgements 2 Heath S. Environment and feline health: at home and in
the clinic. Vet Clin North Am Small Anim Pract 2020; 50:
iSFM Cat Friendly Clinic is sponsored by idEXX, Ceva, Royal 663–693.
Canin, Boehringer ingelheim and Zoetis. The AAFP Cat Friendly 3 Brown J, Taylor S, Wilson A, et al. Comparison of cat-related
Practice Program is sponsored by Zoetis, Boehringer ingelheim, human injury rates in ISFM Cat Friendly accredited clinics
Ceva Animal Health, Elanco, Hill’s, idEXX, Merck Animal Health, and non-accredited clinics [abstract]. J Feline Med Surg 2021;
Purina Pro Plan Veterinary diets and Royal Canin, and is supported 23: 855–856.
by Wedgewood Pharmacy. iSFM and the AAFP gratefully acknowl- 4 AAFP. Cat Friendly Practice Program reduces the risk of
edge the support of these companies in enabling them to deliver and injury. J Feline Med Surg 2022; 24: 676–677.
build on their Cat Friendly Clinic/Practice programmes. 5 driscoll CA, Macdonald dW and o’Brien SJ. From wild
animals to domestic pets, an evolutionary view of domesti-
Conflict of interest cation. Proc Natl Acad Sci USA 2009; 3: 89–109.
6 McCune S. The impact of paternity and early socialisation
Sam Taylor is employed by Linnaeus. Nathalie dowgray is on the development of cats’ behaviour to people and novel
employed part-time as a post-doctoral researcher at the Feline objects. Appl Anim Behav Sci 1995; 45: 109–124.
Healthy Ageing Clinic funded by Royal Canin. ilona Rodan 7 Casey RA and Bradshaw JWS. The effects of additional
serves on an advisory board for Royal Canin. All members of socialisation for kittens in a rescue centre on their
the Task Force have also received financial remuneration for behaviour and suitability as a pet. Appl Anim Behav Sci 2008;
providing educational material, speaking at conferences and/or 114: 196–205.
consultancy work; however, none of these activities cause any 8 Karsh EB and Turner dC . The human–animal relationship.
direct conflict of interest in relation to these Guidelines. in: Turner dC and Bateson P (eds). The domestic cat: the
biology of its behaviour. Cambridge University Press, 1988,
Funding pp 159–177.
9 Turner dC, Feaver J, Mendl M, et al. Variation in domestic cat
The members of the Task Force received no financial support for behaviour towards humans: a paternal effect. Anim Behav
the research, authorship, and/or publication of this article. 1986; 34: 1890–1892.

Endorsements
The ‘Cat Friendly Veterinary Environment Guidelines’ are endorsed by the following organisations and groups. ISFM and the AAFP
are grateful to each one for their support of this cat friendly resource for the veterinary profession. For an updated list of endorsers,
please visit icatcare.org/cat-friendly-guidelines and catvets.com/environment.

JFMS CLINICAL PRACTICE 1161

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:21 Page 1162

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

10 overall KL. Manual of clinical behavioral medicine for dogs veterinary consultation: the usefulness of Feliway spray in
and cats. St Louis, Mo: Elsevier, 2013. reducing cats’ stress. J Feline Med Surg 2016; 18: 959–964.
11 Rodan i, dowgray N, Carney HC, et al. 2022 AAFP/ISFM cat 35 Eagan B and Gordon EFd. The effect of animal shelter sound
friendly veterinary interaction guidelines: approach and on cat behavior and welfare. Anim Welf 2021; 30: 431–440.
handling techniques. J Feline Med Surg 2022; 24: 1093–1132. 36 Furgala NM, Moody CM, Flint HE, et al. Veterinary
12 Ellis SLH. Recognising and assessing feline emotions during background noise elicits fear responses in cats while freely
the consultation: history, body language and behaviour. moving in a confined space and during an examination.
J Feline Med Surg 2018; 20: 445–456. Behav Processes 2022; 201. doi: 10.1016/j.beproc.2022.104712.
13 Carlstead K, Brown JL and Strawn W. Behavioral and physio- 37 Cameron-Beaumont C. Visual and tactile stimulation in the
logical correlates of stress in laboratory cats. Appl Anim Behav domestic cat (Felis silvestris catus) and undomesticated small
Sci 1993; 38: 143–158. felids. Phd thesis, University of Southampton, UK, 1997.
14 Kry K and Casey R. The effect of hiding enrichment on stress 38 Monteiro BP. Feline chronic pain and osteoarthritis. Vet Clin
levels and behaviour of domestic cats (Felis sylvestris catus) North Am Small Anim Pract 2020; 50: 769–788.
in a shelter setting and the implications for adoption poten- 39 Robertson SA, Gogolski SM, Pascoe P, et al. AAFP feline anes-
tial. Anim Welf 2007; 16: 375–383. thesia guidelines. J Feline Med Surg 2018; 20: 602–634.
15 Vinke CM, Godijn LM and van der Leij WJR. Will a hiding box 40 Caney SMA, Robinson NJ, Gunn-Moore dA, et al. Happy cats:
provide stress reduction for shelter cats? Appl Anim Behav Sci stress in cats and their carers associated with outpatient
2014; 160: 86–93. visits to the clinic. J Feline Med Surg 2022; 24. doi: 10.1177/
16 Ellis JJ, Stryhn H, Spears J, et al. Environmental enrichment 1098612X221121907.
choices of shelter cats. Behav Processes 2017; 141: 291–296. 41 Snowdon CT, Teie d and Savage M. Cats prefer species-
17 Wagner d, Hurley K and Stavisky J. Shelter housing for cats: appropriate music. Appl Anim Behav Sci 2015; 166: 106–111.
principles of design for health, welfare and rehoming. 42 Cannon M and Rodan i. The cat in the consulting room.
J Feline Med Surg 2018; 20: 635–642. in: Heath S and Rodan i (eds). Feline behavioural health and
18 Stella JL and Croney CC. Environmental aspects of domestic welfare. St Louis, Mo: Elsevier, 2016, pp 112–121.
cat care and management: implications for cat welfare. 43 Crisi PE, de Santis F, Giordano MV, et al. Evaluation of eutec-
Sci World J 2016. doi: 10.1155/2016/6296315. tic lidocaine/prilocaine cream for jugular blood sampling in
19 Thomas RL, Baker PJ and Fellowes MdE. Ranging character- cats. J Feline Med Surg 2021; 23: 185–189.
istics of the domestic cat (Felis catus) in an urban environ- 44 Wagner KA, Gibbon KJ, Strom TL, et al. Adverse effects of
ment. Urban Ecosyst 2014; 17: 911–921. EMLA (lidocaine/prilocaine) cream and efficacy for the
20 Bradshaw J. Normal feline behaviour: … and why problem placement of jugular catheters in hospitalized cats. J Feline
behaviours develop. J Feline Med Surg 2018; 20: 411–421. Med Surg 2006; 8: 141–144.
21 Ramsier MA, Cunningham AJ, Moritz GL, et al. Primate com- 45 Griffin FC, Mandese WW, Reynolds PS, et al. Evaluation of
munication in the pure ultrasound. Biol Lett 2012; 8: 508–511. clinical examination location on stress in cats: a randomized
22 Heffner RS and Heffner HE. Hearing range of the domestic crossover trial. J Feline Med Surg 2021; 23: 364–369.
cat. Hear Res 1985; 19: 85–88. 46 Rodan i and Cannon M. Housing cats in the veterinary prac-
23 Fiset S and doré FY. Duration of cats’ (Felis catus) working tice. in: Rodan i and Heath S (eds). Feline behavioural health
memory for disappearing objects. Anim Cogn 2006; 9: 62–70. and welfare. St Louis, Mo: Elsevier, 2016, pp 122–136.
24 Vitale Shreve KR and Udell MAR. What’s inside your cat’s 47 Rochlitz i. Recommendations for the housing of cats in the
head? A review of cat (Felis silvestris catus) cognition research home, in catteries and animal shelters, in laboratories and in
past, present and future. Anim Cogn 2015; 18: 1195–1206. veterinary surgeries. J Feline Med Surg 1999; 1: 181–191.
25 Takagi S, Tsuzuki M, Chijiiwa H, et al. Use of incidentally 48 Stella J, Croney C and Buffington T. Environmental factors that
encoded memory from a single experience in cats. Behav affect the behavior and welfare of domestic cats (Felis silvestris
Processes 2017; 141: 267–272. catus) housed in cages. Appl Anim Behav Sci 2014; 160: 94–105.
26 Panksepp J. Affective neuroscience: the foundations of human 49 dornbusch J, Boston S and Colee J. Noise levels in an aca-
and animal emotions. oxford: oxford University Press, 1988. demic veterinary intensive care unit. J Vet Emerg Crit Care
27 Ledoux J. Rethinking the emotional brain. Neuron 2012; 73: 2020; 30: 632–637.
653–676. 50 Hampton A, Ford A, Cox RE, et al. Effects of music on behav-
28 Heath S. Understanding feline emotions: … and their role in ior and physiological stress response of domestic cats in a
problem behaviours. J Feline Med Surg 2018; 20: 437–444. veterinary clinic. J Feline Med Surg 2020; 22: 122–128.
29 Sinn L. Advances in behavioral psychopharmacology. 51 Paz JE, da Costa FV, Nunes LN, et al. Evaluation of music
Vet Clin North Am Small Anim Pract 2018; 48: 457–471. therapy to reduce stress in hospitalized cats. J Feline Med Surg
30 Simon BT and Steagall PV. Feline procedural sedation and 2022; 24: 1046–1052.
analgesia: when, why and how. J Feline Med Surg 2020; 22: 52 McKinley S, Nagy S, Stein-Parbury J, et al. Vulnerability and
1029–1045. security in seriously ill patients in intensive care. Intensive
31 Mellor dJ. Updating animal welfare thinking: moving Crit Care Nurs 2002; 18: 27–36.
beyond the ‘five freedoms’ towards ‘a life worth living’. 53 Kamdar BB, Needham dM and Collop NA. Sleep deprivation
Animals 2016; 6: 21. doi: 10.3390/ani6030021. in critical illness: its role in physical and psychological
32 Vitale KR. Tools for managing feline problem behaviors: recovery. J Intensive Care Med 2012; 27: 97–111.
pheromone therapy. J Feline Med Surg 2018; 20: 1024–1032. 54 Wallinder E. Are hospitalised cats stressed by observing
33 Beck A. Use of pheromones to reduce stress in sheltered cats another cat undergoing routine clinical examination?
[letter]. J Feline Med Surg 2013; 15: 829–830. [abstract]. J Feline Med Surg 2012; 9: 655.
34 Pereira JS, Fragoso S, Beck A, et al. Improving the feline 55 Van der Leij WJR, Selman LdAM, Vernooij JCM, et al. The

1162 JFMS CLINICAL PRACTICE

Cat Friendly Guidelines_CFVE_ASt2.qxp_FAB 29/09/2022 18:21 Page 1163

P R A C T I C E G U I D E L I N E S / Cat Friendly Veterinary Environment

effect of a hiding box on stress levels and body weight in 74 Fransson BA, Peck KE, Smith JK, et al. Transdermal absorption
Dutch shelter cats; a randomized controlled trial. PLoS One of a liposome-encapsulated formulation of lidocaine following
2019; 14. doi: 10.1371/journal.pone.0223492. topical administration in cats. Am J Vet Res 2002; 63: 1309–1312.
56 Behnke AC, Vitale KR and Udell MAR. The effect of owner 75 oliveira RL, Soares JH, Moreira CM, et al. The effects of lido-
presence and scent on stress resilience in cats. Appl Anim caine–prilocaine cream on responses to intravenous catheter
Behav Sci 2021; 243. doi: 10.1016/j.applanim.2021.105444. placement in cats sedated with dexmedetomidine and either
57 Taylor S, Chan dL, Villaverde C, et al. 2022 ISFM consensus methadone or nalbuphine. Vet Anaesth Analg 2019; 46: 492–495.
guidelines on management of the inappetent hospitalised 76 Taylor SS, Sparkes AH, Briscoe K, et al. ISFM consensus
cat. J Feline Med Surg 2022; 24: 614–640. guidelines on the diagnosis and management of hyperten-
58 Eyre R, Trehiou M, Marshall E, et al. Aging cats prefer warm sion in cats. J Feline Med Surg 2017; 19: 288–303.
food. J Vet Behav 2022; 47: 86–92. 77 Acierno MJ, Seaton d, Mitchell MA, et al. Agreement between
59 Abdelrahman W and Abdelmageed A. Medical record keep- directly measured blood pressure and pressures obtained
ing: clarity, accuracy, and timeliness are essential. BMJ 2014; with three veterinary-specific oscillometric units in cats.
348. doi: 10.1136/bmj.f7716. J Am Vet Med Assoc 2010; 237: 402–406.
60 Freeman LM. WSAVA nutritional assessment guidelines. 78 Jepson RE, Hartley V, Mendl M, et al. A comparison of CAT
J Feline Med Surg 2011; 13: 516–525. Doppler and oscillometric Memoprint machines for non-
61 Argüelles J, Echaniz M, Bowen J, et al. The impact of a stress- invasive blood pressure measurement in conscious cats.
reducing protocol on the quality of pre-anaesthesia in cats. J Feline Med Surg 2005; 7: 147–152.
Vet Rec 2021; 188. doi: 10.1002/vetr.138. 79 Haberman CE, Morgan Jd, Kang CW, et al. Evaluation of
62 Rosenberger PH, Jokl P and ickovics J. Psychosocial factors Doppler ultrasonic and oscillometric methods of indirect
and surgical outcomes: an evidence-based literature review. blood pressure measurement in cats. Intern J Appl Res Vet Med
J Am Acad Orthop Surg 2006; 14: 397–405. 2004; 2: 279–289.
63 Gouin JP and Kiecolt-Glaser JK. The impact of psychological 80 Martel E, Egner B, Brown SA, et al. Comparison of high-
stress on wound healing: methods and mechanisms. Immunol definition oscillometry – a non-invasive technology for
Allergy Clin North Am 2011; 31: 81–93. arterial blood pressure measurement – with a direct invasive
64 Cao J, Wang PK, Tiwari V, et al. Short-term pre- and post-oper- method using radio-telemetry in awake healthy cats. J Feline
ative stress prolongs incision-induced pain hypersensitivity Med Surg 2013; 15: 1104–1113.
without changing basal pain perception. Molecular Pain 2015; 81 Cannon MJ and Brett J. Comparison of how well conscious
11. doi: 10.1186/s12990-015-0077-3. cats tolerate blood pressure measurement from the radial
65 Brodbelt dC, Pfeiffer dU, Young LE, et al. Risk factors and coccygeal arteries. J Feline Med Surg 2012; 14: 906–909.
for anaesthetic-related death in cats: results from the confi- 82 Cerna P, Archontakis PE, Cheuk HoK, et al. Comparison of
dential enquiry into perioperative small animal fatalities Doppler ultrasonic and oscillometric devices (with or
(CEPSAF). Br J Anaesth 2007; 99: 617–623. without proprietary optimisations) for non-invasive blood
66 Steagall PV, Robertson S, Simon B, et al. 2022 ISFM consensus pressure measurement in conscious cats. J Feline Med Surg
guidelines on the management of acute pain in cats. J Feline 2021; 23: 121–130.
Med Surg 2022; 24: 4–30. 83 Rollins AW and Murphy M. Nutritional assessment in the cat:
67 Mira F, Costa A, Mendes E, et al. A pilot study exploring the practical recommendations for better medical care. J Feline
effects of musical genres on the depth of general anaesthesia Med Surg 2019; 21: 442–448.
assessed by haemodynamic responses. J Feline Med Surg 2016; 84 Ellis JJ, Stryhn H and Cockram MS. Effects of the provision
18: 673–678. of a hiding box or shelf on the behaviour and faecal
68 Lascelles BdX, Henry JB, Brown J, et al. Cross-sectional study glucocorticoid metabolites of bold and shy cats housed in
of the prevalence of radiographic degenerative joint disease single cages. Appl Anim Behav Sci 2021; 236. doi: 10.1016/
in domesticated cats. Vet Surg 2010; 39: 535–544. j.applanim.2021.105221.
69 Tanaka A, Wagner dC, Kass PH, et al. Associations among 85 davis H, Jensen T, Johnson A, et al. 2013 AAHA/AAFP fluid
weight loss, stress, and upper respiratory tract infection in therapy guidelines for dogs and cats. J Am Anim Hosp Assoc
shelter cats. J Am Vet Med Assoc 2012; 240: 570–576. 2013; 49: 149–159.
70 Solbak S, Epstein SE and Hopper K. Influence of needle 86 Raj dM, Ravi K and Sankar S. A study on preanalytical errors
gauge used for venipuncture on measures of hemostasis in in EDTA blood collected for cell counting. J Evol Med Dent Sci
cats. J Feline Med Surg 2019; 21: 143–147. 2017; 6: 1788–1793.
71 Reynolds BS, Boudet KG, Faucher MR, et al. Comparison of 87 Quimby JM, Benson KK, Summers SC, et al. Assessment of
a new device for blood sampling in cats with a vacuum compounded transdermal mirtazapine as an appetite stimu-
tube collection system – plasma biochemistry, haematology and lant in cats with chronic kidney disease. J Feline Med Surg
practical usage assessment. J Feline Med Surg 2007; 9: 382–386. 2020; 22: 376–383.
72 Suresh N, Koteeswaran V, Natanasabapathy V, et al. Needle 88 Poole M, Quimby JM, Hu T, et al. A double-blind, placebo-
gauge influences pain perception during intrapulpal anaes- controlled, randomized study to evaluate the weight gain
thesia – a randomized clinical trial. Eur Endod J 2020; 5: drug, mirtazapine transdermal ointment, in cats with
191–198. unintended weight loss. J Vet Pharmacol Ther 2019; 42: 179–188.
73 Majcher K, Eichorn d, Waldner C, et al. Assessing the sharp- 89 Bessant C, dowgray N, Ellis SLH, et al. ISFM’s cat friendly
ness of hypodermic needles after repeated use. Can Vet J principles for veterinary professionals. J Feline Med Surg 2022;
2018; 59: 1112–1114. 24: 1087–1092.

Available online at jfms.com, icatcare.org/cat-friendly-guidelines, catvets.com/environment

and bit.ly/JFMSCatFriendly

Article reuse guidelines: sagepub.co.uk/journals-permissions JFMS CLINICAL PRACTICE 1163