- Restraint collars provide the clinician with a non-pharmaceutical method to prevent self-injury.
- Without proper use and monitoring, collars can do more harm than good.
- The most common restraint collar is the Elizabethan or e-collar.
Restraint collar devices are also referred to as ‘neck collars’ or ‘safety collars’. The most common restraint collar is the Elizabethan collar (or e-collar). Many different manufacturers sell e-collars and modified e-collars designed for different species and for specific purposes. Restraint collars have numerous clinical applications. Restraint collars are widely used to prevent undesirable behaviors and self-injury. Clinically, veterinarians have used restraint collars in birds to prevent self-mutilation or self-trauma and to prevent animals from removing intravenous catheters, bandages, and other external devices.
Types of restraint collars
The type of restraint collar used depends on the purpose of the collar as well as the type of animal to which it is applied.
Elizabethan collars or e-collars are named after their resemblance to the white starched lace collars worn by Queen Elizabeth I and her subjects (Fig. 1). They are also called flange collars because of their projecting rim or edge. The flange around the neck is known as the neck or inner flange; the outer projecting edge or rim of the collar is called the outer flange. E-collars function differently depending on their direction of placement (i.e., cranial or caudal). Cranially directed e-collars (like the original lace collars worn in Elizabethan times) prevent an animal from using its mouth to disturb anything on the torso, and prevent any scratching or disturbance of head or neck structures. Some animals are more agile than others and will manage to get around a cranially placed e-collar either necessitating a larger collar or, with birds, directing the e-collar caudally (Fig. 2). If the caudally directed e-collar is very large, the bird will need to grow accustomed to the collar. Initially, it is common for a parrot to walk within the inside of the collar with a paralyzing forward motion until it adjusts to the collar and ‘learns’ to walk again.
Cylindrical or neck collars
Acrylic, spherical, pillow, pipe and foam collars are typically used to keep an animal’s neck in extension so that it cannot easily bend to reach the neck, thorax, or abdomen. Cylindrical collars prevent nibbling at sutures, broken skin, and skin tumors and prevent feather picking. The pillow, pipe, and foam collars are lightweight and often can be custom cut to the desired length. The spherical and acrylic neck collars are used in birds and require special instructions for application and removal. Modifications can be made to acrylic and spherical restraint collars if neck wounds are present. For example, small holes can be drilled into the plastic with a Dremel tool or drill to provide ventilation.
Combined cylindrical and Elizabethan collars
A hybrid collar made of an acrylic tube collar in combination with a vinyl Elizabethan collar is used in birds. Different size acrylic collars are available to join to different size Elizabethan collar extensions.
General issues with restraint collars
Despite descriptions in the literature of animals that adapt well to e-collars well and can eat, drink, and sleep normally, this is not always true. Placing a restraint collar on an animal has the potential to induce a considerable amount of stress. Even though animals may appear to adapt to the collar with time, one study in rats showed that e-collars caused depression of feed intake and loss of bodyweight. In sick and post-surgical animals, the effect of stress should be seriously considered before restraint collar application.
The adjustment period for adapting to a restraint collar is different for each animal. Some appear off balance, fall, roll on their backs, kick with their legs, or lie completely still during the immediate adjustment period. Other animals will adapt right away, and yet others will take anywhere from half-day to days. A veterinary professional should monitor the adjustment period. Collar application should be scheduled early in the day so that the animal can be monitored throughout the day. Placing a restraint collar on an animal and leaving it unattended is never acceptable.
Birds can develop life-threatening hyperthermia from shock induced by the stress of a collar. Some animals hyperventilate. It is not unusual for an animal to rest with its head and neck ventroflexed for hours. In some cases, this is an indication of depression while in others it may indicate that the weight of the collar is too heavy for the individual.
If the collar is too big, the animal can injure itself further or become entrapped. If the e-collar is too loose, the animal may get its feet and or limbs stuck between the inner flange, and its neck. If the e-collar is too tight, the animal can choke or the neck can become abraded and ulcerated. As a rule, it should be possible to get one finger in between the e-collar and the neck of the animal, and yet the e-collar should be able to rotate 360 degrees with minimal difficulty.
It is important that no sharp edges are left on an e-collar. Sharp edges around the neck flange result in neck wounds that can be serious. Attempts should always be made to pad the inside edge of the e-collar or to place a thick layer of tape so the edge is blunt. Many commercial e-collars come with the inner flange padded with material or soft vinyl foam. If the outer flange of the e-collar is sharp, irritation and cuts can occur on the wings. If modifying an avian acrylic collar by drilling holes into the plastic, be sure to file any sharp edges that exist so the bird does not injure itself on any sharp plastic.
If an e-collar is put on an animal that is then placed among other con-specifics fighting may result. Typically, animals with e-collars should be housed individually or only with other animals that also are wearing e-collars. If the collared animal is to cohabitate with others, then introductions must be supervised and occur in neutral territory.
It is imperative that an animal is able to reach food and water with the e-collar in place. Otherwise, an assisted feeding schedule must be implemented. Changes in the environment such as altering food containers and water sources may be necessary. The animal may need to be shown how to acquire food and water. Daily recording of feed eaten and bodyweight may be necessary to ensure the animal is maintaining feed intake and not losing weight. If necessary, alter the cage to ensure the animal will not get caught or stuck anywhere.
Manufacturers usually provide instructions with their restraint collars. Reading all information that accompanies each collar is critical in order to be prepared when working with the animal. If the person monitoring the animal is not the same person who applied the restraint collar it is important that the individual is trained in removing it in the event of an emergency. Some restraint collars, such as avian spherical collars require tools to remove; other restraint collars require experience before the collar can be quickly placed and removed.
It is imperative that the proper type of collar (e.g., Elizabethan collar, cylindrical collar, etc.) is chosen based on purpose and species. But choosing the right type of collar is only the first step toward achieving the desired results. Here, we discuss tips and considerations for the use of restraint collars while avoiding injury and undue stress to the animal.
Whenever possible, an animal should be preconditioned to the restraint collar. Preconditioning is important for animals undergoing surgical procedures. If the animal becomes accustomed to the collar before the surgical procedure recovery is generally much smoother and less stressful. In some cases, application of the collar for several short periods or multiple days in a row is sufficient. In other cases, the collar can be applied one week before the surgery and left in place until recovery is complete.
Although guidelines exist for appropriate sizes for different species, it is difficult to know which collar will be the best size for any individual until it is actually placed on the animal. A small collar may be acceptable for one animal, and yet a larger collar may be necessary for a different animal the same type and size. The animal’s agility, problem solving skills, and physical condition will dictate the size of the collar. If a bandage is placed around the neck, for example due to a neck wound, then a larger size than normal may be required. If the goal is to prevent mutilation of a foot wound, the collar will need to be larger than if the wound is on the abdomen, regardless of the species.
Multiple sizes must be available during the collar fitting. It may be necessary to go through 3 to 5 different collar sizes before finding the appropriate fit. It may even be necessary to place the collar on the animal and then observe it for 24 hours. During the first few hours, the animal may be so stressed that it does not disturb the collar. As the animal adjusts to the collar, it may then attempt to destroy it. Often, after a period of a couple of hours or a couple of days, modifications must be made and the size of the collar might require changing.
Placing the collar
Placement of the collar usually requires two people. One person restrains the animal and the other places the collar. The animal should be held with its neck in extension and the collar applied mid neck. Be sure that the feathers do not get stuck in the collar as it is fixed in place. It may be necessary to hold the animal’s mouth closed to avoid being bitten while placing the collar. Be sure to observe for any signs of respiratory distress if it is necessary to hold the mouth closed during collar application.
In some instances, it is better to place the collar while the animal is sedated. If the animal is upset or agitated and restraint is difficult or dangerous, it may be advisable to anesthetize the animal before placing the collar. The sedated or anesthetized animal must be monitored closely to be sure the ability to breathe is not compromised and that collar placement is not too tight. It is important to realize that the sedated animal will be unable to manifest clinical signs of distress and should be carefully observed.
Fixing the collar in place
There are many ways to fix a collar in place. Some of the collars are equipped with snaps, which make them easy to place and remove as necessary. Acrylic collars come with plastic rivets or screws to hold them in place. Spherical collars have a patented locking system that secures them in place (Fig. 4). Some collars are held in place by Velcro closures; these tend not to be secure so additional fixation with transparent or packing tape is recommended. If the tape is clear, the animal is less likely to see it and focus on removing it. Some collar suppliers recommend using staples but these present health hazards that should be avoided. A dislodged staple can puncture an animal or the animal may ingest the staple. In some cases, the collar can be glued in place with cyanoacrylate bond; this should only be done if you are certain that the fit is correct and the glue will not get on the animal. If glue will be applied, it is ideal to anesthetize the animal first to reduce the risk of complications. The glue (or fumes emitted during the curing process) should not cause any respiratory or ocular irritation since it will be used close to the head.
Once the collar is fixed in place, the animal should be released from restraint into a safe environment. The ideal situation is a cage that does not have bars or any other accessories such as perches, dishes, hide boxes, etc. If possible, place a soft towel in the bottom of the cage. Expect that the animal is going to thrash about and contort itself into many positions while adjusting to the collar. Some animals will adjust quickly, some struggle, panic, roll over on their back, and others refuse to accept the collar. The adjustment period is variable and can range from hours to days.
A veterinary professional should always be accessible during periods of collar acclimatization. In some cases, for the safety of the patient, a judgment call is necessary to remove the collar. Always evaluate the color of the animal’s mucus membranes before and after collar placement. This will be useful when assessing the animal’s ability to oxygenate. An animal can induce serious self-injury when thrashing about; especially if it already has exposed skin from previous trauma or procedure. In some cases, the affected limb or body part may need to be bandaged until the animal becomes accustomed to the collar.
Collar placement should occur early in the day so that the animal can be monitored throughout the day and assisted as necessary. A collar should never be placed on an animal at the end of the day unless 24-hour supervision is available.
In some cases, food can be offered to the animal while it is adjusting to the collar. Many will direct their frustrations from the collar onto the food item. The food may be ingested or simply manipulated. Food can provide an excellent distraction while adjusting to collar placement. Water bowls should only be offered periodically by hand until it was certain that the animal will not fall into the water and drown. In birds that are habituated to them, sipper tubes are an ideal and safe way to provide water for animals wearing restraint collars. As a precautionary measure subcutaneous fluids can be administered at the time of collar placement to prevent dehydration. It is not unusual for an animal to have decreased water consumption for a period of time after collar placement. If the animal becomes severely depressed due to the presence of the collar, it will be necessary to assist it with eating and drinking. If the signs of depression do not subside within 24 to 48 hours, an alternate measure of restraint should be considered.
In some instances if an animal with a collar is frantic, mild sedation (e.g., diazepam) is helpful to calm it. As the sedative slowly wears off, the animal will awaken gradually while becoming accustomed to the presence of the collar.
Most birds can have a collar placed. However, time and thought must be given to the shape and design of the collar, and to the animal’s ability to escape from or remove the collar.