Care of the recumbent or paralysed cat
Canine and feline patients may become recumbent or paralysed for a variety of reasons, but their basic nursing requirements will be similar. Caring for recumbent or paralysed patients can be extremely time consuming, hard work and emotional, but also very rewarding.
What causes recumbency/paralysis?
Recumbency may be defined as a body in a lying down or resting position.
Paralysis is often associated with a clinical condition affecting either the nervous system or the musculoskeletal system. The severity of the paralysis may affect the hindlimbs only (paraplegia), one side of the body (hemiplegia) or all four limbs (quadriplegia). Depending on the degree of immobility, the animal may require round the clock nursing care and supportive therapy. The clinical status of the patient may be temporary or permanent depending on the diagnosis.
Unfortunately, the status of prolonged recumbency comes with associated complications such as decubital ulcers. Recumbent patients, both canine and feline, are vulnerable to decubital ulcers, although cats are less vulnerable due to their smaller body weight. On their own, decubital ulcers are challenging. However, combined with a recumbent patient, they require the most vigilant and dedicated supportive nursing care to maximise the patient's recovery.
What are decubital ulcers?
Decubital ulcers can be defined as a localised injury to the skin or underlying tissue, usually over a bony prominence, as the result of unrelieved pressure.
Decubital ulcers vary in severity from patches of discoloured skin to open wounds with or without exposure of underlying muscle and / or bony tissues. They can result from a large amount of pressure over a short period of time, or a small amount of pressure over a prolonged time.
Decubital ulcers can be classified as Grades I – IV determined by the depth of injury to tissues overlying the bony prominence / prominences.
What can I do to help my cat and prevent decubital ulcers?
Early prevention is key!
It may seem obvious but always ensure that food and water is within easy reach.
Cats that are paralysed or recumbent are unable to move away from urine and faeces, so cleaning any urine of faeces off the patient promptly and ensuring they are dry will also help to prevent urine scalding. Applying a barrier cream to the inside of the cat's back legs, perineal and perianal region will help to protect the skin from urine scalds.
A closed collection urinary system should be considered or careful bladder management.
Grooming frequently allows the opportunity to thoroughly assess the skin surface and identify any irritation, scalding or the beginnings of a decubital ulcer. It has the added bonus of providing mental stimulation and quality bonding time.
Ensure clean, padded, and absorbent bedding and mattresses are provided. Bedding that will allow the urine to wick away and keep the environment clean and dry is best; Vetbed is good for this purpose and should be changed regularly. Be careful to check the underneath surface of the vetbed to assess for soiling.
Limb/head supports should be used to avoid pressure, shearing forces or friction over 'at risk' areas. Rolled towels/blankets and foam wedges are ideal to support patients in positions. Inflatable rings can be used for heavier body weight loading areas.
The patient's position should be rotated between lateral recumbency (lying on right/left side) and sternal (chest) positioning every 2-4 hours to reduce vulnerability to decubital ulcers, maintain skin integrity and provide mental stimulation and carer contact and bonding.
Massage affected limb(s) to maintain circulation and lymphatic draining. Passive range of motion in each joint can be performed as well.
Limit bed rest where possible - take frequent opportunities to move position and exercise using mobility devices or hoists.
Mental stimulation and psychological support is as important as physical support for recumbent patients. When possible, move the patient to different areas of the home preferably where there is activity and visual stimulation and the opportunity for affection.