ST. GEORGE’SUNIVERSITY
INISTITUTIONAL ANIMAL CARE AND USE COMMITTEE
ANIMAL CARE AND USE FORM
FOR ANIMAL CARE AND USE IN RESEARCH
Application No:______R
For Office Use
Pain Cat. (See attached appendix/categories):______Fund Source:______
Date submitted for funding:______Submission type: Initial - Revision – Continuation (circle one)
P.I.:______Department:______
Project Title (in full):______
PROJECT CATEGORY (tick one):
Independent ContractCollaborative Survey Component of higher
ResearchResearch Research (specify) degree (specify)
1.0INFORMATION FOR GENRAL COMMITTEE REVIEW
Species to be Used Approx. # of Animals
Animal Source(s)
(describe in details)
Holding Facility (Arrangements)
Is animal use limited to euthanasia followed by tissue harvesting? YES:______NO:______
Name the faculty members who will be supervising / performing these procedures?
______
List all other faculty, technical employees, and grad. students or assistants that will be directly involved in carrying out the animal procedures, with duties relating to animal care and use, and previous experience/training with the use of this animal species.
______
State the objectives of the project and describe all procedures, techniques or condition, which will be used, on the animals involved in this study.
Brief Abstract of Experimental Purpose: (in LAY terms), and describe how this project will benefit the health and/or well being of animals and humans:
2.0SPECIFIC CONDITIONS OF ANIMAL USE REQUIRING SPECIAL CARE
(Pain, injury and distress to animals must be limited to that which is unavoidable to conduct meaningful teaching, analgesics, anesthetics and tranquilizing drugs must be used appropriately to minimize those conditions.)
Will substance administered cause animal pain, discomfort, or distress? YES:____NO:_____
Are invasive procedures used to collect tissue or body fluids from the live animal (i.e., orbital sinus blood collection; biopsies of skin, lymph nodes, kidneys, intestinal or respiratory tract:
Cystocentesis/transcutaneous urine collection; cutdown procedures of the skin for access to vessels for catherization)? YES:______NO:______
If surgery is to be performed in what facility? (Give facility name and room)
List the anesthetics, tranquilizers, sedatives, and analgesics to be used during the above procedure(s). Indicate dose(s) and route(s) of administration.
Is aseptic technique followed including the use of sterile gloves, instrument, and aseptic scrubbing of the surgical site? YES:______NO:______
Describe method(s) of assessing pain or discomfort during the above procedures, and describe monitoring and supportive care provided during surgery:
Other drugs or medications to be given during the above procedure(s):
Analgesics (indicate doses and route of administration) and any specialized care to be provided after implementation of the procedure(s) described in 1.0 above:
If surgery is involved, describe post-operative care: (a) facility/room where recovery is to take place; (b) physiologic support (i.e., fluids, heating blanket); (c) individual(s) responsible for providing post-op monitoring and care; (d) endpoint at which intensive post-op monitoring is discontinued; and (e) how will post-operative complications be handled during the normal workday, weekends, holidays, and after normal duty hours:
3.0DISPOSAL OF THE ANIMAL(S)
If animal is to euthanized, by what methods and/or euthanizing agents that will be administered? Include dosage(s) of euthanizing agents:
How will animal carcasses be disposed of: Incineration:______Rendering:_____Other:______
If transferred, to where will they be transferred? Records indicating procedures, medications, etc., must accompany any animal that is to be transferred.
4.0PLEASE INCLUDE HERE ANY ADDITIONAL INFORMATION WHICH IS RELEVANT TO IACUC REVIEW FOR HUMANE TREATMENT OF THE ANIMALS INVOLVED.
Notes: Records of the acquisition, final disposal, all treatments/procedures for dogs/cats/rabbits/non humane primates should be kept on file.
5.0SIGNATURE/COMPLIANCE ASSURANCE (to be completed by the P.I.)
Please read the following three statements, and initial the space preceding each, if you are in compliance.
______As Principal Investigator, I assure that the proposed activities do not unnecessarily duplicate activities.
______I have considered alternatives (if any) to all of the above-listed procedures that may cause more than momentary slight pain or distress.
______I assure that the personnel involved in all proposed procedures possess adequate qualifications and training to responsibly conduct the procedures involved.
Please sign and date below using full signature.
The signature of P.I. confirms that all information above is correct, and that he/she has read and is in compliance with the humane care and use of animals in research.
______
PRINCIPAL INVESTIGATOR / DATE
Action of the St. George’s University IACUC:
Meeting Date:
IACUC Recommendation Vote:
The undersigned have evaluated the care and use of animals described in this protocol and find the procedures described appropriate and acceptable, and that the P.I. and staff, have the necessary training and experience with species to be used in order to provide humane, scientifically sound care. Comments and dissenting views may be noted below the approval signatures.
______
Signature of University Veterinarian / Date
______
Signature of IACUC Chairperson / Date
THE FOLLOWING CATEGORIES (A to D) PROVIDES EXAMPLES OF THE POTENTIAL FOR PAIN OR DISTRESS INVERTEBRATE ANIMALS TO BE USED IN RESEARCH OR TEACHING
Please place and “X” on the line(s) indicating the categories
you would expect during your experiment/procedure.
CATEGORY A
______Procedures on vertebrate species that are expected to produce little or no discomfort
______Standard housing of animals
______Intramuscular, intraperitoneal, or intravenous injections; or intravenous blood collection
______Observing natural behavior
______Behavioral testing without noxious stimuli
______Experiments on completely anesthetized animals which will be euthanized before regaining consciousness
______Tattooing and other cutaneous markings (degree and duration must be short, e.g. ear punching)
______Wingbanding
______Other (explain below):
CATEGORY B
______Experiences involving some discomfort (or short lasting pain) to vertebrate species.) Anesthetic agents and analgesics are not contraindicated and may be used.
______Long term chair or stock restraint of animals adapted and pre-trained to the restraint
______Imposition of environmental (temp, humid, light, noise) and nutritional conditions outside those naturally experienced
______Behavioral testing involving noxious stimuli where escape is possible (e.g. electrical shock, chemical stimuli)
______Surgical procedures resulting in slight postoperative discomfort (e.g. cutaneous biopsies, cutaneous wounds)
______Markings involving more pain, e.g. toe clipping
______Exposure of blood vessels and catheter implantation under local anesthesia
______Gonadectomy (male) by acceptable veterinary standard methods
______Infections which produce minor systemic alterations
______Intracardiac blood collection
______Orbital sinus blood collection
______Intestinal biopsies under anesthesia
______Social isolation or crowding
______Other (explain below):
CATEGORY C
______Experiments involving significant but unavoidable pain or distress to vertebrate species. P.I. should explore alternative designs to ensure that unavoidable distress is minimized. If surgery is involved, general anesthetics must be used, and post- operative analgesics are highly recommended. If procedure involves distress, tranquilizers may be required.
______Noxious stimuli where escape is not possible
______Electrical shock (reinforcement)
______Injection of agent inducing excessive inflammation or necrosis (Bradley-Kinin, Freunds adjuvant, certain infect. agents)
______Chair or stock restraint of unadapted animals (use tranquilizing agent)
______Drug or radiation toxicity testing
______Induction of behavioral stress to test its effects
______Major surgical procedures resulting in significant post-op. Discomfort or functional deficit
______Oophorectomy-hysterectomy
______Maternal deprivation with substitute of primitive artificial surrogate
______Infections which produce major systemic alterations
______Induction of aggressive behavior leading to self-mutilation
______Intraspecific aggression
______Fracturing bones
______Cage restraint of wild-caught unadapted species
______Other (explain below):
CATEGORY D
______Procedure resulting in severe pain in conscious unanesthetized, untranquilized animals, in which the use of analgesics (pain relieving drugs) would adversely affect the experimental result due to the necessary design of the experiment. P.I. must provide strong justification for withholding analgesics and indicate the significance, necessity and value of the research
______LD-50 or ED-50 determinations
______Draize testing (skin or corneal corrosive testing)
______Burning or Freezing on Unanesthetized animals
______Inescapable stress, terminal stress
______Second or subsequent surgical procedure where animal is not euthanized, but is recovered
______Recovery of consciousness after severe trauma caused under anesthesia, with no pain relief administered
______Severe deprivations
______Maternal deprivation – no surrogate
______Excessive water or food deprivation leading to malnutrition
______Infections which produce life threatening systemic alterations
______Use of muscle relaxants or paralytic agents (succinylchloride or curariform drugs) for surgical restraint without anesthetics sufficient to produce unconsciousness
______Other (explain below):
1