ST. GEORGE’S UNIVERSITY
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
Research
1.0
Contract
Research
Collaborative
Research (specify)
Survey
Component of higher
degree (specify)
INFORMATION 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?
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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.
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1
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:
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2.0
SPECIFIC 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:
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3.0
DISPOSAL 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.
4.0
PLEASE 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.
5.0
SIGNATURE/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
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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
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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
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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
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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):
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CATEGORY C
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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 postoperative 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
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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):
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