Monitors are not only essential for procedures, but they can be part of your customers’ routine practice

With the number of procedures and surgeries being performed in vets’ offices today, it’s clear that monitoring is a must. “Studies have shown that more than 70 percent of anesthesia complications are detected by monitoring equipment before the problem is recognized by trained technicians,” says Andrew Schultz Jr., president and CEO, Sharn Veterinary Inc., Tampa, Fla. “That may be just a second or two, but sometimes, seconds count.”

While it’s true that many vets have some kind of monitor in their offices, sales reps can’t take too much for granted. For example, vets need to know that hand-me-down monitors from a medical doctor’s office, or a monitor meant for the medical market, might not be the most appropriate piece of equipment for the veterinarian market, says Schultz. What’s more, they need to know that monitoring multiple parameters is the best way to ensure the well-being of anesthetized animals.

“We have a tremendous opportunity to teach veterinarians to improve patient care through monitoring,” says Schultz.

Risks of anesthesia

Although sales reps aren’t experts on physiology, they should have some knowledge of the potential risks related to anesthesia, and the ways in which monitors can help to reduce and prevent them.

The greatest of those risks is hypotension and the cardiovascular problems that some animals - particularly, older ones - might have that predispose them to hypotension, says William Muir, DVM, PhD., DACVA, DACVECC. Hypotension, or low blood pressure, can to lead to oxygen deprivation in the brain and other vital organs, leading to shock and death. An industry consultant, Muir was formerly affiliated with Ohio State University, and is the co-author of several books, including The Handbook of Veterinary Anesthesia and Equine Anesthesia.

Veterinary studies have shown that as many as 25 percent of patients are hypotensive during surgery. In many cases, blood pressure simply isn’t being monitored.

The second greatest risk is hypoventilation, which is more insidious than hypotension, says Muir. Although an animal might appear to be breathing normally, there’s a chance that the exchange of oxygen and carbon dioxide is inadequate. “The animal might be getting into trouble, because there may not be actual functional breathing taking place,” he says. “By the time something goes wrong, usually the animal has been in a precarious state for many minutes.” Without adequate oxygen, or, conversely, with a buildup of carbon dioxide in the blood, the blood becomes more acidic, and cellular function is impaired, he says.

Anesthesia-related problems can manifest themselves not only during the procedure, but after discharge as well. Human studies have shown that the second and third leading causes of death within one year after surgery (following the condition that led to the surgery in the first place) are anesthesia depth and anesthesia duration, says Schultz. “There’s no way to measure the depth unless you’re monitoring end tidal Co2 [that is, the level of carbon dioxide in the air exhaled from the body] and blood pressure,” he says. “So we have a tremendous opportunity in veterinary medicine to turn that around and discuss these key issues.”

Parameters

Monitors today can detect all five vital parameters recommended for human patients by the American Society of Anesthesiology, says Schultz: EKG/heart rate, temperature, oxygen saturation of hemoglobin in blood, blood pressure and end tidal CO2.

“Not everyone is monitoring all these things,” says Muir. “But they should. In today’s world, there are enough multiparameter monitors that have been made practical, versatile and inexpensive enough that if you’re going to do anesthesia in surgery routinely — for procedures that [last] more than five or 10 minutes, then yes, those things should be on your list.”

That said, multiparameter monitors aren’t cheap, so sales reps must speak with vets in terms of saved lives, reduced perioperative complications, revenue opportunities and return on investment.

Vets who are new to monitoring might be well-advised to start out slowly, says Schultz. That is, they might want to buy a monitor with just one or two of these parameters. “You don’t want to overwhelm them,” he says. That being the case, the sales rep should consider selling the vet a simpler - and cheaper - monitor, perhaps one that monitors blood pressure only. With the revenue that the vet collects with that machine, he or she can eventually upgrade to a full multiparameter model. 

Vet-specific monitors

Sales reps need to walk their customers through some other considerations as well. For example, monitors made for the human market must pass muster with the U.S. Food and Drug Administration, whereas those for the vet market do not. Unfortunately, that means that unscrupulous manufacturers can dump inadequate monitors into the vet market. “That has hurt the reputation of vet-specific monitors, to a certain degree,” notes Schultz. “They were sold as promised, but now, the vet is saying, ‘This thing doesn’t work.’”

At the same time, vets who purchase monitors manufactured for the human market must put up with menus or manuals that use words like “neonate” and “adult.” Worse, says Schultz, they might have to put up with a pulse ox probe designed to clip onto a fingertip instead of a tongue; an EKG algorithm that is calibrated for the human heart instead of that of an animal; high CO2 sidestream sampling rates of 140 ml/min or more, which risk outpacing the tidal volume of the small veterinary patient; or blood pressure that doesn’t work on cats.

Sales reps must also discuss with their customers whether an invasive or non-invasive monitor is best. Simply put, invasive monitors enter the body, non-invasive ones do not. Invasive, or direct, monitoring, is more accurate than non-invasive monitoring, says Muir, who offers blood pressure measurement as an example. “The reason is, you’re measuring pressure from within the artery,” whereas a non-invasive device (for example, a blood pressure cuff on the outside of the arm) uses a computer algorithm to interpret the strength and duration of the pulse it detects, he says.

Indirect methods are fairly accurate for determining systolic blood pressure, that is, the pressure recorded in an artery due to the heart’s contraction, but they are not so accurate with diastolic and mean pressure. (Diastolic pressure represents the pressure in the artery when the heart relaxes between beats.) That said, it is usually only in the sickest animals where the diastolic and mean pressures fail to follow the same trend as systolic, he adds.

“The trend and preference is toward non-invasive monitors,” says Schultz. However, some practices, in an effort to “clean up the work space,” forego the various external connections to the patient (e.g., ECG leads and temperature probes) in favor of a simpler (and less cluttered) esophageal probe. Though the Sharn monitors are non-invasive, the company offers such probes. “The desire is to give the vet the simplest means of getting the most accurate and reliable measurements as possible,” says Schultz.

Revenue opportunities for the vet

One final note: Monitors have many applications other than procedures. In fact, they can become part of the veterinarian’s routine practice, such as senior wellness exams or feline hypertension screenings, for which he or she can collect revenue. Sometimes it’s up to the sales rep to point them out.

“When I’m talking to reps, I tell them to make the business case to their customers as to why they should be monitoring,” says Schultz. “Vets are humanitarian; they’re interested in providing the best patient care. But they have to look their client in the eye and convince them why they need to spend the extra 10 or 20 dollars for monitoring. It comes down to the sales rep arming them with the information to do that, and teaching them they can. Incorporating a comprehensive monitoring business plan into a vet clinic can be shown to add between $100,000 and $500,000 to the value of the practice.

“If vets are going to do routine blood pressure measurement, not only can they use that to market their business and differentiate themselves from the vet down the street, but they can use it as a customer driver that will ultimately help the patient population. If they get baseline blood pressure readings and charge for a routine blood pressure check once a year, they’ll catch things quicker, and they’ll develop a database and relationship with clients that shows them they’re on the cutting edge of practicing veterinary medicine.”