Show your customers that hand-me-downs and medical monitors will not ensure the safety of their patients

While it is generally safe to anesthetize animals during surgery, there are risks involved. For instance, hypotension, or low blood pressure, can lead to oxygen deprivation in the brain and other vital organs, causing shock and death. Hypoventilation can occur when the exchange of oxygen and carbon monoxide is inadequate. Although the animal may appear to be breathing normally, inadequate oxygen or a build-up of carbon dioxide in the blood can cause the blood to become more acidic, leading to impaired cellular function. Close monitoring can better equip veterinarians to protect their patients from these and other complications. When distributor reps know the ins and outs of monitors, they can ensure their customers are at the top of their game when it comes to patient safety.

How they work
Monitors today can detect all five vital parameters recommended for human patients by the American Society of Anesthesiology. These include:

• Blood pressure. Measures indirect cardiac output and the mechanical function of the heart, as well as anesthetic depth. Veterinarians can benefit from monitors that provide animal-specific algorithms, a broad heart range to accommodate large and small animals, and a wide selection of small animal cuffs.
• End tidal CO2. Provides instant feedback on the patient’s ventilation status.
• EKG. Looks at the rate and rhythm of the heart. Lead placement is critical. For instance, as cats age, the angle of their heart changes, and the vet may not get the same waveform as with a young kitten. In addition, vet-specific algorithms and multiple filters to eliminate baseline noise are also important.
• Temperature. Hypothermia, or a drastic drop in body temperature, presents a danger to any animal. Some breeds of dogs also are susceptible to hyperthermia, or an extremely elevated temperature.
• SpO2 or oxygen saturation of hemoglobin in the blood. Newer digital technology reportedly mitigates artifacts caused by patients moving (e.g., shivering or panting) or poor perfusion. A variety of sensors are available, including tongue clips and reflectance sensors.

While all of the five parameters provide information critical to a patient’s well-being, blood pressure and end tidal CO2 enable the veterinarian to be proactive and prevent any unnecessary complications. Normal blood pressure indicates that the patient’s heart is working well. Similarly, monitoring end tidal CO2 helps measure pulmonary function. The veterinarian can identify a detrimental situation within a couple of breaths, before it results in cardiac arrest. EKG, temperature and oxygen saturation are important as well, but have slower feedback.

Invasive vs. noninvasive blood pressure
Invasive blood pressure monitoring, or direct arterial pressure monitoring, in which a catheter is inserted directly into the patient’s artery, is more accurate than non-invasive monitoring. It measures pressure from within the artery using a computer algorithm to interpret the strength and duration of the pulse. However, it is not practical to use this approach during most surgical procedures, according to experts.

Non-invasive or indirect methods are relatively accurate and widely accepted for determining blood pressure. Two primary indirect methods include Doppler and oscillometry.

Doppler devices - manual systems comprised of a pressure cuff and an acoustic transducer - do not provide much information beyond the patient’s systolic pressure. The vet or assistant must shave a spot on the animal’s limb and apply ultrasonic gel and the transducer, which is connected to headphones. Then, the user pumps up the cuff, which cuts off the patient’s blood flow. The pressure is let out, and the moment at which the blood begins to flow again is the measure of systolic pressure.

Although early human oscillometric devices did not provide reliable reading in smaller veterinary patients, today’s more vet-specific systems are said to be automatic, fast and efficient, even with cats and dogs, and they are growing more popular among veterinarians for measuring blood pressure. Whereas a Doppler device requires the veterinarian’s assistant to manually take the patient’s blood pressure every three to five minutes, most oscillometric devices can be cycled to measure blood pressure at periodic intervals. In addition, they include alarms that are pre-set to alert the veterinarian if the patient’s blood pressure becomes too high or too low. Oscillometric systems are hands-off and the vet can focus on the surgery. Whether veterinarians opt for Doppler or oscillometric technology, the distributor rep must help his or her customers select the right cuff sizes for patients to ensure the greatest accuracy.

Just as reps should understand the difference among the various monitoring technologies, so too should they recognize - and convey to their customers - that monitors designed for humans do not perform as well on animals. Because animal heart rate and blood pressure are monitored differently than human heart rate, it is important that veterinarians rely on systems with animal-specific algorithms.

Cost and value
Monitors vary in price, depending on how comprehensive they are and whether or not they are automatic. Although some veterinarians may prefer to add different monitors to measure different parameters, one comprehensive, automatic monitor can be much more efficient. All of the data is supplied in one place, and fewer wires must be connected. And, in the end, it may be more economical, as the veterinarian must purchase less equipment.

An automatic monitor that measures all five parameters can cost between $5,000 and $9,000. Veterinarians unable to afford such a monitor may opt to start out with a blood pressure monitor designed for both the exam room and the OR. By establishing an efficient blood pressure screening program, the practice can generate additional revenue and at some point buy a pricier, more comprehensive monitor.

How to sell
As with many products, distributor reps should explore their customers’ needs before suggesting a monitor to best meet them. Find out what the veterinarian generally monitors or would like to monitor. Explain the importance of using technology designed specifically for animals, rather than using human hand-me-downs. And find out if your customers understand the importance of end-tidal CO2.

Some of the most common objections veterinarians have to purchasing new monitors involve cost. Some veterinarians believe their human monitor works just as well on animals. Others are nervous about replacing several older pieces of monitoring technology with a newer all-in-one model because they fear that if a comprehensive system fails, they will be without any monitoring technology. True, monitors can fail, but this often is due to user error or because accessories wear out. Manufacturers generally provide a loaner program, so it is up to the distributor rep to keep his or her customers apprised of this.

Accessories
Monitor accessories play a critical role in the monitor’s performance and, as such, should be replaced before they wear out. In most cases, the cost of replacement is reasonable:

• Blood pressure. Blood pressure cuffs should be replaced when the Velcro wears out. Veterinarians should not rely on tape to hold cuffs together, particularly since it can lead to inaccurate readings, and a new cuff costs roughly $6.
• End tidal CO2. Veterinarians should replace the adaptor for the main stream CO2 and periodically replace the sampling line for the side stream CO2. The replacement cost is $20 or less.
• ECG. As the ECG clips and wire leads fray or break, they, too must be replaced.
• Temperature. Temperature probes generally are durable and last a long time. Eventually, though, they too may have to be replaced.

Educating your customers on the value of monitors can help them save lives, increase revenue and improve the reputation of their clinic.

Editor’s Note: Vet-Advantage would like to acknowledge the contribution of Sharn Veterinary Inc. (Tampa, Fla.), a division of Midmark Corp.