Equipment Guide 2017, Part 1
From autoclaves to ultrasound: What you need to know.
As we head into the fourth quarter of 2017, many veterinarians will decide whether to make capital equipment purchases to take advantage of Section 179 in the Internal Revenue Service tax code. This provision allows businesses to deduct the full purchase price of qualifying equipment bought or financed during the tax year.
The Today’s Veterinary Business Equipment Guide provides basic insight into major categories and may help guide veterinarians on potential purchases. Technological advances have made many procedures easier to do in the practice, and upgrades to existing equipment may make sense from a clinical or financial perspective.
We hope this is helpful in getting the conversations started.
This is the first in a two-part series. Part 2, published in the December 2017/January 2018 issue, covered anesthesia, laser therapy, centrifuges, dentistry, lighting and hematology analyzers.
Autoclave units ensure proper sterilization, which is essential for a safer work environment and to extend the life of instruments and linens. From disinfection to sterilization, autoclave steam sterilization helps ensure that practice teams work effectively and provide optimal patient outcomes.
Autoclave options vary widely, and each has its benefits and disadvantages related to ease of operation, noise and sterilization. The most advanced models are very quiet and reduce the mess involved with handling contaminated instruments or other tools.
Several important considerations in selecting an autoclave sterilizer include:
- Size or volume: How often is the autoclave being used? High-volume clinics may benefit from a larger unit to increase efficiency.
- Speed and reliability: Clinics requiring quick turn-around may want to consider a faster, more efficient unit, or upgrade from a manual to an automatic/digital autoclave.
- Instrument packaging: Does the practice prefer cassettes, pouches or direct load?
- Cassettes: The handler is less likely to get stuck by contaminated instruments. And cassettes, which typically are prewrapped, may be transferred from the sterilizer directly to the shelf for storage. In comparison, when direct load, unwrapped instruments are placed into the sterilizer, they must be used immediately at the end of the process to comply with current infection-control guidelines.
- Pouches: Pouches require less space, so they may be used with a smaller sterilizer. And they can be transferred directly to the shelf, where sterilized instruments can remain until needed (like cassettes). But since they’re made of paper and plastic, they provide less protection from sticks. Regardless of the type of packaging used, it must be FDA-cleared and indicated for use with a particular sterilant. During sterilization, packaging must permit air removal and steam penetration. Afterward, it serves to maintain the sterility of the sterilized items during storage.
Peripheral equipment for autoclave systems include:
- Steam indicator strips.
- Sterilization pouches.
- Sterilization tubing.
- Surgical pack wraps.
- Instrument marking tape.
- Autoclave tape.
- Autoclave cleaner.
To save precious time when a patient is ill, injured or being prepared for surgery, more practices are using in-house lab testing. Testing in-house increases client convenience and compliance.
With results delivered in minutes during a scheduled appointment, clients can leave with a treatment plan and medications, rather than schedule a follow-up or return to pick up a prescription – or order drugs elsewhere. And, when armed with more information about their animal’s condition, owners likely will follow through with recommended treatment plans, ultimately providing veterinarians with more business.
The chemistry analyzer serves as the in-house lab hub because of the critical data it provides. Chemistry analyzers help quickly assess emergency cases, identify potential risks before surgery and anesthesia, and conduct wellness tests to establish a baseline and measure changes.
As you know, a patient’s liver and kidney functions must be tested before anesthesia is induced because an unknown, underlying condition could put the patient at serious risk of complications or even death. Chemistry analyzers help identify that risk.
Today’s chemistry analyzers offer broad test menus that allow for quick screening of kidney, liver, pancreatic and other metabolic diseases. In fact, nearly every chemistry test sent to the outside lab can be run on an in-house chemistry analyzer. These include blood chemistry tests, electrolytes, urine-protein creatinine ratios, bile acids, T4 (thyroid) and cortisol.
Many chemistry analyzers use dry slide technology, with filtering layers for greater reliability.
- With dry slides, you place the patient’s serum or plasma on top of a slide.
- The analyzer reads the reaction occurring as the test chemicals permeate the filtering layers.
- Interference from lipemia (fatty serum), icterus (jaundice) or hemolysis (red blood cells burst in test samples) is minimized, providing an accurate result.
- Other analyzers offer dry bead systems that provide the reagent stability required, but also incorporate reference laboratory chemistry technology because the endpoint is read manually.
- Many chemistry analyzers provide results in eight minutes, and some require fewer steps.
- Some offer slides preloaded in a clip, which do not need to be unwrapped.
- Some automate the process with an onboard centrifuge, automated calibration and built-in quality control.
Peripheral centrifuge equipment includes centrifuge tubes, microhematocrit/capillary tubes, blood tubes such as serum separators, EDTA, Sheather’s solution, fecal loops, microscope slides, microscope cover slips, test tube rack and differential counter.
DR technology enables veterinarians to produce X-ray images without film, messy chemicals or darkroom processing. Images may be saved and shared electronically. Digital radiography has a number of important advantages over traditional X-ray equipment and film processing.
DR images are captured on an electronic detector or screen, and then converted into a digital format, which is displayed on a computer monitor. Today’s images are practically instant and easier to read, a plus for patients and clients.
Faster, easier imaging means patients spend less time under anesthesia. Precise digital images can be enlarged and enhanced, facilitating more accurate readings and diagnoses. And veterinarians can more easily explain the pet’s condition to its owner. Other benefits include:
- Fewer retakes. Images may be viewed immediately and enhanced.
- Ease of use. Images can be immediately enlarged to see bone or soft tissue in a single exposure.
- Easy storage and transmission.
- Easy to access. Add them to patient records or transmit to other doctors.
- Increased revenue. Faster service and improved diagnoses can attract more patients to the practice.
There are three types of DR systems, and each relies on different technologies to acquire digital images.
- Computed radiography (CR): A reusable coated screen, similar to a film cassette, temporarily captures X-rays. The cassette is positioned below the animal (or in the Bucky tray) for exposure and then inserted into a digital scanner, which converts the latent image into a digital one within minutes.
- Flat-panel detector (FPD): This provides direct or indirect image capture within five to 10 seconds, making it desirable in high-volume practices. FPDs employ a plate that replaces a conventional radiography cassette or film and eliminates the need for scanning.
- Charge-coupled device (CCD): Similar to digital camera technology, this indirect system captures signals from digital cameras. Computer software converts the signals into a visible light pulse using a fixed phosphor-coated screen.
DICOM, PACS and teleradiology: Digital Imaging and Communications in Medicine (DICOM) is a medical interoperability standard imaging format. Veterinarians can use various imaging devices to communicate and share images. Check for DICOM imaging capabilities (send, print, query and retrieve, compress and search). Picture Archiving and Communications Systems (PACS) software enables veterinarians to capture and review images, make enhancements and store them in a centrally located, easy access database.
Specific advantages of digital radiography over traditional film-based systems include:
- No hazardous chemicals. Eliminate exposure to fumes and the handling of harmful chemicals.
- Cost savings. Darkroom space can be converted to other uses. Film and chemical costs are eliminated.
- Speed. Images are generated faster, decreasing exam time and improving workflow.
Electrosurgery is becoming a popular alternative to traditional scalpel surgery because it provides animals with a much-improved surgical experience. Innovative electrosurgery techniques are on the rise for veterinary surgery, offering an efficient, clean alternative to traditional incision approaches.
Before the development of electrosurgery, steel scalpels were always used to create incisions. Now, electrosurgery electrodes and other devices are being used at a rapidly growing pace because they offer:
- The ability to cauterize wounds or stop bleeding at the incision site.
- A reduced risk of hemorrhaging.
- A swifter recovery with reduced incision chewing.
- Less time spent at the veterinarian’s office.
Electrosurgical units (ESUs) are used for surgical cutting or to control bleeding by causing coagulation (hemostasis) at the surgical site. They deliver high-frequency electrical currents and voltages through an active electrode, causing desiccation, vaporization, or charring of the target tissue.
In monopolar electrosurgery, tissue is cut and coagulated by completing an electrical circuit that includes a high-frequency oscillator and amplifiers within the ESU, the patient plate, the connecting cables and the electrodes. In most applications, electric current from the ESU is conducted through the surgical site using an active cable and electrode. The electrosurgical current is then dispersed through the patient to a return electrode returning the energy to the generator to complete the path. The delivery system can be a hand-controlled pencil (reusable or disposable) or a foot-controlled pencil.
In bipolar electrosurgery, two electrodes (generally the tips of a pair forceps or scissors) serve as the equivalent of the active and dispersive leads in the monopolar mode. Bipolar electrosurgery does not require a patient plate. Electrosurgical current in the patient is restricted to a small volume of tissue in the immediate region of application of the forceps. This affords greater control over the area to be coagulated. Damage to sensitive tissues in close proximity to the instrument can be avoided. There is less chance of current directly arcing to surrounding structures such as the bowel. Patient burns are virtually eliminated. (Multipurpose electrosurgical generators offer both monopolar and bipolar functions, available from 60 watts to 400 watts.)
Smoke evacuators are critical because electrosurgical devices create an unwanted by-product called surgical smoke (vapor), a potential hazard to the patient and staff and a risk for the medical facility. Smoke evacuators (local exhaust ventilation portable systems) reduce inhalation risk.
To provide patients with a consistent level or slow delivery of drug effect, practices use a constant rate infusion (CRI) through intravenous (IV) pumps
Veterinary teams want the consistent effect produced by CRI during IV anesthesia, anesthetic supplements, extended-duration chemical restraint, time-dependent antibiotics and pain relief.
Almost all veterinary practices employ CRI techniques and administer IV fluids. Dopamine and dobutamine infusions are commonly used to improve cardiac output and arterial blood pressure during anesthesia. Bicarbonate is frequently administered to combat metabolic acidosis. Various methods of infusion control methods and CRI applications include:
Infusion pumps and syringe pumps, the most precise control of delivery rate.
- Pumps are the preferred methods for controlling CRI delivery, especially when drugs with potent clinical or adverse effects are administered by IV infusion.
- Pumps are more expensive than the other control methods discussed, but the long service life of a quality unit reduces the prorated cost of ownership.
- Syringe pumps control delivery from a mounted syringe. These pumps accept a variety of syringe sizes and typically offer a wider array of delivery modes, requiring a few more steps in the activation process when compared to an infusion pump.
IV flow-control devices have been used for decades to control the delivery rate of infusions. IV flow-control devices have direct contact with the infusion solution. Like the solution administration sets, they are disposable items intended for short-term use.
Solution administration sets are the most cost effective and readily available method. Counting the number of drops per 10 seconds provides an accurate assessment of the drip rate. “Cold creep” and crimping can produce variations in delivery rate. Setting the initial drip rate and any subsequent adjustments generally take more time than other devices.
Elastomeric infusion systems feature a highly engineered elastic bag, ideal for large animals. When filled properly and used with the associated tubing, these systems deliver a fixed rate of infusion. They’re attached directly to the patient, making them ideal when the patient is not confined, such as in a paddock or pasture setting, or when return of the unit could be inconvenient (transport analgesia for colic patients sent to a referral hospital). They also provide targeted antibiotics delivery to joints, tendon sheaths and other confined areas.
Peripheral IV pump equipment includes these items and several others:
- IV fluids (lactated Ringers, sodium chloride).
- IV solution sets (for specific pumps).
- IV extension sets.
- IV catheters, plugs and guards.
- Winged/butterfly infusion sets.
- Luer adapters and connectors.
- Three-way stopcocks.
- Fluid warmers.
- Multidose vial adapters.
- IV poles or stands.
Practices use carbon dioxide (CO2) laser technology to reduce tissue trauma and recovery time for patients facing routine or advanced surgical procedures.
The interaction of laser light with patient tissue provides an alternative to traditional scalpel-related surgical methods and practice.
CO2 lasers remain the gold standard of surgical lasers and are used daily for routine actions such as cutaneous mass removals, spay/neuter procedures, feline onychectomy and even procedures once performed only by specialists, such as anal sacculectomy and entropion repair.
Instead of using a scalpel to cut into tissue, surgical CO2 lasers vaporize, excise or incise soft tissue using a highly intense, focused beam of infrared light. This approach benefits the practitioner and the patient because laser energy is quickly absorbed by the tissue and instantly vaporizes, while simultaneously sealing capillaries, small blood vessels, lymphatics and nerve endings.*
Because of the rapid absorption and sealing, patients experience less bleeding, swelling, infection and pain, and recovery may be faster than it would be under traditional methods. To the surgeon, laser surgery affords increased visibility and precision and less postoperative care.
Veterinarians have complete control over the size, power and aim of the target laser beam, providing them with tremendous accuracy. Plus, accessory devices offer the right tools for practically any surgical procedure, such as:
Laser surgical devices allow practices to offer clients more services, which brings more opportunities to grow revenue.
Protecting patients and staff members is imperative. Safety procedures must be understood and followed when using laser surgery tools. Safety goggles specific to blocking the laser wavelength are needed, as are cloth or other means to protect a patient’s eyes.
* Source: Aesculight
To properly diagnose and treat patients, veterinary practices often need to examine patient samples microscopically using solutions that aid in their research.
Microscopes are used in veterinary practices for a wide range of purposes. Common clinical uses are viewing urine sediments, fecal parasites, ear swabs and basic blood cytologies. Advanced uses include tumor aspirates, differential counts, sperm motilities, embryo transfer, skin issues and more.
The benefits of a new microscope include:
- New optics ensures crisp and bright images.
- New LED illumination ensures you won’t make panicked bulb searches on a Friday afternoon.
- New cameras improve staff training, client education and patient history documentation.
- A second microscope in a busy clinic can improve efficiency.
- The investment pays dividends for 20-plus years if the microscope is well maintained.
The newest microscope technologies include these beneficial features:
- LED illumination: No heat, superlong lifespan and daylight-color illumination provide amazing clarity and color representation, plus no worries about bulb replacement for 20 years.
- Larger high-focal-point eyepieces: These eyepieces have a very large front lens, allowing the user to see more of the slide at each magnification (like sitting on the front row at the movie theater).
- Infinity plan flat-field optics: High-resolution infinity optic microscopes, usually found in pathology and research labs, are affordable to the veterinary clinic. Plan flat-field optics means that the blood cell at the very edge of view is just as clear and focused as the cells in the middle. When buying a cytology microscope, infinity plan is important for efficient scanning and proper diagnosis.
- 50x oil objective: The 50x infinity plan oil objective is the best available because it produces the highest resolution by using oil to minimize refraction. It also produces a flat field of view and twice the field of view as the 100x oil objective. It’s worth the investment if a practice performs a lot of cytologies.
- High-resolution digital cameras: Digital USB cameras can mount to a trinocular head or even into the eye tube of any microscope and capture images directly into client management software or for email to the pathologist. New Wi-Fi cameras transmit images directly to multiple iPhones, iPads, androids and tablets in exam rooms for client and staff education. New high-def cameras will plug into large flat-screen TVs.
- Heated stage and phase contrast: Provides accurate motility analysis of sperm, even in the winter barn.
- Dual-head teaching microscope: This allows two users to look into the microscope simultaneously to train or discuss critical cases.
Other microscope options include:
- 20x objective for wide cytology scans.
- 50x objective for high-resolution close-up cytologies.
- Pro service kit so techs can keep the microscope performing like new for years.
- Dust covers to keep microscopes clean when not in use.
- Hard and soft cases for portability.
- Slides and coverslips as must-have consumables.
- Differential counters and hemacytometers for practices performing blood cell counts under a microscope.
Scales are critical to veterinary care because the weight of each patient is an important factor in determining health, ideal weight and treatment responses.
Veterinary scales have come a long way in patient friendliness, ease of use for the veterinary team and, best of all, accuracy.
Today’s models come in a variety of sizes and styles for dogs, cats, horses and exotic animals. They offer low-profile, pet-friendly platforms, comfortable rubber mats and convenient, easy-to-read LED displays. Some models offer a large, separate LCD display that may be wall mounted or used on a desktop.
Most models have AC and battery power options, and some have wheels to move them easily from room to room. Some small models are completely portable.
A practice should use veterinary scales that are tested and calibrated and carry a manufacturer’s warranty. In digital scales, load cells convert the weight source (a pet) into an electrical signal.
Stainless-steel cells typically offer the best accuracy, reliability and ruggedness, especially when you are weighing animals of all sizes day after day.
Digital veterinary varieties include:
- Walk-on or platform scales.
- Equine scales.
- Digital pediatric/cat scales.
Veterinarians use diagnostic ultrasound equipment to see precise images inside the patient’s body for diagnoses and treatment.
New advances in ultrasound equipment are providing unlimited versatility and excellent imaging for abdominal, cardiac, musculoskeletal, vascular and other diagnostic needs. The latest user-friendly designs are reducing exam time by up to 63 percent while producing deeper and wider crisp images for the most diagnostic information possible.
In addition, a unique new real-time ultrasound system with an external camera allows veterinary practices to share clinical images live via telemedicine with a sonographer. This not only provides the clinic with real-time clinical guidance, it has the added benefit of hands-on training for the veterinary staff any day or time of their choosing and with the machine they’ll be using going forward. This takes the guesswork out of diagnostics for many practices.
Ultrasound equipment uses sound waves to present internal images of an animal’s body. The sound waves are picked up by a transducer, which creates an image of the scanned organs.
Ultrasound equipment includes the following primary components:
- A transducer probe to scan the animal and to send and receive sound waves.
- A computer and keyboard the team uses to program settings for specific patients and procedures, and then it receives, calculates and displays the findings from the transducer.
- Controls that allow the veterinary professional to change settings such as amplitude, frequency and duration of the sound waves (pulses), depending on the diagnostic purpose.
- A monitor displaying the ultrasound image.
The newest ultrasound technologies offer these benefits to practices:
- High-definition resolution for crisp images.
- Customizable automation tools for each practice.
- Flexible configurations for each staff member to view precise images for each patient.
- Advanced transducers for use with animals of all sizes. (They are great for large-animal practices.)
- Comparison assistant and scan assistant in some models to enhance the diagnostic information, especially over time as a patient is treated.
Real-time ultrasound solution with an external camera includes:
- Simple operation with touch-screen technology.
- Multiple imaging modes for a wide range of cases and patients.
- Internet connectivity for easy updates or upgrades to stay current with new technology and new features.
- Remote support team delivering live review of images for training the team.
- Quick learning for any veterinary professional, even those new to ultrasound.
- Oncology protocol to give clients a choice of receiving care from their primary veterinarian or a specialist.