Equipment Guide 2017, Part 2
From anesthesia to laser therapy: What you need to know.
Many veterinarians will decide in the fourth quarter of 2017 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 second in a two-part series. Part 1, published in the October/November 2017 issue, covered electrosurgery, microscopes, ultrasound, chemistry analyzers, IV pumps, laser surgery, scales, digital radiography and autoclaves.
Anesthesia equipment is used to administer agents or drugs that temporarily provide sedation so an animal won’t move or feel pain during a medical procedure. Basic inhalation anesthesia machines deliver a controlled amount of an anesthetic agent mixed with oxygen, and provide a method of assisting the patient’s breathing. Veterinarians can reduce the level of patient risk by using modern, fully functioning anesthesia equipment and by developing patient-specific protocols for anesthetic and vital-signs monitoring.
Equipment at a glance
All anesthesia machines include the same four components:
- Gas source (typically oxygen)
- Gas pressure regulator
- Flowmeter that controls the amount of gas to the patient
- Vaporizer that delivers a concentration of the anesthetic agent to the patient.
Recent improvements in anesthesia equipment have led to improved patient safety. For example, occlusion valves make it possible to close the adjustable pressure limiting, or APL valve (used to manage excess waste gas), with the touch of a button. (Previously, you had to turn a dial to close the valve and then remember to open it to avoid over-pressurizing the machine and putting the patient at risk.)
In modern surgical suites, the staff uses patient monitoring equipment to make sure vital signs aren’t compromised during sedation. These include machines that monitor heart rate and blood pressure, the amount of carbon dioxide being expelled during breathing and the amount of oxygen in the blood.
Well-maintained anesthesia equipment can last many years, but machines do break down and must be replaced to avoid risking patient and staff safety. For instance, covering holes in breathing circuits with porous medical tape is not sufficient to prevent waste gas expired by the patient from leaking into the clinic.
Quality anesthesia equipment varies in price depending on the accessories needed and the sophistication level required for measuring oxygen and anesthetic agents. Higher-priced units generally are constructed of high-quality materials that last longer, are less likely to leak, and often include safety features, technical support and compliance to International Organization for Standardization (ISO) manufacturing standards.
Patient monitoring options include a vital signs monitor designed to measure parameters such as blood pressure, temperature and blood oxygen saturation. Other products that can aid veterinarians in their patients’ recovery include fluid pumps and patient warming devices.
Peripheral equipment includes Sodalime, Breath Fresh canisters, endotracheal tubes, anesthesia masks, anesthesia mask diaphragms, anesthesia circuits, breathing bags, roll gauze and endotrach tube tie-downs.
Practices are attracted to this fast-growing category because laser therapy instruments are significantly reducing pain and inflammation in patients.
Clinical studies and real-world uses are proving that veterinary laser therapy alleviates pain and inflammation, reduces swelling, and stimulates nerve regeneration and cells involved in tissue repair.
Class IV therapy lasers are quickly becoming the technology of choice for therapeutic treatments because they reduce pain and inflammation and accelerate healing, all in a noninvasive, drug-free way. They use electromagnetic energy (light) that interacts with tissue to produce “photo-bio-stimulation” or “photo-biomodulation.” This response decreases pain perception through its effect on nerve cells and nociceptors, by increasing stimulation thresholds, reducing neuronal impulses, and increasing the release of tissue endorphins.
Laser therapy benefits include:
- Improved patient outcomes
- Effective relief of pain, inflammation and swelling
- Extremely well tolerated by pets; no known side effects
- May decrease the need for surgery and medications
- Reduces healing time
- Requires no sedation or clipping
- Quick and easy to administer (approximately three to six minutes per site)
- Allows pet owners to be present and feel that they are participating in the healing process
- Versatile for all animals across a wide range of conditions: Applicable for osteoarthritis, degenerative joint and disc disease, hip dysplasia, dermatologic disorders (hot spots, interdigital dermatitis, acral lick granuloma), acute and chronic otitis, periodontal disease (feline stomatitis), post-operative healing (to treat incision pain and reduce inflammation before the patient wakes up), acute traumas (sprains or strains without radiographic changes or ruptured ligaments).
- Increase practice revenue: Therapy lasers can work alongside other treatment modalities to maximize effectiveness, and can be safely and easily applied by veterinary technicians or staff to free up the valuable time of veterinarians. Treatment plans for chronic patients are typically sold in groups of five or six, so you can ensure compliance and encourage repeat clinic visits. Once you recoup your investment, there are no further financial obligations.
- Retain existing clients and attract new clients: Offer a new drug-free option to treat patients that are noncompliant with treatment regimens or unable to tolerate drugs. Reduce recovery time.
Important: Safety procedures must be understood and followed when using laser therapy tools. It is imperative to have safety goggles specific to blocking the wavelength of their specific laser, and cloth or other means to protect a patient’s eyes.
Source: AAHA Therapeutic Laser Buyer’s Guide
Intestinal parasites such as hookworms, roundworms, whipworms and tapeworms are primary disease agents in pets, and are potentially transmissible to humans, or zoonotic.
Depending on the region in which a veterinary clinic is located and the health issues predominant in that region, a veterinarian will need to prevent these parasites or treat infected patients.
To test for parasites, fecal examinations should be performed between two and four times in the first year of a dog’s and cat’s life. After that, a fecal exam is usually part of routine biannual or annual wellness exams.
Some veterinarians opt to send tests to outside reference labs, although some experts raise the concern that because results are not available for about 24 hours, treatment is delayed. That’s why many practices use in-house parasite testing on fecal samples.
Two in-office methods are available for conducting a fecal exam: flotation and centrifuge.
With both, the goal is to concentrate the parasite eggs, making them more visible under a microscope. Both methods call for the veterinarian or lab technician to mix the fecal sample with a solution.
With a flotation device, the eggs float to the surface of the solution.
The centrifuge technique loosens the eggs from the parasite before allowing them to float to the top of the solution. In addition, advanced centrifuge collection kits enable the user to obtain the sample with a coring tool, add it to a tube and mix it with a standard flotation fluid, simplifying the process and reducing the mess.
Peripheral centrifuge equipment includes:
- Centrifuge tubes
- Microhematocrit/Capillary tubes
- Blood tubes such as serum separators, EDTA, etc.
- Sheather’s solution
- Fecal loops
- Microscope slides
- Microscope cover slips
- Test tube rack
- Differential counter
Veterinary dental equipment is not just for teeth cleaning. It helps practices identify and treat oral-health problems so more patients can avoid serious medical issues.
Dental disease is the most common disease in dogs and cats, affecting more than half of canines and felines over age 3. Not only does dental disease cause discomfort to pets, it can lead to issues such as liver and kidney disease.
Practices can make a huge difference to patients by offering preventive dental care, plus early diagnosis and prompt treatment of dental and oral health issues. The latest diagnostic tools (radiography, for instance) help veterinarians identify hidden dangers.
In addition, veterinarians can use advanced ultrasonic dental scaling equipment to remove plaque and therefore eliminate certain oral disease concerns. Ultrasonic scalers generally last at least five years, and many veterinarians use them about 500 times a year at $200 per teeth cleaning, increasing practice revenue while preventing serious illness.
If serious dental/oral issues are discovered during the diagnostic and cleaning phases, other tools are required to address and treat the problems, including anesthesia and monitoring equipment, surgical equipment, drills, extraction equipment and others.
Veterinarians providing dental care need:
- Hand instruments (scalers, polishers, curettes, probes for measuring pocket depth, explorers for examination of hard-tissue defects, and prophy cups and paste)
- Diagnostic equipment, particularly conventional and digital X-ray units
- Dental drill units, hand pieces and burs
- Extraction instruments (e.g., periosteal elevators, luxators, periodontal elevators, extraction forceps)
- Anesthesia and monitoring equipment
- Infection control disinfectants, instrument cleaners, autoclaves and personal protective apparel
- Suction equipment
- Fiberoptic light source
- Mayo and Metzenbaum scissors
- Needle holders
- Mouth mirror
- Head/eye loupes or other methods of magnification
- Antiseptic rinse, fluoride, sealant
- Needles and syringes
- Items to prevent hypothermia (e.g., towels, blankets, circulating water blanket, hot air blanket, etc.)
- Gauze and sponges
- Suture (4-0 and smaller)
- Bone augmentation material
Today’s veterinary lighting innovations for surgery, treatment, dental and exam areas are relegating outdated fixtures to the scrap heap, because they’re greener, cooler, longer lasting and more efficient.
For many years, halogen-based bulbs and their incandescent predecessors were the norm in the veterinary industry. Everything is different now. Exciting new technology has emerged, bringing veterinary lighting to an ecofriendly, high-performance level. Dramatically improved lighting products emit considerably lower heat, offer major increases in the life of light sources, and operate on a fraction of electricity previously needed.
LED-based lighting represents the biggest and most important change in veterinary lighting, because of its lasting performance, eco-friendly output, high efficiency and extremely cool light output.
LED light sources offer numerous advantages including a much cooler light output, cooler overall emission of ambient heat from the fixture, higher color temperatures and the most noticeable feature–the incredibly long life of the LEDs. In fact, LED technology has grown so quickly that the rated life of these light sources is now 50,000 hours. Additionally, the average LED light runs on about half the electricity of its halogen counterpart.
With that in mind, owners of an LED-based surgery light may well find that they never require an LED replacement. In other words, the entire light fixture may age to the point of replacement before the LEDs themselves. A stunning example of the difference: A typical halogen-based surgery light of 65,000 lux output, using a 100-watt halogen bulb, with a color temperature of 4,000 degrees Kelvin and a considerable amount of heat for that type of fixture versus a same-sized fixture with LEDs producing 65,000 lux output, emitting an improved color temperature of 4,300 degrees Kelvin and giving off virtually no heat.
In-house hematology tests provide complete blood counts and other data for disease detection and treatment monitoring. Newer models typically provide advancements in CBC and other blood values that can provide missing clues for certain patients. These clues can allow doctors to provide better answers to clients during the office visit. Running these tests in-house allows practices to start treatment in minutes if needed.
A complete blood count (CBC) and differential/platelet count provide practitioners with a broad overview of a patient’s general health and may help detect early disease, when treatment can be most effective. The CBC can also be helpful for monitoring treatment response to disease, making a prognosis and even preventing blood diseases.
Many practices traditionally sent out CBC panels to an outside lab, having to wait 24 hours or more for results. In addition, during the time it takes a blood sample to reach the outside lab, the sample could become compromised by coagulation or cell deterioration. With a point-of-care hematology analyzer, the wait is reduced to 8 to 10 minutes (a little longer for additional panels). Plus the sample is fresh and has not broken down at this point.
A hematology analyzer performing just a CBC usually reports values on white cells, red cells, hemoglobin, hematocrit, and distribution of certain factors within the blood cells. A hematology analyzer that also includes a differential/platelet count can report on neutrophil granulocytes, including band lymphocytes, monocytes, eosinophil granulocytes, and basophil granulocytes.
Three basic types of in-house hematology analyzer technologies are used:
- Laser flow cytometry with optical fluorescence and laminar flow impendence: These technologies scatter individual cells, recording size, nuclear characteristics, and cytoplasmic contents. This provides an advanced five-part white blood cell differential, absolute reticulocyte count, and banded neutrophil and nucleated red blood cell (nRBC) parameters.
- Impedance counting: Cells are classified on size, based on the change in resistance as the particles pass through a small aperture between two electrodes. However, cell size is considered only limited data.
- Quantitative buffy coat (QBC) analysis: Blood samples are separated (under high-speed centrifugation) into plasma, the buffy coat (containing white blood cells and platelets), and red blood cells. No five-part differential, banded neutrophils.
The most advanced systems facilitate the veterinary team’s confident interpretation of a CBC, as well as differential cell counts and cell morphology. An accurate five-part differential provides expanded information, gives veterinarians more clues into their patients’ conditions, including serious bacterial, viral and parasitic infections. The more information veterinarians can glean from a CBC, the earlier and better they can diagnose and treat their patients, improving prognosis and the quality of life.