Equipment Guide

Companion | Trends | December 2018

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FROM DENTISTRY TO ULTRASOUND: WHAT YOUR CUSTOMERS NEED TO KNOW

The fourth quarter is when many veterinary practice owners seriously consider whether they should buy capital equipment before the year is over – not only to improve patient care and services but also for tax purposes. Section 179 of the IRS code provides incentives for the purchase of veterinary equipment, from X-ray and dental machines to lights and monitors. Here is a look at how equipment features and capabilities have changed over the past decade. (A special shoutout to Rick Warter, RVT, national equipment sales manager at MWI Animal Health, for his insights.)

Dentistry
Oral health services make great sense when a veterinary practice wants to stand apart from nearby practices and give patients the most comprehensive care.

If the veterinary practice uses only a tabletop scaler-polisher, they should consider purchasing advanced equipment so they can perform more procedures and complete them faster. Here’s what they should look for:

  • Compressor-driven dental machines: Today’s best units are air-driven and include high- and low-speed hand pieces, so veterinary practices can perform most, if not all, dental procedures in-house. High speed has become the standard of care and is “essential for removing teeth that have damaged crowns but still have healthy roots, where sectioning is needed,” Warter said.
  • Lighted hand pieces: Lighted models provide enhanced visibility during exams and procedures.
  • Digital X-rays: Veterinarians will want to see below the gums and identify oral health problems, such as fractures, cysts and tumors, that could be treated before they become worse. At the very least, digital X-rays provide baselines that can be referred to later.

Keep in mind that a growing number of states have rules stating that a clinic cannot perform oral surgery without the availability of dental X-ray equipment. (Be sure to check your state policies.)

As your customers look into adding oral care capabilities, help them to consider the services as a new revenue source that pays for itself quickly as additional treatments are performed each year.

Digital Radiography
Digital imaging technology has matured since its launch in the late 1980s, and it has proven to be a highly effective and efficient way to examine patients. Veterinary practices won’t go wrong with any of today’s digital X-ray machines because they use time-tested technology to deliver crisp detail, varying depths of view, notation capabilities and instant connection to patient records.

So, what’s new in digital radiographs? Manufacturers are developing better workflow features at a lower overall price tag. Here are a few of the most popular features:

  • Image libraries: “Normal” images can be displayed next to the patient’s X-rays during a client consult, showing the pet owner what’s typical and what’s not.
  • Position coaching: Pictures of a patient in the correct position give staff members clear guidelines to follow.
  • Cloud PACS: These picture archiving and communication systems store images directly to a secure cloud site for viewing from any device that has a web browser. It’s great for sharing with specialists anywhere.

Because of workflow improvements and other upgrades, practices are moving from CR (computed radiography) to DR (digital radiography) in record numbers.

When choosing a digital imaging system, veterinary practices should research the manufacturers, the software and their technical support. Suggest to your customers that they request a demo and ask these important questions:

  • “Once I acquire a patient image, where does it go and how can I work with it?”
  • “Explain the warranty and support. Who provides the support and training?”

Since imaging systems are complex, it’s sometimes best to stay with veterinary-specific units from companies with a track record of product excellence and great support.

Electrosurgery
Has it been a while since your veterinary practice customer upgraded surgical tools and procedures? Are they still using classic blade techniques? Now might be the time for them to switch to today’s electrosurgical units (ESUs) or cutting laser technologies.

Transitioning to either an ESU or a cutting laser can deliver these important benefits:

  • When using a standard blade, the cells are split open and the material inside the cell goes into the surrounding tissue and causes an immune response: inflammation and pain. ESUs and cutting lasers evaporate the “stuff” inside cells so that they lose their bond with surrounding cells, causing less inflammation and pain.
  • Reduced inflammation and pain can lead to better outcomes and faster healing.

If the veterinary practice customer is using older laser tools, they can expect today’s models to give them more power and features for less money.

Most of today’s better units provide greater control of cutting and coagulation procedures. Depending on the tool, the veterinarian can use a pencil switch or a foot-control switch with a button to fire cutting and “coag” separately. This is much more efficient. No more wasted time and effort when switching the power mode from cut to coag.

In addition, today’s ESUs won’t fire if the patient is not well-grounded on the dispersive electrode. This major safety enhancement keeps patients from getting burned.

The veterinary practice may encounter a learning curve with the latest ESUs and cutting lasers, but most manufacturers provide extensive training either onsite or online. Plus, they’ll find technique courses offered at the VMX conference and other industry training venues.

With practice and today’s high-tech tools, your customers can become proficient in no time and offer a high-value patient and client experience.

Hematology Analyzers
The field of in-clinic laboratory equipment is quite interesting these days. Advanced chemistry and hematology analyzers are available from a number of reputable companies, and they all promise easy-to-use procedures and accurate results.

As manufacturers continue to fine-tune and upgrade their analyzers, one piece of big news concerns urinalysis (UA) equipment. Recently, two major providers of in-clinic diagnostics machines released urine analyzers that essentially use a microscope and a camera to capture images of urine sediment and use facial recognition-type software to provide a report.

Before this major technological advancement, the veterinarian would send urine samples to an outside reference lab and wait 24 hours. In the meantime, the veterinarian would possibly go down a treatment path and then get unexpected results, causing the veterinarian to change direction and bring the client back. That scenario does not create the greatest client experience.

The other problem comes from trying to have a trained staff member interpret results. Not everyone is good at this, so there’s always a risk of missing something.

The new technology is truly a landmark moment in in-clinic diagnostics. The veterinary practice will receive reliable UA results before the client leaves the exam room, so they’re ready to recommend the correct treatment right away. This helps patients, clients and the practice through better care and reduced staff time.

Consider what rapid-response UA results would mean for more patients and clients. In the past, veterinary practices might have hesitated to run a UA test because of the hassle of sending it out, the wait time and the lack of a qualified team member to read results.

As a distributor sales rep, you can help to set up a demonstration, review the cost of ownership against the additional revenue your customer will make, and discuss the warranty and training support they’ll receive.

IV Pumps
Today’s calibrated infusion pumps are reliably accurate when used with their own IV-line brands. (Each brand has a specific stiffness and hole size.) Unfortunately, some busy clinics mix IV line brands, creating a problem for patients because the wrong line can overdeliver or underdeliver the amount of fluid you’re trying to administer.

We asked Rick Warter, RVT, national equipment sales manager at MWI Animal Health, to explain why mixing pumps and IV lines could be a big issue. “For instance, let’s say you want to give the patient 100 milliliters an hour,” Warter said. “Using the wrong line, you might deliver 120 ml in an hour, which means in five hours you intended to deliver 500 ml but instead delivered 600 ml. In a small animal, this can be very bad. Or it can go the other way, where you don’t deliver enough fluid to a dehydrated animal with a heart condition. This puts an extra burden on the circulatory system.”

To avoid this problem, the newest veterinary IV pumps allow the veterinary practice to select which line they’re using, so they can change between lines and still maintain accuracy. Warter recommends either sticking to a pump in which they can select the IV line they want to use or make sure they always use the lines for which their pump was calibrated.

If they’ve used the same infusion pumps for several years, not only is the wrong IV line an issue, but they might be at higher risk of a pump suddenly failing and disrupting care until the pump can be repaired or replaced. (Note that finding replacement parts for older pumps can be difficult.)

How old are your customers’ IV pumps? This may be a good time for them to consider an upgrade to a new system.

Laser Therapy
Patients suffering from pain or injury. Patients with hot spots or muscle or tendon strains. All kinds of animals benefit from laser therapy, a modality that is steadily growing as an accepted and even in-demand veterinary service.

The good news is laser equipment is more effective than ever for physical therapy purposes. Even better, some equipment manufacturers offer evaluative tools and business management programs to help a veterinary practice grow their laser services and revenue.

Many of today’s laser-therapy tools come with on-screen guidance that standardizes treatments. The prescribed doses and treatment times are based on the patient species, size, weight and other factors.

Using these settings, everyone on the veterinary practice team follows the same protocol. Training new staff members is easy. (Different state boards have different rules, so be sure their technical staff is qualified to apply laser treatments.)

When buying from a larger manufacturer, veterinary practices can find analytics support that helps them track:

  • How many treatments were done and which type.
  • How many treatments were done by each doctor.

Armed with this information and other business-management resources, your customer can establish patterns or benchmarks that will help them identify opportunities to increase usage and revenue. Most practices are just beginning to see the potential of offering laser therapy to more patients who could benefit from it.

You can help your customers choose the appropriate laser units for their hospital and assist with training, implementation and safe practices. This is especially important if your customer hasn’t offered laser therapy or if they want to expand it as a more effective revenue center.

Lighting
Medical lighting has seen a major advancement in recent years in the form of light-emitting diode (LED) technology. When a veterinary practice switches from halogen or tungsten technology to LEDs in their surgery and treatment rooms, they can expect:

  • More effective patient care: LED lamps provide brighter, whiter light and reduce shadows, making it easier to see a patient’s tissue color. Also, LEDs produce less heat, meaning less desiccation of tissue. (Hot halogen lights can hasten tissue deterioration.)
  • 80 percent less energy use and cost: Because LED lights are more efficient at converting electricity to light, they drastically reduce energy usage and the bill.
  • No downtime due to bulb failure: LED lighting doesn’t use traditional bulbs, so your customers won’t experience an outage or have to change bulbs at inconvenient times. Professionally installed LED lighting lasts as much as 50,000 hours of use or more, resulting in a lower total cost over the life of the equipment.

As veterinary practices think about making a switch to LED lighting, they will want to keep the following in mind.

  • Installation budget: Plan for a one-time expense to properly install higher-end LEDs. The investment is worth every penny because improper installation and cheap lights can cause failures or, at least, reduced benefits. They’ll need to make an LED investment only once every 10 to 15 years, so they should buy the best they can afford.
  • Brightness and color: LED technology is very bright and can cause eye fatigue. This can be overcome by installing quality LED lighting that comes with a dimmer switch.

To help your customers see the difference, you can arrange for them to visit a nearby clinic that has LED lighting.

Also, veterinary practices should do a cost analysis of their electric bill, current bulb costs and the price they would pay to repair their halogen system if it failed. This alone might justify the expense of upgrading.

Monitors
If the veterinary practice’s patient monitors are 5-10 years old, they’re likely missing out on potentially lifesaving benefits offered by the latest models. Let’s take a look.

  • Anesthesia: Since anesthesia affects so many patient functions, many of today’s monitors go well beyond measuring the breaths per minute and the heart rate. They provide highly accurate multiparameter data for a total picture of a patient under anesthesia.
  • Blood pressure: If they haven’t updated their BP monitor in a while, they’ll be amazed at the technological advancements that make BP readings more reliable through automation.
  • ETCO2: Measuring a patient’s breathing/ventilation during anesthesia used to be tricky and expensive with ETCO2 machines’ frequent gas calibrations and fragile sensors. Today, the technology is easier to operate, more robust and reasonably priced.
  • Pulse Ox: The new PVI (Pleth Variability Index) technology has exciting possibilities for assessing fluid status in a more reliable way. No more “locked numbers” from losing the signal just when an animal starts to have issues.

Using outdated or underperforming monitors brings a higher risk of patient death or postsurgical complications. For example, with kidney function:

  • If a patient’s ETCO2 goes above 50mm/hg for a long period, the patient can develop respiratory acidosis.
  • If MAP (mean arterial pressure) drops below 60mm/Hg, the patient will not have adequate perfusion.

These problems could kill 50 percent of the kidneys and the veterinary practice wouldn’t know it. Even postsurgery blood tests won’t show a problem. (BUN/creatinine do not start rising until 75 percent of the kidney function is lost.) So, when the patient comes in with kidney failure at 6 years old, connecting the problem to an anesthetic event during a spay at 1 year old is difficult.

Since your customers are devoted to providing the best care possible, investing in new monitor technology is well worth it.

Ultrasound
While ultrasound image quality is improving year after year, the big news these days is related to a telemedicine service called scan coaching. Here’s how it works.

  • Several advanced ultrasound units allow the veterinary practice to contact a specialist or technical expert who “remotes in” and views the ultrasound image. The professional then coaches them on how to interpret the scan so they determine what’s happening with the patient.
  • Some units have split-screen capability during the remote session. One side shows what the image should look like. Meanwhile, the coach guides the veterinary practice to move the probe until the image looks like the one on the “sample” side. This feature helps them quickly build confidence in reading ultrasound scans for various patients.
  • Ultimately, remote coaching improves patient care because it improves their ability to diagnose beyond what they can see on a digital X-ray.

Veterinary practices should look for ultrasound companies that offer training along with the ultrasound purchase. Another option is to pay for a training class, such as basic abdominal scanning, so they can test-drive the latest ultrasound units, know what a good image looks like and get familiar with moving the probe.

Are your customers ready to buy their first ultrasound system, replace an outdated one or add more units? Suggest they keep the following in mind:

  • Low-cost units might have lower image quality. When they’re learning how to diagnose conditions using ultrasound, a poor image can make the determination much harder.
  • Spending more for a high-quality unit that offers scan coaching can be worth the expense. They’ll quickly gain expertise that they can turn into extra revenue as they offer the service to more clients.
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