biochem machine

RE: biochem machine

Beats — Tue, 30 Jun 2020 10:24:48 GMT

Does anyone have any feedback on Idexx VetStat?

RE: biochem machine

Beats — Sat, 27 Jun 2020 12:38:41 GMT

[quote userid="3169" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/20690/biochem-machine/223879"]Can you spike the sc fluids with potassium or does it have to be IV?[/quote]

Not sure answer re SC fluid with potassium, but you can definitely give it oral and there is probably some logic to this given is predominantly an intracellular ion and risk of death with rapid intravenous infusion if done accidently etc?

RE: biochem machine

Michael Woodhouse — Sat, 27 Jun 2020 11:44:48 GMT

[quote userid="6386" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/20690/biochem-machine/223867"] I use sc fluids far more than iv these days[/quote]

I've always liked sub cut fluids in cats, but the rest of the staff call me old fashioned! Can you spike the sc fluids with potassium or does it have to be IV?

I use a lot more fluids sub cut as it's pretty quick and pretty cheap cf IV.

RE: biochem machine

Bob Russell — Fri, 26 Jun 2020 11:11:45 GMT

Zoetis/Abaxis dreadful to deal with as a company but our rep tries to be helpful despite the obvious struggle with head office. Not sure it is a very 'happy' company to work for at the moment.

We have bought replacement biochem and haematology machines from the US for a fraction of the new price. Going to tempt fate and say they are very reliable and results are close to external lab results (except platelets of course).

RE: biochem machine

Kate Richardson — Fri, 26 Jun 2020 09:49:41 GMT

[quote userid="8991" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/20690/biochem-machine/223853"]I agree with you actually, but that is not a failure of not having in house bloods but poor clinical reasoning. Truly symptomatic hypokalaemic cats are obvious, but also hypokalaemia should be assumed in anorexic animals, especially with vomiting. Dealing with the symptoms of vomiting and anorexia pharmacologically (fluids, appetite stimulants including colvasone, anti emetics) and supplementing fluids with conservative KCl in those cases, absolutely. But, to me, that does not justify in house bloods when you can get results in less than 24h whilst treating the animal symptomaticslly (and yes the bsava formulary supplementation table is almost pure guesswork). [/quote]

And I agree with you! But I do feel that having access to in house bloods especially electrolytes can speed up the corrections ie amount and rate of potassium supplemented which in turn can speed up recovery and minimise hospital time, which is a priority for me with cats. The sooner I can correct abnormalities, the sooner the cat can go home as I am a strong believer in recovery being better in their normal environment and I use sc fluids far more than iv these days (mostly due to the fact that I can't hospitalise them in my own clinic, they have to go to our main hospital). But it depends on the case/owners/finances as well. It also helps me differentiate between those cats that will benefit from sc fluids versus iv, which isn't always possible to tell just from examination. I'm not talking about the obviously dehydrated cat, more the subtle ones. I've also been surprised at how the blood results don't correlate with the clinical appearance in many cases.

RE: biochem machine

Joyce Whitehead — Thu, 25 Jun 2020 21:54:57 GMT

We also have a vet scan Vs2 and find it pretty reliable. We regularly do QC and find it matches well. We use the comprehensive profiles for sick animals, it’s useful to get a quick result for some cases, that dog in renal failure on a Friday night that you can give a more accurate prognosis to the owner after 15 minutes.

I’m glad you find their accounting department rubbish too Dinu, we have similar problems. Much worse since Zoetis took over too.

RE: biochem machine

David Mills — Wed, 24 Jun 2020 21:46:45 GMT

[quote userid="6386" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/20690/biochem-machine/223851"]And I disagree with you. Sort of. I agree they won’t die of hypokalaemia but they might get euthanased because not eating because of an easy correctable deficiency. And in cats unless you consider adding potassium to your iv fluids you risk making them more hypokalaemic. [/quote]

I agree with you actually, but that is not a failure of not having in house bloods but poor clinical reasoning. Truly symptomatic hypokalaemic cats are obvious, but also hypokalaemia should be assumed in anorexic animals, especially with vomiting. Dealing with the symptoms of vomiting and anorexia pharmacologically (fluids, appetite stimulants including colvasone, anti emetics) and supplementing fluids with conservative KCl in those cases, absolutely. But, to me, that does not justify in house bloods when you can get results in less than 24h whilst treating the animal symptomaticslly (and yes the bsava formulary supplementation table is almost pure guesswork).

RE: biochem machine

Dinu Catilina — Wed, 24 Jun 2020 21:41:48 GMT

[quote userid="12930" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/20690/biochem-machine/223838"]

Hi Dinu,

What did you decide?

[/quote]

We decided to buy a Vetscan VS2 second hand from this forum. Best thing ever. Rotors easy to use and it works with extremely small amounts of blood which means potentially exotics as well. You can have electrolytes in a full profile or separate. T4 and a few other options as well. I worked with Catalyst before and I like Vetscan more.

You can buy a second hand machine cheap on ebay. Plug it in and it works.

Zoetis rep was very helpful, she was quite good actually but their accounting department is pain in the back side.

We need inhouse electrolytes for the few Addisonian dogs on treatment and monitoring. It saves us from sending them home and getting them back another day for Zycortal.

We still don't have a haematology machine, we were very close to buy a new one from Zoetis but Covid came and I can't justify the cost. PCV and blood smears are all we need.

RE: biochem machine

Kate Richardson — Wed, 24 Jun 2020 21:29:13 GMT

[quote userid="8991" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/20690/biochem-machine/223848"]As for blood gases, they are important in humans with a high caseload of respiratory cases. They add almost nothing to veterinary medicine. Similarly lactate - only use is knowing whether to cut or kill a GDV. [/quote]

Lol! Agreed.

[quote userid="8991" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/20690/biochem-machine/223848"]I disagree. They can almost always, if not always, wait. No cats die of hypokalaemia, and normally if you reperfuse anything with electrolyte imbalances they improve.[/quote]

And I disagree with you. Sort of. I agree they won’t die of hypokalaemia but they might get euthanased because not eating because of an easy correctable deficiency. And in cats unless you consider adding potassium to your iv fluids you risk making them more hypokalaemic.

RE: biochem machine

David Mills — Wed, 24 Jun 2020 21:09:28 GMT

I disagree. They can almost always, if not always, wait. No cats die of hypokalaemia, and normally if you reperfuse anything with electrolyte imbalances they improve.

The only life threatening thing I see re electrolytes is hypocalcaemia and that is blindingly obvious based on history and clinical exam. And, of course, almost immediate response to calcium. Yes, that includes Addisons. Those that are critical are almost always textbook cases with bradycardia. Ecg if you must. But bloods? No. Haven't had in house bloods for years, and don't miss them at all. Don't confuse nice to have with essential.

As for blood gases, they are important in humans with a high caseload of respiratory cases. They add almost nothing to veterinary medicine. Similarly lactate - only use is knowing whether to cut or kill a GDV.

RE: biochem machine

Kate Richardson — Wed, 24 Jun 2020 21:03:44 GMT

Not disputing their use but I dont see many critical patients now so in terms of numbers that I personally find them helpful in, not many.

RE: biochem machine

David Mills — Wed, 24 Jun 2020 21:03:07 GMT

Just use a urine disptick or urine sample

RE: biochem machine

Kate Richardson — Wed, 24 Jun 2020 21:01:41 GMT

I have found potassium is often higher on external samples than in house due to leakage from cells. I think spinning and separating helps but doesn’t always give a true reflection of what’s happening ‘now’. Often still low normal on external bloods but not as low as when done immediately. Just my experience

RE: biochem machine

Beats — Wed, 24 Jun 2020 20:58:44 GMT

[quote userid="6386" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/20690/biochem-machine/223841"]Ignoring the blood gases (which I mostly do as I’m not a critical care expert just a GP and if I’m honest I find them very confusing unless you are really used to interpreting them) [/quote]

helpful for ethylene glycol in cats though maybe?

RE: biochem machine

Beats — Wed, 24 Jun 2020 20:57:26 GMT

[quote userid="6386" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/20690/biochem-machine/223841"]electrolytes often can’t wait until tomorrow plus they are often inaccurate due to ageing of the sample[/quote]

i don't think aging is an issue as long as you separate? e.g. heparin tube, spin after mixing and separate plasma I can't see there would be inaccurate results at external lab from aging even if in post 3 days? I could be wrong on this!

RE: biochem machine

Kate Richardson — Wed, 24 Jun 2020 20:55:55 GMT

Ps I think the only benefit of in house Bloods (excepting electrolytes) is speed. Plus they cost more to the client.

RE: biochem machine

Kate Richardson — Wed, 24 Jun 2020 20:42:19 GMT

I have to say if I only had access to one machine it would be an epoc. I think electrolytes often can’t wait until tomorrow plus they are often inaccurate due to ageing of the sample. But I see cats and am obsessed with potassium! I was less concerned when seeing dogs but they seem less sensitive/prone to hypokalaemia IME But an epoc gives me the critical info I need to decide if the cat’s potentially a goer or not or if it needs hospitalisation or not (and in my experience more don’t need it than do). Ignoring the blood gases (which I mostly do as I’m not a critical care expert just a GP and if I’m honest I find them very confusing unless you are really used to interpreting them)

RE: biochem machine

Beats — Wed, 24 Jun 2020 20:30:24 GMT

[quote userid="8991" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/20690/biochem-machine/223839"]with courier collection[/quote]

we use Royal Mail for starters. After 3pm on a Friday means no results before 1pm Monday at best. and then there's Christmas...

[quote userid="8991" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/20690/biochem-machine/223839"] I cannot think of an electrolyte or any other abnormality that a) needs electrlyte measurement immediately and b) cannot be diagnosed by a good clinical examination c) cannot be stabilised successfully by applying clinical reasonaing.[/quote]

I partly agree with the comment about not needing to have in-house potassium/sodium, but I'm very used to it and while it is rarely of use, it sometimes is very useful:

1) Is that an addisonian dog with hyperkalemia? Or should I ex-lap it to check for possible GI obstruction? I don't have to wait 1-3 days to find out with an easy answer.

2) Have picked up the odd addisonian that did not expect (if don't have in-house electrolytes, currently run on all in-house blood samples, I would have missed some of these personally), new graduates have picked up their first ever addisonian (often that they didn't expect; the look of joy on their faces is almost worth having the VetLyte).

3) adjusting potassium supplmeentation to drip bags (a bit retrospective if results 1-3 days later).

Essential, maybe not. But I will miss them if I bin VetLyte and don't replace with something else able to do potassium/sodium.

[quote userid="8991" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/20690/biochem-machine/223839"]I suppose in-house normally generates more profit[/quote]

That statement has never made sense to me. I cannot see why in-house would generate more profit? I can make more profit by reducing costs (does in-house really reduce costs? genuine question?) or increasing what is charged. I can make more profit by increasing the amount I charge for blood tests whether these are done in-house or at an external lab; for instance I can make large profits by running very basic external lab profiles at a cheap external lab and charging a lot for them. I don't see the connect between having in-house blood machines and increased profits [but then this may be one of the many reasons why I am an employed vet and not a business owner!]

For clarity, though, in this instance the VetLyte unambiguously does not make a profit and never has done - it operates at a loss (as in we could run in-house bloods at the same price without it and would clearly make more profit without its running costs). Indeed if the aim is increasing profits then ditching the vetlyte, maintaining the same price for in-house bloods, and charging an extra fee with a nice mark-up for sending electrolytes to an external lab would clearly be a more profitable option. I could send a lot of potassium/sodium samples to a cheap external lab for £1200, and that is not counting running costs or the next time it breaks or needs electrodes replaced.

[quote userid="8991" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/20690/biochem-machine/223839"]Most places IME rarely QA their machines.[/quote]

We QA our machines, as do all practices I have ever been in for the last 25 years, and those generally haven't been fancy practices (save some locum positions that I really don't know about).

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What is wrong with these (other than the obvious of being on ebay and potentially not working; there are quite a few of them about for reasonable prices inclduing ones that look reliable to be in working order)? I've never heard them menitoned, so assume there is a fatal flaw...

https://www.ebay.com/itm/OPTI-Critical-Care-Analyzer/173892482875?_trkparms=aid%3D1110001%26algo%3DSPLICE.SIM%26ao%3D1%26asc%3D225086%26meid%3D49576c52c28e46d7b930b70a2c21282c%26pid%3D100010%26rk%3D4%26rkt%3D12%26sd%3D263099056332%26itm%3D173892482875%26pmt%3D0%26noa%3D1%26pg%3D2047675&_trksid=p2047675.c100010.m2109

RE: biochem machine

David Mills — Wed, 24 Jun 2020 19:10:40 GMT

Why does anyone need them? Set up with a reliable external lab company with courier collection and you have the results in <24h normally. The initial treatment very rarely changes with a good history and clinical exam in any case, I cannot think of an electrolyte or any other abnormality that a) needs electrlyte measurement immediately and b) cannot be diagnosed by a good clinical examination c) cannot be stabilised successfully by applying clinical reasonaing.

I suppose in-house normally generates more profit and probably some client confidence, but apart from that, struggling. Most places IME rarely QA their machines. I would love to see a big data project on the clinical utility of all blood tests in first opinion practice...

RE: biochem machine

Beats — Wed, 24 Jun 2020 18:58:00 GMT

Hi Dinu,

What did you decide?

I'm threatening the VetLyte with the bin again (Idexx have claimed would cost £1200 to replace two electrodes and one other bit, and can't be sure will work after that) so back to deciding what to do...

I've read once post on here from someone querying the electrolyte reliability of the Catalyst (and doing electrolytes would seem to be the only significant advantage of Catalyst to a VetTest for me), and we're really very happy with our VetTest and Lasercyte otherwise, so I'm very reulctant to change everything just for the sake of potassium and sodium available in-house.

I may decide just to post them out in the medium term at least until something better comes along (you could post a lot of potassisum and electrolytes on query addison's cases for £1200...; and I tend to post a basal cortisol on suspect cases anyway as can't rule out on electrolytes alone...)

Other options I'm going to look at are:

iStat

VetStat

epoc

Am I missing any other obvious choice to get trustworthy in-house electrolytes?

RE: biochem machine

Lindsey Edwards — Mon, 28 Oct 2019 15:49:10 GMT

I have recently rented a Samsung biochem machine (to add to Abaxis haematology) - not much use so far but runs smooth and very easy to use with little maintenance required. Results have matched clinical picture so far. Nice range of cartridges and CRP - rumours of adding hormonal assays shortly

RE: biochem machine

Thomas Johnson — Mon, 28 Oct 2019 10:18:14 GMT

We have an Idexx Procyte and Catalyst One. I find the Procyte more reliable than other haematology machines I have used, for example we had a dog with IMHA last week (secondary to bladder stones!) and the haematology was run on our machine and sent to Idexx, the results were pretty much identical. I like the Catalyst as well, the big advantages for me over the Vettest are the ability to do electrolytes and T4, and doing a UPC is much easier than on a Vettest

To be worth spending the money you have to commit to doing the majority of your blood testing in-house, and I think that necessitates having both machines. One of our smaller branches just has a Catalyst One, and what tends to happen is that if they want haematology as well it gets sent externally for all the testing.

RE: biochem machine

Bob Russell — Mon, 28 Oct 2019 09:47:21 GMT

[quote user="robloxley"]

[quote user="Bob Russell"]Probably not going to make myself popular with QCR but we replaced our VetScan biochem machine with one from the US. Much, much cheaper even with import duty and VAT. Actually a fraction of the price of a new machine[/quote]

They keep it quiet, but Abaxis UK (certainly before they became part of Zoetis) would sell reconditioned & fully warrantied machines at a fraction of the cost of new, once it became clear you were not going to buy new.
Also, if anyone's in the market for a Vetscan2 in full working order send me a message

[/quote]

We were ready to pay about £5000 for a replacement haematology machine from them. I had decided to go ahead until they told me the price would be £8000 and no negotiation (Zoetis influence?).

I bought one from the States. Delivered within 5 days and less than £2000. About a year ago I think.

Not sure whether they have become more amenable to negotiation but they were a hairs breadth from losing a buyer for the stupidly expensive reagent packs.

I do find the results match laboratory ones within reasonable limits. Generally pre-an bloods (not done routinely) and emergency mainly.

RE: biochem machine

Dinu Catilina — Sun, 27 Oct 2019 16:12:17 GMT

The Vettest we have works pretty well and we have a VetLyte that is turned off for now. There are two things we need, one to connect with our PMS and second to do electrolytes without breaking the bank. Gas blood would be nice but we are not that busy yet to need it regularly.

We looked at Catalyst last year but we had some differences in term of pricing and it wasn't worth moving from Finn to Idexx. We still don't run many test/day, we run more progesterones than anything else but for this we have a Vidas from Bi

Roboxley, I've Pm'ed you.

Thank you everyone for your input. I'll let you know what we decide

RE: biochem machine

Rob Loxley — Sun, 27 Oct 2019 15:49:21 GMT