Measurement of Blood Pressure for Clinical Cases

Re: Measurement of Blood Pressure for Clinical Cases

KathW — Mon, 08 Dec 2014 08:14:41 GMT

Lots of information there - thanks for all the replies. I'll now make more effort to measure BP more often in relevant cases.

Re: Measurement of Blood Pressure for Clinical Cases

Rob Davis — Fri, 05 Dec 2014 13:15:53 GMT

I always used to clip too, until a colleague suggested that I try using spirit instead, and have never clipped one since!

Re: Measurement of Blood Pressure for Clinical Cases

Martin Atkinson — Thu, 04 Dec 2014 18:27:55 GMT

[quote user="Rob Davis"]Clipping isn't necessary and does add to stress - I use spirit to flatten the coat and ultrasound gel on the doppler probe - works fine with no clipping.[/quote]Different experiences then Rob. Unless I've been very unlucky and it is just totally coincidental that the ones I didn't clip were the ones that were going to be difficult anyway then I find the not-clipping technique doesn't work. But then I don't find that clipping stresses them any more, usually less than clipping a leg for blood sampling. Maybe I'll try the next time on a cat I know is always easy and see how we go.

Re: Measurement of Blood Pressure for Clinical Cases

Louise6732 — Thu, 04 Dec 2014 12:15:03 GMT

I used to admit the cat for BP, mostly due to time constraints, but I then moved over to measuring BP in consult with O', my last practice was cat friendly so we managed very well and used a quiet consult room. It depends on the situation, if it's the first presentation for the cat for e.g. weight loss, PUPD etc., then clinical exam, bloods and U+ are the first priority, as by the time these are collected BP can be falsely high. I was always reluctant to measure BP before bloods as I didn't want to p**s the cat off by fiddling about with BP then not be able to get bloods and U+! Where possible a quick retinal exam can tell you if there may be any BP issues. We always endeavoured to do a retinal exam in the majority of geri cats.

If I did find renal disease, hyperthyroidism etc. then the next time the cat came in I would check BP, but make an extended consult. Luckily I had the facility to do this without getting told off for taking up consult slots!

Nurses are invaluable in these situations, and cats can be booked in for BP checks in one consult with a nurse, if it's only a BP check, I think even 10mins is enough time for cat to come out of basket, have a wander around whilst nurse sets up BP measuring equipment, then BP check.

Often being in the hospital is stressful for cats, as wards can be busy with people coming out and in, different smells, noises of other cats and dogs. In a consult with the owner, usually sitting on the table on top of their own blanket, or even on the owners lap, is less stressful. Of course it depends on the cat. I routinely measure BP from the tail, this way the owner can fuss the cat at the head end and the cat doesn't really know what I'm up to. I think foot or tail is fine, but it is important to write details on records i.e. BP measured from tail, cuff size 2, in consult with O' present, by 'name of vet/nurse'. I found it frustrating when all that was on the notes was 'BP 170' with no reference to cuff size, location of measurement or operator. At least then trends can be evaluated.

Re price, we had a 'geriatric' package which covered CBC & diff, biochem, T4, USG + dip and BP for cats. It was a very good price, as the bloods alone were only £2 less than the whole package so no problems getting owners on board.

Louise

Re: Measurement of Blood Pressure for Clinical Cases

Rob Davis — Thu, 04 Dec 2014 11:05:48 GMT

[quote user="Martin Atkinson"]My technique is to clip the sole of the foot, apply KY jelly and use headphones to listen for the beat[/quote]

Clipping isn't necessary and does add to stress - I use spirit to flatten the coat and ultrasound gel on the doppler probe - works fine with no clipping.

I always admit for a couple of hours to enable me to do it in an unstressed manner once the cat has calmed down from the car journey. I admit to not doing it as often as I should.... must try harder!

Re: Measurement of Blood Pressure for Clinical Cases

Thomas Johnson — Wed, 03 Dec 2014 15:00:32 GMT

[quote user="ChrisBVSc"]

[quote user="Thomas Johnson"]

We charge £30, which I don't think is unreasonable for the time it takes and cost of the equipment, I don't do as many as I should but I've never had an owner decline on cost grounds.

[/quote]

Say the cat is in for a routine checkup for its ongoing CRF/hyperT or whatever, do you charge the £30 on top of your consult fee if it's done at the same time? Only asking as we have a similar fee which always results in a very expensive recheck if you charge "correctly."

[/quote]

We would normally charge it on top of the consult fee, though routine check-up's are charged at the lowest consult fee. If the consult has been very short, for example in a cat with idiopathic hypertension, I may just charge the blood pressure fee.

Re: Measurement of Blood Pressure for Clinical Cases

ChrisBVSc — Wed, 03 Dec 2014 14:53:11 GMT

[quote user="Thomas Johnson"]

We charge £30, which I don't think is unreasonable for the time it takes and cost of the equipment, I don't do as many as I should but I've never had an owner decline on cost grounds.

[/quote]

Re: Measurement of Blood Pressure for Clinical Cases

Thomas Johnson — Wed, 03 Dec 2014 10:25:30 GMT

We charge £30, which I don't think is unreasonable for the time it takes and cost of the equipment, I don't do as many as I should but I've never had an owner decline on cost grounds.

Re: Measurement of Blood Pressure for Clinical Cases

Anthony Dennison — Wed, 03 Dec 2014 09:01:30 GMT

We charge a ridiculous amount (not going to say how much because I'm a little embarrassed it's so much tbh...) which means people hardly ever do it

Re: Measurement of Blood Pressure for Clinical Cases

KathW — Tue, 02 Dec 2014 19:51:32 GMT

We charge - I think it's about £12. of course the problem then is introducing it and convincing vets (and owners) that it should be done.

Re: Measurement of Blood Pressure for Clinical Cases

Martin Atkinson — Tue, 02 Dec 2014 19:07:36 GMT

[quote user="Michael Woodhouse"]Are you guys charging specifically to measure blood pressure?[/quote]Yes £10 (when I remember)!. It takes additional time and skill not to mention it is an item that cost money and may need replacing/servicing (already has both). We should not be afraid to charge for these. If I was running renal clinics I might not charge to encourage uptake but I'm not so I do.

Re: Measurement of Blood Pressure for Clinical Cases

Michael Woodhouse — Tue, 02 Dec 2014 17:17:28 GMT

Are you guys charging specifically to measure blood pressure? We have a doppler and when we bought it we set up a modest charge. It doesn't get a lot of use (mainly things under anaesthetic).

Re: Measurement of Blood Pressure for Clinical Cases

Andrew Kent — Tue, 02 Dec 2014 10:34:03 GMT

[quote user="KathW"]One question is do you check BP at all and if so do you do it within a (hopefully longer) consult or do you keep the cat in for a few hours and let the nurses do the BP check later in the day?[/quote]

Depends on the cat and how long you have for consults. It is doable in a longish appointment with a relaxed cat but otherwise I would hospitalise or (even better) do a house visit (or send a nurse) and have it measured relaxed at home.

[quote user="KathW"]

For example having diagnosed hyperthyroidism in a cat do you get the cat back for BP measurement before starting on medical treatment or would you wait until the hyperthyroidism was under control and then check it?

[/quote]

I would check BP at diagnosis and then monitor if high (unless really really high) to see if normalises with treatment and medicate if not.

[quote user="KathW"]For a cat diagnosed with renal disease do you routinely check its BP? Is this done soon after diagnosis and then how often would you re check it?[/quote]

Yes I would check at every recheck, so probably every 3 months ideally so that you can act to change management if it is high.

Andy

Re: Measurement of Blood Pressure for Clinical Cases

Martin Atkinson — Tue, 02 Dec 2014 09:38:48 GMT

I try to remember to measure all old cats and especially those with suspected CKD or hyperthyroidism but I confess it is not yet routine. However, all cats on medication are required to come back every 3 months and that triggers me to monitor them. I try to get all cats with hypertension onto amlodypine. If on this routine check the BP was high or low then I would change the dose accordingly then re-measure every 3 weeks until it was stable then go back to the 3 month check.

My technique is to clip the sole of the foot, apply KY jelly and use headphones to listen for the beat. This way I will be able to measure BP in all but a stubborn few where despite whatever technique I use I cannot hear the pulse beat. I will usually inflate and deflate the cuff 3 times in a session and average the value but I find it is always within a couple of mmHg. If you are calm and reassuring with the cat I don't believe 'white coat' effect has any more than 5 mmHg effect on the true result. The important thing is to be consistent with your approach so you have consistent values.

I am rarely fully booked so I am happy to take 15 minutes for the consultation, let the cat wonder about and bit an have a chat to the client which I'm sure helps.

Re: Measurement of Blood Pressure for Clinical Cases

Anthony Dennison — Tue, 02 Dec 2014 09:23:47 GMT

I would say it's hard to get an accurate reading in even an extended consult (how extended?). Admitting for the day and taking multiple readings over the course of the day may give a better idea.