Blood pressure machines..is Doppler still gold standard?

RE: Blood pressure machines..is Doppler still gold standard?

Alasdair Hotston Moore — Tue, 26 Nov 2024 09:01:11 GMT

This is true Sarah. But the starting point is what population are screening tests applied to. Usually this seems to be no more than guesswork. BP in all cats over 8 or 10 or whatever. But the prevalence of hypertension in the study population has a big bearing on the value of the test ( prevalence of false positives/negatives). When health screening is rolled out, surely we can do better in the modern world when corporates have access to data from millions of registered pets?

[quote userid="9515" url="~/f/clinical-questions/31080/blood-pressure-machines-is-doppler-still-gold-standard/245983#245983"]we should consider that perhaps the investigations that lead on from screening tests [/quote]

RE: Blood pressure machines..is Doppler still gold standard?

Sarah Keir — Sun, 10 Nov 2024 18:28:39 GMT

[quote userid="5012" url="~/f/clinical-questions/31080/blood-pressure-machines-is-doppler-still-gold-standard/245974#245974"]Is it ethically acceptable to run diagnostic tests where there is no clinical indication to do so? [/quote]

Yes because it is not being used as a diagnostic test but a screening test. If we don't look then we don't find, and how many first presentation hypertensive cats are brought in because of sudden onset blindness. But we should consider that perhaps the investigations that lead on from screening tests may cause more overall harm than good on a population level, as has been discovered with breast cancer screening.

Doppler all the way. I perform several Doppler blood pressures daily and have got it such as I can do it in 2 minutes. The high-definition Oscilliometric devices are better but you need to view the trace to check it is accurate rather than blindly accepting the numbers generated. The cheapo oscillometric machines are random number generators, especially in conscious animals.

RE: Blood pressure machines..is Doppler still gold standard?

Sara Ramsey — Sat, 09 Nov 2024 15:24:28 GMT

Thanks, we were looking at this one and a good point using the Doppler afterwards.

RE: Blood pressure machines..is Doppler still gold standard?

Sara Ramsey — Sat, 09 Nov 2024 15:21:24 GMT

I agree 100%.

But...targets/KPIs/audits/ spread sheet/ re-structures

Just trying to make it a bit easier for my nurses.

It's certainly not something I push..however it's advertised externally and there are some clients who are very proactive and it's a good deal for those who ask off their own volition.

RE: Blood pressure machines..is Doppler still gold standard?

Clive Ansell — Sat, 09 Nov 2024 10:24:30 GMT

[quote userid="7002" url="~/f/clinical-questions/31080/blood-pressure-machines-is-doppler-still-gold-standard"]The powers that be want a 30 minute wellness screen with bp, bloods, hx, exam and urine dipstick and it's a struggle (but that's another topic) [/quote]

I was working in a practice during 2022 where wellness screens were being trialled.

I think they were 20 minutes appointments run by RVN's, marketed/peddled at owners of healthy animals for a general "wellness" screen. From memory it included basic blood work, urinalysis, BP, basic TPR examination.

They didn't really work.

1. There were very few takers. The practice is in a very poor area, where we struggle to get owners of sick animals to commit to diagnostic tests. Very few owners of outwardly well animals, where there is nothing obviously wrong, would do this.

2. Not enough staff to run it most of the time. It needs a minimum of 2 staff members to take a blood sample, and these appointments were slotted in during lunchtime and early afternoon after vet consults had finished. Often only 1 nurse on premises, and even when there were 2, by the time they had finished with and discharged ops and inpatients. had lunch breaks etc, little or no time left. Somedays they could only offer one appointment.

3. Still needs veterinary surgeon involvement to interpret the results, and often vets had no free appointments and no free time. Often, clients had questions that an RVN could not answer, so the only advice they could give would be "make an appointment with a vet" which would be days or weeks away.

4. If anything were found, a veterinary appointment would still be needed to discuss further investigation or treatment. Again, short of appointments so days or weeks to get them seen.

5. RVN's just had a blanket tickbox list of which tests to run, and they were not focused or selected based on the findings of a full consultation, history and clinical examination.

6. Is it ethically acceptable to run diagnostic tests where there is no clinical indication to do so?

RE: Blood pressure machines..is Doppler still gold standard?

Rob Loxley — Sat, 09 Nov 2024 09:31:43 GMT

Have you looked a petMAP devices - they claim to be an improvement on earlier oscillometric models?

[quote userid="7002" url="~/f/clinical-questions/31080/blood-pressure-machines-is-doppler-still-gold-standard"]and it's a struggle (but that's another topic)[/quote]

it's an interesting one - I do think you need to be delegating what you can eg the bp and blds and urine, or at least having great assistants in the room ready

RE: Blood pressure machines..is Doppler still gold standard?

Beats — Fri, 08 Nov 2024 23:04:49 GMT

Suntech v20 might be an option. For screening BP in cats then arguably less accurate but more cats may have more benefit. It is scr3ning so can book 2 week recheck with doppler if high. Not likely to make any treatment on single BP check in well cat.

RE: Blood pressure machines..is Doppler still gold standard?

David Mills — Fri, 08 Nov 2024 20:52:49 GMT

Ah BP. A real bugbear.

I find oscillometric as frustrating as pulse ox machines. Often wildly different readings even when under GA depending on cuff position.

Doppler is yes the most accurate. But also the biggest faff esp when conscious. Oscillometric might be ok for trends but the sometimes 40-50mmHg differences in readings make me wonder. It normally says too low than too high, which won't be ideal if you're trying to catch hypertension