blood pressure machines

Re: blood pressure machines

Karen Eggleton — Sat, 10 Oct 2009 16:54:24 GMT

Hi Mike,

Thanks for the advice. Apologies for not replying sooner-lost thread in hectic week!

The cat is 3.72kg, BUN 12.7(6-10), crea 147(60-170). I have requested urine samples but none been forthcoming so, sorry, no UP:UC or USG.

Thanks!

Re: blood pressure machines

Mike Martin — Thu, 08 Oct 2009 09:05:25 GMT

I thought Mike B was swearing....

Re: blood pressure machines

Arlo Guthrie — Thu, 08 Oct 2009 08:47:05 GMT

[quote user="Mike Brampton"]Not sure why the filter/sensor cut in there[/quote]

Nor am I. Mike, could you tell me what the missing word was, and I'll fix it!

Re: blood pressure machines

Anonymous — Wed, 07 Oct 2009 18:37:49 GMT

Not sure why the filter/sensor cut in there, but yes the cuff range marker, shows the diameter of the limb

Re: blood pressure machines

Hannah Wynne Richards — Wed, 07 Oct 2009 12:06:50 GMT

I don't have a BP machine, it's on the wish-list, but would definitely agree with the description cold and blue for dedetomidine-horrible drug. I only use it because I do a lot of charity neutering-it works intra-cat with a spitting feral brought in in a cat-trap !!!!

Wynne

Re: blood pressure machines

Mike Martin — Wed, 07 Oct 2009 08:57:18 GMT

[quote user="nobbygonzo"]hypertensive retinopathy. It is on istin 1/8 uid & 12.5mg atenolol uid and its BP is now 174.[/quote]

In an asymptomatic cat, I'd probably agree and feel that was acceptable. But in one with retinal hypertension, I'd be fairly aggresive in controlling the BP. I'd almost certainly go bid, but what weight is the cat? Maybe more? And what's renal function like, urine SG and P:C? Might it also need benazepril?

Atenolol needs to be given bid in cats & dogs (unlike humans), so we use a dose of 25mg 1/4 bid, in cats with symptoms of heart failure.

Re: blood pressure machines

Karen Eggleton — Tue, 06 Oct 2009 22:30:08 GMT

Can I be cheeky and sneak a clinical question in here? it's been niggling away at me... I see an aged cat with HCM and intermittent SAM, also previous, partly salvaged, hypertensive retinopathy. It is on istin 1/8 uid & 12.5mg atenolol uid and its BP is now 174. Would everyone say that this was an acceptable level to stay at? I was aiming for less than 170 but I'm thinking that the white coat effect might be in play here.Or should I be going to BID istin?

Also, I usually use a Parkes but have been borrowing a neighbouring practice's Thames. However, I really struggle with picking up the pulse in this cat. I don't normally have a problem. I have not clipped and only intermittently use spirit.Is this the answer?

Thanks!

Re: blood pressure machines

Stephen Ashman — Tue, 06 Oct 2009 21:50:18 GMT

[quote user="Mike Brampton"]but as its a *** measuring, there is a range marker on our cuffs, if you are in range you've got the right cuff.[/quote]

Does the range marker show the diameter of the limb that it is suitable to be used for? If not what does it relate to?

Re: blood pressure machines

Anonymous — Tue, 06 Oct 2009 18:20:49 GMT

From the original clinical work I was involved in at Guys Hospital with prof Poswillow, we noted a definate drop in BP particularly after a bolus induction dose, it hits a couple of minutes after induction and can last up to about 5 mins. Pulse oximeters will often loose the signal during this phase because of peripheral shutdown. This is why it is now recomended to titrate dosage rate to effect.. The slower the delivery the less you will notice the BP drop.

Re: blood pressure machines

Mike Martin — Tue, 06 Oct 2009 17:34:23 GMT

[quote user="Laurence Webb"]The drop in BP following propofol can be scary enough![/quote]

Can't say I've notice that with propofol. We do direct arterial monitoring of our interventions (ie. PDA closures & balloons). Blood pressure routinely is 20-40% lower in most dogs whilst under GA.

Re: blood pressure machines

Laurence Webb — Tue, 06 Oct 2009 17:21:10 GMT

[quote user="Jill Macdonald"]Another use for the Doppler is anaesthetic monitoring, (the most interesting being listening for the pulse return after you've given antisedan to reverse Medetomidine!) as it gives a really good idea of pulse strength and character in anaesthetised animals.

[/quote]

I've done this, but not as much as I ought to. The drop in BP following propofol can be scary enough!

Other ways to 'misuse' your BP monitor is looking for femoral pulses in cats with probable saddle thrombi and for pregnancy diagnosis in small animals. It certainly makes clients happy if they can hear heartbeats at 2 different speeds (mother and kittens).

I do, however, warn people that this is not what the machine is designed for so absence of heartbeats just means I'm not using it for its correct function.

I've also used it to identify the blood supply for pedicle skin flaps so I be sure it's got a decent blood supply before making the flap and I can mark its position on the skin so I don't chop through it accidentally.

We've had the Thames Medical one for a few years now and we've been very happy with it.

Re: blood pressure machines

Anonymous — Tue, 06 Oct 2009 16:29:53 GMT

A couple of things if I may join in as the designer of this particular piece of kit:

Cough cough, by "puffer" I presume you mean the sphygmomanometer? or sphyg for short!!

We talk about clipping here? you are all right air and hair both interfere with doppler transmission, I find alcohol tends to reduce resistance in most cases, and very much so in this case. A liberal dosing of alcohol to strip the oil out of the hair, and then liberal doses of gel, should see you right.

Cuff width, absolutely correct again The cuff width should be roughly 1/3rd the circumference of the limb, but as its a *** measuring, there is a range marker on our cuffs, if you are in range you've got the right cuff.

As a member of the AVA, I am aware of this drug, Domitor, this posts ends here, at least antisedan has a warm pink label...does what it says on the tin I guess, cold and blue and warm and pink!!

Re: blood pressure machines

Jill Macdonald — Mon, 05 Oct 2009 15:31:44 GMT

Lol re Domitor.. Indeed it can be a little scary.. The Doppler tells a tale all of its own..

Good tip re puffer training (is puffer the technical term? :-)) .. I don't work in that field so sadly won't be able to pass that on.. It certainly is diff to get controlled pressure release. Demonstrating the cut off that the cuff produces is good for empathy, so also is using the ECG crocodile clips!

Re: blood pressure machines

Mike Martin — Mon, 05 Oct 2009 15:04:39 GMT

[quote user="Jill Macdonald"]measure the circumference of the cat's leg at the point of the cuff, and the cuff width should be 40% of this measurement[/quote]

Yep. But to make it easy the cuffs have "range" marks to indicate when the measure is correct.

[quote user="Jill Macdonald"](the most interesting being listening for the pulse return after you've given antisedan to reverse Medetomidine!)[/quote]

Sounds scary. But as a Cardiologist, I've never ever used Domitor. You don't make feel like I'm missing out either

Jill I note ur at Liverpool Uni. A tip for training students (even vets). I find vets visiting us, struggle to work the puffer, ie. release the pressure slow & steady. So I get them to put a cuff on their own wrist and practice getting a slow steady (not jumpy) reduction in the pressure. It also makes them aware of what its like to have ur circulation cut off, so they remember not to dilly dally with a patient.

Re: blood pressure machines

Jill Macdonald — Mon, 05 Oct 2009 14:30:13 GMT

Thanks Mike, oooh, this is all making me wish I was back in practice!

From what I remember, there was some kind of calculation- something like measure the circumference of the cat's leg at the point of the cuff, and the cuff width should be 40% of this measurement? Or was I dreaming? The kit we had contained about 6 cuff sizes..

Another use for the Doppler is anaesthetic monitoring, (the most interesting being listening for the pulse return after you've given antisedan to reverse Medetomidine!) as it gives a really good idea of pulse strength and character in anaesthetised animals.

Re: blood pressure machines

Mike Martin — Mon, 05 Oct 2009 14:19:19 GMT

Oh...and another thing. If I'm unsure which cuff size is best, I do the reading with both. So I might get a cat in which I record 2 readings (cuffs 2 + 3), but I'll note on the record the reading for each cuff - they're usually a little different.

False-positive hypertension ....... in some hairy CKCS, or similar breeds, I'll get an artifactually high result, eg 200mmHg. I'm not sure I understand clearly why, it might be because the hairs (feathers) prevent normal compression of the artery, or some conformation reason. So be careful of not embarking on treatment of such a case.

Re: blood pressure machines

Mike Martin — Mon, 05 Oct 2009 14:14:26 GMT

Useful advise Jill, I agree. To add to that, I shave the hair of the site in every animal. I usually use the metacarpal artery, but if that fails use the tail. Some use primarily the tail. I then spirit the site and then add loads of gel.

I'm right handed and find I need to control the puffer with my right hand, so I hold the probe in the fingers of my left and my thumb over the paw, so like shaking hands. I use head phones, as the animal may be disturbed, but also, its easier to hear weak pulses with them.

I take enough readings to get a consistent result. Often the reading is a little high, so it takes 3-4 before the animal settles. But if I get 3 readings in a row that are the same, I'm happy. I record that reading to the nearest 5mmHg.

Re: blood pressure machines

Jill Macdonald — Mon, 05 Oct 2009 13:45:20 GMT

I used to use one very similar to this also, (a freebie from Novartis- Fortekor) and agree, whilst it takes some time to get used to, it is an excellent piece of kit.

Just a couple of extra bits of info I thought might help (although I might be teaching a grandmother to such eggs!), use plenty of ultrasound gel to get a good sound, if there is any air in the way it limits it markedly.. If the cat has very hairy feet then fur clipping realy helps. I used to take about 10 readings, forget any wild ones and average the rest, becuase you can get quite a lot of variation.

Quiet room is a must, minimal restraint, and the correct width cuff (very narrow for a cat).

I'd like to add, I am a nurse :-)

Re: blood pressure machines

Mike Martin — Fri, 02 Oct 2009 10:57:09 GMT

Re: blood pressure machines

Gillian Mostyn — Fri, 02 Oct 2009 09:56:15 GMT

[quote user="Mike Martin"] Surely there are such things on the vet market?[/quote]

I assume a typo - but very funny

Re: blood pressure machines

Mike Martin — Fri, 02 Oct 2009 09:09:28 GMT

[quote user="Arlo Guthrie"]

You are also allowed to say if there are any you find particularly useless!

[/quote]

Couldn't possibly comment! Surely there are such things on the vet market?

Re: blood pressure machines

Arlo Guthrie — Thu, 01 Oct 2009 18:02:07 GMT

[quote user="Mike Martin"]Am I allowed to say my favourite? Am I breaching any regs? [/quote]

Of course you can! That's what communities like this are all about. You are also allowed to say if there are any you find particularly useless!

Re: blood pressure machines

scarlet — Thu, 01 Oct 2009 17:00:43 GMT

thankyou mike - i was hoping you'd be online to advise! i will obviously listen to other suggestions as well , and then go beg the boss!!!

Re: blood pressure machines

Mike Martin — Thu, 01 Oct 2009 16:53:59 GMT

Am I allowed to say my favourite? Am I breaching any regs? There's probably some I can't keep up with. Arlo, delete this quick if I am.

Anyway my favourite is the Thames Medical Doppler......

http://www.thamesmedical.com/products/cat_doppler.htm

It takes a little bit of time and a little patience (so I get my nurses to take the BPs). But I believe it is the most consistent and reliable. Of course, other cardiologists may have different viewpoints.