Biochemistry analysers

Re: Biochemistry analysers

Rob Loxley — Mon, 31 Jan 2011 19:39:56 GMT

[quote user="Rob Davis"]But how commonly do you see these at critical levels?[/quote]

Not often I agree, but doing lots of thyroidectomies I can imagine there will be one at some point that we want to rule out clinically significant hypocalcaemia.

[quote user="Rob Davis"]An istat (or epoc) would cover this.[/quote]

Indeed, but my answer was in reply to a question on what conditions instant results might make a clinical difference.

Re: Biochemistry analysers

Rob Davis — Mon, 31 Jan 2011 13:54:21 GMT

[quote user="robloxley"]

[quote user="Anthony Todd"]what those conditions are[/quote]

Well how about marked hypo- and hyper-calcaemia for starters?

[/quote]

But how commonly do you see these at critical levels? An istat (or epoc) would cover this.

Re: Biochemistry analysers

Rob Loxley — Sun, 30 Jan 2011 15:30:32 GMT

[quote user="Anthony Todd"]what those conditions are[/quote]

Well how about marked hypo- and hyper-calcaemia for starters?

Re: Biochemistry analysers

Anthony Todd — Sat, 29 Jan 2011 21:09:10 GMT

We get same-day or results by 10am next day.

I wonder just how many cases require instant results that will significantly change the treatment regime and what those conditions are.

I mean, nice to have but do they really make a difference by being "instant"?

Re: Biochemistry analysers

Bob Russell — Sat, 29 Jan 2011 10:57:55 GMT

With QCR we fax a copy of the failed rotor results to them and generally not much happens but the support we get from their 'local man on the ground' is great and he sorts things out so we are not out of pocket for failed rotors. We had a spate of failures a few months ago but this was tracked down to a problem batch and they were replaced FOC. Not had much of a problem since.

Sorry it sounds as if I am a salesman for the Vetscan but genuinely we have found it serves our purposes well. Perhaps not so suitable for high throughput practices except perhaps as a back up.

Re: Biochemistry analysers

Rob Loxley — Fri, 28 Jan 2011 23:50:45 GMT

[quote user="Michael Woodhouse"]If I was in the OP's position I would look at one of the hand held blood gas machines like the Istat. The blood gasses and electrolytes may make a difference to the patient today, it's creatinine level unlikely to?[/quote]

The istat will do BUN and CRE (http://www.qcrandtrio.co.uk/media/catalog/product/cache/1/image/9df78eab33525d08d6e5fb8d27136e95/i/-/i-stat-chart-dec09.gif).

[quote user="David Beattie"]So even if I had a VetScan VS2 in place and therefore equipment costs were all 'sunken costs' anyway, still wouldn't use it for T4 testing as I make it cheaper to send samples away[/quote]

Yup, it costs more to run the VS2 T4 rotor than send off to an external lab. We very rarely seem to run T4 rotors for dogs but quite frequently for cats, particularly ill animals where knowing the T4 result soon is helpful and often for same-day pre-op screening. Maybe it's just that being able to add it to the in house bloods makes us more likely to measure T4? And we see lots of cats - and lots of hyperthyroid ones at that!
Again being able to run in house bile acids is not critical but often useful.

[quote user="David Beattie"]coupled with the fact that sometimes your rotor won't read properly and needs repeated[/quote]

Unless user error is implicated (e.g. underfilling of rotors), credit is given for 'failed' VS2 rotors (and it's rare).

Re: Biochemistry analysers

Anonymous — Fri, 28 Jan 2011 12:56:56 GMT

[quote user="Bob Russell"]

I disagree with the comments about T4 our set up (non-idexx) gives good results. They agree closely with the external lab results.

[/quote]

Even if I put my concerns of validity of in-house T4 results compared to using external lab to one side, I still need some convincing. If you're using the Vetscan VS2, then my understanding is that individual rotors for this cost more than a UKAS accredited external lab, coupled with the fact that sometimes your rotor won't read properly and needs repeated, I make it more expensive to run a T4 in-house on a VS2 than to post it away. For canine hypoT4 screening, I usually want minimum of T4/TSH anyhow (so need to use external lab), and can't remember ever wanting an urgent T4 result that couldn't wait 24-72hrs (certainly not for routine monitoring purposes...). So even if I had a VetScan VS2 in place and therefore equipment costs were all 'sunken costs' anyway, still wouldn't use it for T4 testing as I make it cheaper to send samples away (and don't have concerns re validity of results of UKAS accredited external lab test).

Re iSTAT - if you think that's a good option, may be worth considering versus Woodley's 'epoc' (even if just to drive the price down on your favourite of the two)

Re: Biochemistry analysers

Bob Russell — Fri, 28 Jan 2011 10:51:01 GMT

[quote user="Michael Woodhouse"]

If I was in the OP's position I would look at one of the hand held blood gas machines like the Istat. The blood gasses and electrolytes may make a difference to the patient today, it's creatinine level unlikely to?

[/quote]

Would tend to agree with this one but our istat was bundled with the 5 part diff machine so was not particularly expensive.

I disagree with the comments about T4 our set up (non-idexx) gives good results. They agree closely with the external lab results.

We cannot as yet measure cortisol results in-house but apparently it is on the way with the Vetscan. In-house labs may not be good profit generators but I would hate to be without ours!

Re: Biochemistry analysers

gcvetsa — Fri, 28 Jan 2011 10:40:04 GMT

Lots of food for thought. I agree about inhouse haematology hence my initial question was only about biochem. Sorry, I should have added electrolytes as well. The plan is to use manual PCV and blood smear to provide the haemotology picture and send a sample to an outside lab if I want a fuller picture. I think the problem with some of the inhouse analysers like Istat is the relatively short shelf life of the cartriges. This can be managed if you dont have to buy whole boxes at a time or can share but it can add to the overall cost of having the machine in the clinic. It also depends if you are a blood gas convert or not. While not a necessity, I like to be able to get some results within a short period of time. It's a personal choice but it suits me and the way I work. The fact that clients may be impressed is a bonus. I have worked in clinics that have not had inhouse analysers so appreciate it is not a big issue and can be easily managed. As regards the cost of the machine, with all the types of deals available and compared to the overall cost of setting up, I have made the decision that this is an area I am prepared to invest in. Within reason though and thus want to try get it right. In my mind, the ideal would be the flexibility of doing individual tests and profiles as well as both biochem and electrolytes on one machine without that machine costing an arm and a leg. Maybe a pay as you use deal without monthly minimums or being tied into lengthy deals. Problem with my plan is that I am not sure what is in it for the companies that supply the machines apart from my abiding affection and loyality. Anyone know of any good deals on Idexx Catalysts out there?

Back to my original question though, does anyone have any experience of using the Menarini Spotchem EZ analyser with or without the seperate electrolyte analyser (Spotchem EL)? I did a search through the forums and found one remark about it. I get the feeling it is not a common setup found in practices. Thanks for all the feedback so far though.

Re: Biochemistry analysers

Michael Woodhouse — Fri, 28 Jan 2011 00:33:28 GMT

Re: Biochemistry analysers

Gillian Mostyn — Thu, 27 Jan 2011 21:53:22 GMT

I suppose I don't know enough about profit margins involved in running your own tests to comment as much as I have- sorry! I only know the waffle I got from the 'common' lab machine provider and that, if used lots (over-used?) then it could make us £xxxxx etc a year. Whether this would have turned out to be true I have no idea.

I do, however, make decent profit margins on our lab work. I charge according to our GtoPC in that I charge the lab work at cost and then add separate blood sampling and lab results interpretation fees which together come to approx £18 on top of the fee. That means the client gets charged the same fee regardless of the cost of the labs (although we have a higher interpretation fee for certain labs that will take longer to sort, such as allergy testing etc.) Maybe we do, in the end, make more money sending labs out.... I'm just aware of how much a basic pre-an screen costs when run in-house........does it really cost that much????

[quote user="David Beattie"]The main advantage to my clients is cost - my lab fees are significantly less than in -house ones.[/quote]

Hmm..have re-read this and it comes across differently to how I intended. I should say that I don't lose sleep worrying about how much my fees are costing my clients. I offer the service - it is their choice if they want to pay it. However, I find that I can run full blood profiles and pre-an screens pretty much whenever I think it is needed because the fees aren't prohibitive. Makes my life easier.

Re: Biochemistry analysers

Anonymous — Thu, 27 Jan 2011 18:24:19 GMT

[quote user="Gillian Mostyn"]

The disadvantages are that I make a lot less profit from my lab work ...

The main advantage to my clients is cost - my lab fees are significantly less than in -house ones.

[/quote]

I'm totally with you Gillian that the necessity of in-house lab machines can be over-egged. Certainly I'm of the opinion that you get more information from a blood smear and manual PCV than an in-house haematology black-box (which really is of most use as a screening tool, with blood smears obligatory for results outwith reference intervals anyhow), and if you do both, then the haematology machine only helpfully really adds haemoglobin and a total wbc count - I could think of better investments for a few grand if starting up a new practice personally...

Don't follow your point above though. Your proft margin on lab work is entirely up to you surely? If you have lower overheads from not having in-house machines (which are rarely genuinely profitable in a small vet practice unless over-used I would imagine, though don't personally know the figures), then I would have thought you could make a good profit on your lab work, if you wish to, by charging more!?

I also agree about the reliablity of results - in-house T4 and cortisol assays (rarely of much urgent use, though I do appreciate some value in 'ruling out' Addison's) are IMHO for vets who don't know how to use a post-box

Re: Biochemistry analysers

Gillian Mostyn — Thu, 27 Jan 2011 17:52:43 GMT

oops. I really did try NOT to say 'in-house labs are rubbish' - because obviously they have their place and can be invaluable in some circumstances. And, as I said, some practices run them brilliantly. If your practice does so Bob, then that's great. I was simply pointing out that alternatives exist.........costs are so high already in a new set-up!

Re: Biochemistry analysers

Bob Russell — Thu, 27 Jan 2011 16:19:11 GMT

'The quality of the results from in-house machines is so variable, depending on the maintenance of the machine, how regularly QC is carried out and the ability of the staff member running them. Some places gets that spot-on. Others don't.'

Our machines are automated, all staff can run them as there is little special training. Maintenance is routine and involves changing reagent packs which is not difficult. QC is mostly built in but samples can easily be sent to an external lab. Our system is absolutely vet proof as the nurses keep saying!

Owners are impressed beyond belief to hear the results will be available in a few minutes compared to the NHS. You also know if that cat really does have renal failure within a short time. Electrolytes sent to an external lab are often of little value by the time the results get back.

In house labs do not replace a good external lab but compliment them wonderfully.

Re: Biochemistry analysers

Gillian Mostyn — Thu, 27 Jan 2011 16:06:06 GMT

We've had this discussion previously so I don't want to bore everyone again. But you are correct to assume we don't have our own in-house biochem or haem. Samples get sent to a lab with, usually, a max 24hr turnaround.

The advantages to me are that I don't have to pay for, maintain or staff these machines. I love that. I also know I can trust my results 100% of the time and know they will be able to be accurately comparable to future results. The quality of the results from in-house machines is so variable, depending on the maintenance of the machine, how regularly QC is carried out and the ability of the staff member running them. Some places gets that spot-on. Others don't.

The disadvantages are that I make a lot less profit from my lab work (which doesn't bother me but may bother some people) and I don't get instant results.

The main advantage to my clients is cost - my lab fees are significantly less than in -house ones. They REALLY aren't bothered about next-day results - in fact, most are amazed by the speed. They don't expect to go to the GP and get bloods done and reported the same day, so why would the local vet be any different?

In the event of results being needed instantly we have a local daytime and OOH clinic that will run them for us.

This system works for us and I really do prefer not running the machines myself. I know that some people really want/need in-house, but was just saying that in a new set-up (as we were) the hassle and costs of running your own lab can be avoided.

Re: Biochemistry analysers

Rob Loxley — Thu, 27 Jan 2011 14:57:06 GMT

[quote user="Gillian Mostyn"]Have you considered the possibility that you may not need one at all?[/quote]

A centrifuge for PCV and microscope, glucometer and BUN dipstick can get you a very minimum database but has big gaps - e.g. knowing the animal's calcium or potassium or white blood cell count or some other parameter is often just so helpful.
We have 3 external labs within 10 miles drive so could easily use them for same-day results but there's the issues of saturday mornings, sundays or OOH (if we were open), late evenings etc. and just ferrying samples around.
I guess you could partner up with another local friendly vet surgery?

Re: Biochemistry analysers

Martin Atkinson — Thu, 27 Jan 2011 14:33:50 GMT

[quote user="Gillian Mostyn"]

Have you considered the possibility that you may not need one at all?

[/quote]

Does that mean you don't Gillian? One of the greatest advantages of in-house labs is that we can make a diagonosis while the client waits, this has huge impact on being able to treat the animal promptly and does wonders for client relations. Admittedly there are limitations to in-house analysers but near-instant results far outweight them.

Re: Biochemistry analysers

Gillian Mostyn — Thu, 27 Jan 2011 12:55:52 GMT

Have you considered the possibility that you may not need one at all?

Re: Biochemistry analysers

gcvetsa — Thu, 27 Jan 2011 10:28:56 GMT

Thanks for the feedback. It seems to be be coming back to the same point as other threads. That is, if you want flexibility it is going to cost you. So the search and negotiations continue. It may take a little time but I will update this thread when we choose a supplier plus give some feedback about how the deal stacks up in real life. That will be the important part.

Re: Biochemistry analysers

Bob Russell — Wed, 26 Jan 2011 17:31:55 GMT

We never managed to make that work although we tried.

Re: Biochemistry analysers

Rob Loxley — Wed, 26 Jan 2011 17:29:24 GMT

[quote user="Bob Russell"]A bug-bear of the older machine (3 part) was you had to put a card into the side that limited the life of the reagent box and we would throw half the contents away because the machine would not work with 'expired' chemicals.[/quote]

We still have an HMT and have come across the same and - not that I'm sure the manufacturers would be happy - changing the date on the analyser is a dirty workround...

Re: Biochemistry analysers

Bob Russell — Wed, 26 Jan 2011 16:53:30 GMT

You can be very pushy and sometimes get a very good deal on an istat as well if you buy at the same time. This fills in most of the gaps including ionised Ca.

The limits to flexibility are balanced by the small numbers of rotas that you need to keep and store to get you going. For a one man band this can be a real bonus!

Re: Biochemistry analysers

Martin Atkinson — Wed, 26 Jan 2011 16:09:11 GMT

I have a Vetscan and it is very easy to use plus does K & Na on the comprehensive rota. Downside is you have to run a whole rota for one test, your'e stuck with a fixed menu on a limited range of rotas and you cant do a chloride like on a separate electrolyte analyser but overall I feel its a better bet financially for a sole charge practice with relatively few tests going through. I had a look at the Menarini machines but chose against them cant remember why now but I think it was cost and the salesman was a bit pushy.

Re: Biochemistry analysers

Bob Russell — Wed, 26 Jan 2011 13:52:06 GMT

We have the Vetscan and Haemat 5 (5 part diff) haematology. Good for relatively low throughput practices. Straight forward to use and results are usually in-line with external lab samples. A bug-bear of the older machine (3 part) was you had to put a card into the side that limited the life of the reagent box and we would throw half the contents away because the machine would not work with 'expired' chemicals. The 5 part does not have that issue.

Our Vetscan is about 8 years old and is (touch-wood!) still going strong, long after it is all paid for! The haematology machine is new and a million times better than the old three part machine it replaced. I think that machine is residing in my tack room!

Be very careful with one of the larger companies they will try the hard sell and offer a deal that will seem too good to be true and I suspect it will be just that!

The large company will tell you the equipment will cost you nothing but with us demanded a minimum spend each month which was far more than we were already spending.

For a start up go for a machine with low running costs if not used often. Some seem to go through a lot of reagents even if not used.

HP seems the most tax efficient way of buying at the moment and the total can be written off against tax in one year if your accountant recommends it!

Others will have different opinions of course! Good luck!