NIBP machine

Re: NIBP machine

Nick Shackleton — Sun, 16 Aug 2009 17:41:22 GMT

have you seen the RVC after after nurses currently??? Kno it would mean moving but not really that far as well as Davis near Lutton, both hospitals would deffo listen to nurses!

And I think you've hit the nail on the head as to why so many nurses leave the proffession there is no room for progression....... anyways that is a subject for another thread. If you got any more questions regarding anaesthesia feel free, if I cant answer will consult our anaesthetist

GOOD LUCK FLUFFY

Re: NIBP machine

Laura Ringsell — Sun, 16 Aug 2009 17:37:50 GMT

Oh thanks Nick - that is really kind. I am very hopefully on the move soon(fingers crossed very tightly as all of a sudden the future is looking bright!) and then intend to get myself on a few of these RVC courses as I have heard that they are very good. First off though find an employer who is happy to listen to a nurse about things learnt on CPD and not discount nurse CPD as rubbish as that is about the most de-motivating thing ever

Re: NIBP machine

Nick Shackleton — Sun, 16 Aug 2009 17:27:44 GMT

Oh was gonna say we will be holding another CPD evening later on in the year but we are based in the Norh West!!! And I could of put in a word that nurses are interested in monitoring techniques for nurses. I do believe the RVC are running a few advanced anaesthesia courses

http://www.rvc.ac.uk/CPD/Courses/Course.cfm?course=278

Re: NIBP machine

Laura Ringsell — Sun, 16 Aug 2009 17:24:33 GMT

Deepest darkest Surrey - and on the look out for a new job!!!

Re: NIBP machine

Nick Shackleton — Sun, 16 Aug 2009 17:21:52 GMT

Fluffy where are you based???

Re: NIBP machine

Laura Ringsell — Sun, 16 Aug 2009 17:17:39 GMT

I have always been told to place the cuff (usually around front leg just above stopper pad) and then raise the leg so it is in line with the heart ? - when under GA they are generally in lateral with the legs at approx 45 degrees ???. As to the size of the cuff I was taught 40% of the circumference of the limb - or roughly the width of the limb. Our fancy machine came with three sizes - you can guess the variation - small cat size, large dog size and, giant dog size - good luck to anything in between!!!

Beginning to feel like I need to go back to college - or find a practice where people care about doing things right and don't just roll their eyes with that 'here she goes again' look...

Re: NIBP machine

Nick Shackleton — Sun, 16 Aug 2009 11:15:08 GMT

Sounds like you have oscilmetric BP machine and your vet is correct they ain't very accurate, esp on the smaller patients. Doppler is better (althou only reads systolic) and direct blood pressure is gold standard (either arterial or CVP).

Provided there are no cardiac issues when we have low BP (<60mmHg) we give a bollus of crystalloid @ 10ml/kg as quick as possible (ie set fluid rate to max on drip pump na dset volume to be infussed at the amount of 10ml/kg). Wait 15mins and assess response.

Where are you placing your cuff? If the cuff is placed above the patients heart base then you will get a false low reading

Are you using the correct size? Check that fits snug and is not too big or small for the patient. (depends which kind of cuffs your using as to the method of checking correct sizing.

Re: NIBP machine

Laura Ringsell — Sun, 16 Aug 2009 10:05:00 GMT

We have a does it all (mechanically!) anaesthetic monitoring machine with a cuff BP - since it has been installed I am forever saying 'the BP is a bit low' - and i get nothing back from the vet as I think they are not sure what we can do about it - we unfortunately don't have doppler. Even with patients on surgical rate fluids - maybe it is just an inaccuracy thing but it makes me wonder why they make these fancy machines with all the gadgets that aren't suitable for the purpose....it also takes an age to get the animal connected to all the gizmos and you have a frustrated vet wanting to get started on their op - so most of the attachments don't get used- what's the point of that??? rant over!

One of the vets recently went on a senior cat CPD which apparently dissed our BP machines saying they were not to be trusted and that doppler was the way to go - let's see what comes of that - meanwhile we will carry on treating and diagnosing cases based on the technology (?) we have......

Re: NIBP machine

Nick Shackleton — Thu, 06 Aug 2009 23:15:55 GMT

All our patients routinely have IV fluids, if the have low Mean blood pressure (<60mmHg) over several readings (generally look for trends rather than one off low readings). these patients would then recieve a bollus of crystalloids @ 10mk/kg

If after 15mins after the end of the bollus has been given BP is still reading low then a bollus of colloids will be then given at 5ml/kg (remember that the max amount of colloids that can be given is 20mls/kg/24hrs)

Oh and btw I work in referral only practice, so our routines are generally ortho, neuro or soft tissue surgeries........

Re: NIBP machine

Anonymous — Thu, 06 Aug 2009 23:10:33 GMT

Nick do you give IV fluids for low blood pressure patients?

Re: NIBP machine

Nick Shackleton — Thu, 06 Aug 2009 22:47:36 GMT

I use micropore directly on the patient the loop the doopler cable up (like drip line) and then tape in place with elastoplast!

Re: NIBP machine

Kim Buckley — Thu, 06 Aug 2009 22:44:58 GMT

That's like the one I used at the RVC when I was on placement there. I miss working in referral Any handy tips on how to keep the doopler on the pulse. I've used tape but it always seems to slip!

Re: NIBP machine

Nick Shackleton — Thu, 06 Aug 2009 22:21:09 GMT

I've used NIBP alongside IBP (using an arterial line) and the measurement do not corrilate at all! The smaller the patient the less accurate ossclimetric BP reading is!

I use our Doppler BP machine on my smaller patients and do ABP if the patient is critical as direct blood pressure measurement is gold standard monitoring

the Doppler machine we use is a Parks Doppler, pretty compact and portable and easier to use in theatre

http://www.aasmedical.co.uk/index.php?id=45 available from here! Just remember that if you are going to use doopler ensure that ultrasound gel is used and not ECG gel as the latter will corroid the crystals and therefore makes it useless!!!

Re: NIBP machine

Kim Buckley — Thu, 06 Aug 2009 21:09:52 GMT

No it was normal surprisingly! Couldn't have been a very stressful day!

Re: NIBP machine

dinkyd — Thu, 06 Aug 2009 21:06:59 GMT

LOL hope its not high

Re: NIBP machine

Kim Buckley — Thu, 06 Aug 2009 21:04:09 GMT

Well we've managed for years without one but one of the vets asked for it and my boss gave in. Ah well. It's fun for taking our own blood pressures :P

Re: NIBP machine

dinkyd — Thu, 06 Aug 2009 21:00:51 GMT

Lol no 20yrs old isnt good!I understand what you mean but personally i use other methods of monitoring patients - we use all other aspects of our multiparameter machine but the BP cuff doesnt get touched due to the poor readings.

Re: NIBP machine

Kim Buckley — Thu, 06 Aug 2009 20:54:48 GMT

Yeah but dopplers are quite hard to use in theatre when the patient is covered in drapes. Doesn't help that ours is about 20 years old either

Re: NIBP machine

dinkyd — Thu, 06 Aug 2009 20:49:01 GMT

I have found the doppler to be the most accurate - dont trust our multi parameter bp machine lol!

Re: NIBP machine

Kim Buckley — Thu, 06 Aug 2009 20:36:10 GMT

We have a doppler one which we've had for years and use for blood pressures on cats who are in specifically for blood pressure readings, The new one is one of those automatic ones which just uses a cuff and we're going to be using that in theatre.

I was using it today during a cat spay and I couldn't believe how low it went on induction with propofol!

Is there anything I should be doing if the blood pressure shoots up or goes down dramatically?

Re: NIBP machine

Nick Shackleton — Thu, 06 Aug 2009 00:03:20 GMT

Any where BP is gonna be an issue to be honest so small dogs and cats, hypovaemic patients, where blood loss may occur.

just remember that the cuff should be placed below the base of the heart, otherwise you will get a false reading.

the cuff should meassure roughly 1/3 the circumfrence of the patient's limb.

Do you have doppler blood pressure (for monitoring renal patients) as this is a far better way of monitoring BP (althou only gives you asystolic reading)

any other questions???