Blood Pressure Monitoring · HDO®High Definition Oscillometry · Learn to accurately and safely measure the systolic and diastolic blood pressure, in addition to the heart rate and other blood flow parameters.
Importance of Blood Pressure Monitoring
Blood Pressure (BP) measurements are of vital interest for todays veterinary practice. The ability to measure and monitor blood pressure trends provides important data about patient cardiovascular status and may help define approach to treatment. There are many indications for recording blood pressure in veterinary patients but measuring blood pressure in small animals is possibly one of the most neglected aspects of routine health care in veterinary practice today.
The ability to monitor blood pressure in a variety of patients is essential health care and even more, to providing top-quality veterinary care. The measurement is particularly useful not only to detect disease early, monitor hemodynamically active drugs and in any case of target organ damage, but also when monitoring critical care and high-risk anesthesia patients.
Blood pressure measurement techniques
Arterial blood pressure can be monitored in different ways:
Invasive blood pressure measurement (IBP)
IBP is technically demanding, as it requires placement of an arterial catheter and the use of a transducer and monitor. Complications, such as hematoma, infection, clotting are quite likely to develop. As this procedure is painful, local anesthesia has to be considered. IBP is considered as a gold standard, but even invasive measurement can vary significantly from each other. As IBP is included in all multiparameter monitors, the benefit of that technique clearly is the combination of different hemodynamic parameters. Since HDO is considered as the only non-invasive gold standard (Martel et al. 2013) , IBP is mainly used in high risk anesthetized animals for continuous measurements.
Non invasive blood pressure measurement (NIBP)
NIBP relies on noninvasive detection of arterial blood flow or arterial wall movement in a peripheral artery and provides intermittent measurements of arterial blood pressure. To obtain a NIBP reading, a cuff is inflated over an artery until the artery is completely occluded and no blood flow is present at this moment. The cuff will slowly be deflated until blood flow is initiated again: Systolic Arterial Pressure (SAP). This is called the Riva–Rocci principle. Depending on technology, systolic (SAP) diastolic (DAP), mean (MAP) arterial pressure and pulse can be measured. NIPB can be performed conscious as well as under anesthesia, as it is not harmful.
High Definition Oscillometry (HDO)
High Definition Oscillometry is the only technology, allowing for real-time evaluation of both – blood pressure as well as pulse waves. It displays each single pulse wave in realtime onto the computer screen, allowing for immediate judgement of good reading vs. artefacts, true measurement of SAP, DAP, Mean and pulse, as well as pulse wave analysis in realtime.
In contrast, conventional oscillometric BP technologies only measure MAP and caluclate systolic and diastolic pressures by using a computer algorithm, a process that can result in biased measurements under several hemodynamic conditions. Further it is strongly influenced and mislead by artefacts which cannot be identified by the user.
Thus the currently state-of-the-art HDO method is unique:
- Realtime visual control of the pulse waves morphology: good reading vs. artefacts
- Reatlime visual control of rhythmic vs. arrhythmic situation
- Realtime visual control of endothelial function
- early signs of upregulation of the Renin Angiotensin Aldosteron System (RAAS) – early detection of disease
- stress related influence on the vascular system
- T4 related influence on the vascular system
- Vasoconstriction and vasodilation due to different disease, medication, allergies, shock etc.
Blood pressure measurement by HDO differs from conventional oscillometry and doppler by providing rapid and more sensitive measurements, much higher accuracy, visual control and pulse wave analysis.
Blood Pressure and Pulse Wave Analysis (PWA) · Intensive workshop
You can benefit tremendously from a reliable way to measure blood pressure and vital signs. This workshop will guide you through a basic understanding of blood pressure and pulse wave analysis, disease and target organ damage associated with high or low blood pressure, consequences if not taken into account, how to measure fast and reliable, how to interpret your results and last but not least: how to treat a patient with hyper- or hypotension.
Blood pressure monitoring is often the responsibility of the nursing staff. After successful completion of that workshop you will be able to:
- have the technical skills to accurately assess blood pressure.
- recognize abnormal values and understand their implications.
- obtain and help identify early markers of disease and complications during baseline and geriatric health checks, control visits, anesthesia and in ICU
- know when to alert the clinician who is managing the patient.
- avoid the most common errors in measuring blood pressure
- measure fast and reliable on different species
On-site course on Blood Pressure and Pulse Wave Analysis (PWA) for vets, vet nurses or even the entire staff!
Content and time frame of this workshop can individually be planned according to your needs. The workshop takes place in your practice to allow training of even the entire staff:
trained and motivated receptionists will invite and convince pet owners to agree on this important routine parameter
trained nurses and techs can take blood pressure during the waiting time without the vet
trained vets can quick and easy interpret PWA and blood pressure towards a complex and complete evaluation of a patient.
Would you really want to miss such easy and fast obtainable values, if they help you to detect disease early, avoid target organ damage, help to judge for the right medication, fullfill expectations of your pet owner, allow the pet a normal life expectancy and good quality of life?
ATF credit can be applied for 5-7 ATF-hours (nur für DACH)
Course Director: Dr. Beate Egner, CEO VAHL, Board Member of the Veterinary Blood Pressure Society (VBPS), editing author of the book: Essential Facts of Blood Pressure in Dogs and Cats. Co-author in: EKG made EASY,The Feline Patient, The Cat, Cardiology in Horses, Essential Facts of Ophthalmology in Dogs and Cats, Essential Facts of Physical Medicine, Rehabilitation and Sports Medicine in Companion Animals, Principles of Safety Pharmacology,…
"Trust is like blood pressure. It's silent, vital to good health, and if abused it can be deadly."
~ Frank K. Sonnenberg
Example for content and time frame of HDO workshop
- 10.30 – 11.00
Most important indications for blood pressure measurement - when should we measure?
- 11.00 – 11.15
Integration into daily practice: envolve your receptionist and your nurses.
- 11.15 – 11.45
Preparation and design of workplace – how to set up your unit - working with HDO software
- 11.45 – 12.00
What is HDO? Myths and Truths of blood pressure technology.
- 12.00 – 12.45
What is a good, what is a bad measurement, how does a standard curve look like, how to reveal physiologic and pathologic deviation, when to refer to the vet…
- 12.45 – 13.30
- 13.30 – 14.30
How to measure - on animal labs (cats and dogs)
- 14.30 – 15.30
How to interpret the results – interactive approach
- 15.45 – 16.30
Why hypertension restricts life expectancy
- 16.30 – 17.30
Update on therapeutic approaches and final discussion
News: HDO blood pressure measurement in elephants
Wilhelma is a zoological and botanical garden in the setting of a 19th century park which is a classified historical monument. It is the only both zoological and botanical garden in Germany and is one of the zoos with the largest amount of animal species in the world. At Wilhelma, Zella the elephant was recently allowed to do pioneering work as part of a research project. She is now one of the first pachyderms to have her blood pressure recorded. The long-term goal of this project is to determine standard values for elephants and other animal species so that deviations can be detected more quickly in the future. For Dr. Beate Egner, the Wilhelma even provided the opportunity for a premiere in the field: for the first time, she was able to take measurements of boa, king snake and bearded dragon.
Veterinarian Dr. Beate Egner was responsible for the measurements. She is specialized in the field of cardiology and has been particularly involved in blood pressure and pulse wave analysis since 1991.