When many of us started out in the veterinary industry, the standard for monitoring, especially with exotics, was manual observation. This was not because we collectively decided it was best practice. Rather, it was because even the most robust available technology at the time provided less usable information than visual cues and a stethoscope. Over the past few decades, monitoring equipment has come a long way. Now, it not only offers reliable parameters for veterinary care but also an infrastructure of support and innovation built to help drive the industry forward. History of healthcare The most apparent problem with technicians performing patient monitoring by hand is the limited depth of the available information. Even the most skilled practitioners can only glean so much from a Doppler over the animal’s heart and visually check for respiration. Timing can also be an issue, as the more subtle changes that indicate possible complications are not always visible to the naked eye. Delays in detection result in delays in intervention, and every second is critical when managing patients under anesthesia. There are also some less obvious issues resulting from manual monitoring. With the technician as the primary line of defense on patient observation, they are unavailable to perform other tasks to assist in surgery without leaving the patient unmonitored. One such role that often goes unfulfilled in these scenarios is recordkeeping. Every veterinary professional knows that detailed notes from a procedure are one of the best tools for patient care. Not only do they help inform future care, but they can also be invaluable in protecting the care team against litigation if a patient complication results in morbidity. However, manual monitoring offers neither the time nor the detailed measurements needed to adequately document vitals. Access to multiple parameters that accurately monitor patient condition is critical to boosting a veterinarian’s confidence during a procedure. Photo courtesy Melissa Ortiz Wired for wildlife Veterinarians are used to the technology in our industry being slightly less robust than what’s used in human medicine, and this disparity was especially felt in monitoring. While human patients all have the same basic anatomical structure and a relatively small range of vital measurements, companion animals come in all shapes, sizes, and measurement ranges. Developing a monitor that can accommodate a parakeet weighing only a handful of ounces with rapid heart rate and respiration, while also having the capabilities for a 100-lb tortoise with much slower vitals and lower temperatures, is a significant feat in engineering. Accomplishing a monitor that was well-suited to companion animals required both software and hardware considerations. “Because of the number of species and care considerations for each of them, developing veterinary-specific parameters involves extensive research, including collaborating with top industry experts to build out a pool of data and guarantee a high level of scientific rigor and clinical relevance,” says Eduardo Miranda, president of Digicare Animal Health, a company that manufactures multiparameter monitors for the veterinary industry. A unique algorithm created specifically for animal health incorporates specialized QRS detection and classification criteria to ensure accurate readings tailored to animals’ unique cardiac characteristics. This helps minimize the risk of double-counting, false positives, and other misinterpretations that can be common with systems that have not been optimized for veterinary settings. Along with taking on the role of patient monitoring, some systems have also been designed to provide recordkeeping services. These additional features log patient vitals in real time and produce a detailed report at the end of the procedure, freeing up the technician for other less menial tasks during the anesthetic event. Some monitors even offer cloud-based memory systems to easily store and access patient data for increased efficiency. With the accessories now available, veterinary professionals no longer have to solely rely on manual monitoring while treating patients, such as this guinea pig. Photo courtesy Melissa Ortiz Optimized equipment Exotics often exist in extremes, usually going either far below or far above the range of typical monitors. The wider range of measurement capabilities was initially what drew my team to the monitoring solution we currently use, and now we can notice potential issues faster, respond more meaningfully and improve overall patient outcomes. However, flexibility was also an important consideration in the hardware and accessories available with our system. Variety is key in the physical design of a monitoring system. The attachments and probes that connect to the animal to provide real-time vitals input should be available in a range of options that work with the patient’s anatomy without compromising accuracy or harming the animal. An esophageal EKG lead with nodes that flush with the rest of the wiring instead of protruding can prevent pressure necrosis in smaller patients. Loops in the wires can be used instead of clips to attach to animals with small parts and fragile skin or bones. We had a rat in our clinic to remove a mass that weighed 100 g, which was about a third of the animal’s entire mass. Our system offered a tiny cuff that we were able to attach around the circumference of her tail to improve the available information and enhance the surgeon’s confidence during this delicate procedure. Utilizing loops and a tail clip enables vitals readings from this mouse, which weighs 70 g. Photo courtesy Melissa Ortiz Even a shortened SPO2 probe can provide easier access. Veterinary monitors are typically designed for dogs and cats, which both have easily penetrable skin for placing the sensor. For animals with hard-to-pierce skin on their legs, such as birds, a shortened probe provides the practitioner with the flexibility to place the sensor somewhere with easier access. Wings, toes, and even tails are all options available with a shortened probe that offer easy attachment without harming the animal or sacrificing data accuracy. For the first time, these features have provided our clinic with the capability to provide comprehensive monitoring services for patients of all sizes. The system is intuitive, allowing all members of the staff to easily access and utilize the technology even between different species, and it provides us with a level of confidence during procedures that previous solutions simply could not match. This versatility improves outcomes for patients, but it can also open opportunities for collaboration with additional entities. Zoos, shelters, reserves, and other animal care facilities may not have the resources available to provide veterinary-specific monitoring. A monitoring system that is adaptable can go beyond companion animals and make the practice a valuable partner for well-rounded care. We have been able to offer services for local zoos and other animal health organizations all on the same system that we use in the clinic every day. Not only does this offer another source of revenue for our clinic, but it also allows us to elevate the level of exotics to a broader community. The wide range of equipment available for each parameter allows for the monitoring of everything from rodents to reptiles, including this bearded dragon. Photo courtesy Melissa Ortiz Better together In addition to partnerships between these businesses, collaboration with manufacturers and end users can help secure success. Even if a clinic is not actively providing feedback for its equipment, ongoing communication with the manufacturer is still critical for ensuring the best results. Quality customer service is always appreciated, but it is especially important with monitoring in the veterinary industry. The variety of attachments and ranges that need to be learned for each animal patient would make training employees on veterinary monitoring a challenge in and of itself. However, the staffing shortages and high turnover rates faced by clinics across the industry further exacerbate the issue. Working with a manufacturer that prioritizes ease of use is critical. This can be accomplished in the engineering of the machine itself, but it can also be accomplished with continued contact and training resources. A company that will work with the clinic in the months and years following a purchase to ensure all staff members are comfortable using the equipment shows investment in both the business’ success and the health of the patients. We have come a long way since the best available method was watching to make sure an animal’s chest was rising and falling. The growing accuracy and capability of veterinary monitoring parameters have been accompanied by an equally exciting increase in accessories, design and usability all optimized for animal health. As the collaboration between manufacturers and veterinary professionals maintains this momentum of creating new and exciting innovations, we will continue to gain more insights into an animal’s condition that allows us to provide the standard of care that both the industry and our patients deserve. Melissa Ortiz (MO), LVT, is the practice manager at Thrive Center for Avian and Exotic Medicine NYC, the only exotics-exclusive hospital in New York City, and can be reached at melissa.ortiz@thrivepet.com.
