Clinical Equipment

Uncover the secrets to selecting the perfect centrifuge and PRP kit company that will improve your regenerative medicine procedures. Also, get insider tips and expert advice on how to streamline your inventory, reduce costs, and improve efficiency, to elevate your workspace and create a seamless patient experience.
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Don't miss this opportunity to stay ahead in the rapidly evolving world of orthobiologics. Listen to the full episode now!

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Transcript

Intro

Hey, I'm Dr. Ariana De Mers. I'm an Orthopedic Sports Medicine Surgeon, and I have successfully integrated orthobiologics into my busy practice so that I can provide a continuum of care and treat patients who are in the gap. The gap is this gray area in orthopedics where standard conservative treatments have not been effective, but surgery may not be warranted. And we usually tell our patients, come back when it's worse. What? These are your patients coming to you for help. Orthobiologics is that solution that can fill the gap and help you treat your patients who are in your office looking to you for help. Orthobiologics can also be an excellent treatment for frustrating problems without good surgical outcomes. This podcast will help you create the orthobiologics business that will make you love your job again. We will focus on the value of orthobiologics, patient selection, how to talk to your patients about money, office setup, and other logistics. If this is something you've always wanted but don't know where to start, join me in "The Business of Orthobiologics" podcast.

Dr. Ariana

Hi, welcome to "Equipment Procurement". How to get what you need and how to figure out what you really need. Here's what we'll cover. We're going to talk about Centrifuge and PRP kit company selection, ultrasound selection, office supplies, medical supplies, and what you may or may not need. So first, we're going to talk about PRP kit and Centrifuge selection. So first, are you already using a company that has PRP? Look into their outcomes. Here are some considerations on how to make good PRP. Is it a single-spin system? Is it a double-spin system? Is it a buffy coat system? Is it a gel system? What are their platelet concentration outcomes? What is the percent recovery? How much RBC contamination is there? Also, look at what their white blood cell count is. And is it neutrophils, monocytes? Is it considered leukocyte-rich, leukocyte-poor, or leukocyte depleted? Can you manipulate the concentration and the leukocyte concentration? These are all factors that need to be evaluated. And if the company can't tell you that, then the recommendation is to maybe continue to look. Also, I would consider factors such as processing time, automation, ease of use, and the number of PRP samples that can be processed at one time. Take into account who's going to be processing your PRP. Is it you? Is it variable? Is it one person with a lot of expertise? Definitely take that into account. Additionally, we want to talk about platform flexibility. Can we change the volume? Can we change the concentration? Can we change the content? Leukocyte-rich, leukocyte-poor, leukocyte depleted. Now, talking about volume, we do know that it has to be about 60ccs of blood draw to create a high concentration PRP. We also want to make sure that it's reproducible, that it's easy for physicians and staff to obtain the same product. Quality of the product, meaning you know, how much contamination, RBC contamination is there, what's the percent recovery of platelets, and then consider price. I would have considered the overall price, but also, I think more importantly, when you're trying to compare apples to apples, the price per billion platelets. And then this is a must FDA compliance. So it has to be a Class II medical device, a 510 (k) approved device through the FDA. Now, when we look at plasma versus buffy coat systems, a plasma-based system is based on low spin force and gives you low concentration PRP. It is simple to use and very straightforward, but definitely is a low-concentration option. The buffy coat procedures or kits are usually higher spin force. They're a little customizable. They need more manipulation and thus more skill to clearly get the PRP product that you're looking for. Let's talk a little bit about single versus double spin systems. We'll talk about the explanation of system, process and mechanism, and then the pros and cons. So in a single-spin system, whole blood is collected from the patient and placed in a centrifuge. The centrifuge then spins the blood at a relatively low speed to separate it into its components of red blood cells, plasma, and the platelet-rich plasma. The resulting PRP is relatively low concentration, is collected simply and easily, and then used for therapeutic purposes. These systems would include the gel tube-type systems as well. This mechanism of action is that the single spin systems rely on density differences between the components. It is a lower speed and the heavier red blood cells settle to the bottom. The platelets and plasma remain in the upper layers, and then the PRP is obtained from a single spin. It is low to moderate concentration and then we also have those white blood cells and some plasma proteins. Sometimes some of the gel separator tube systems can-- depending on the density of the gel, can in-theory separate out the different types of white blood cells from the other types, such as monocytes. And some companies will say that maintaining the monocytes but filtering out the neutrophils is of benefit, and thus their product is better than other gel-separated type products. So pros for a single spin system. It's simple, it's easy to use, and it requires very minimal technical expertise. It's time efficient. The process of obtaining this PRP is generally faster compared to double spin systems, and in theory, it's cost-effective. Single-spin systems are usually more affordable than the double-spin counterparts. The cons, definitely lower platelet concentration. It is typically, you know, 1.5 times blood concentration, 2-3 times blood concentration. You sometimes have variable quality with the concentration varying depending on the individual patient characteristics and specific system that's used. And then you do have this potential for contamination. Single-spin systems may have a higher risk of contamination due to the inclusion of other blood components. So let's talk a little bit about the double spin systems. A double spin system involves an additional centrifugation step to further concentrate the platelets. So after the initial centrifugation at a higher speed, the PRP is obtained and then further processed to remove excess plasma and then to highly concentrate the platelets. The PRP is spun out again at a higher speed, causing the platelets to separate from the remaining plasma, usually in a palate or at the bottom of the collection tube or device. And then the resulting PRP is then collected and reconstituted using your selection of the platelet-poor plasma to then dial in the amount or volume that you're going to be using. This is typically utilizing or yielding higher concentrations of platelets. So the mechanism of action is a double spin system, takes advantage of this different sedimentation rate of platelets and plasma. Initially, the initial centrifugation step separates the red blood cells and then the platelet-poor plasma and platelets are suspended in the upper levels. Second, a centrifugation step then concentrates the platelets and removes the platelet-poor plasma resulting in a higher platelet concentration. There are variable formulations available by changing the aliquots collected. And in this double-spin technique graphic, it shows how varying amounts of the lower buffy coat RBC segment will vary the white blood cell concentration as well as the red blood cell contamination. So if we talk a little bit about the pros and cons, our pros are that there's a higher platelet concentration, especially when compared to single-spin systems, and may have enhanced therapeutic potential. The increased concentration of growth factors and bioactive molecules in the double-spin PRP may enhance tissue regeneration and healing. Additionally, this is customizable for most double-spin systems. It allows for better control over the final platelet concentration, allowing for tailoring the specific patient needs. The cons. Technical expertise is required. The double spin system may require more expertise to operate and optimize the centrifugation parameters, and we have longer processing times. The double spin system typically involves an additional centrifugation step, making this overall process longer. Additionally, the double spin systems appear to be a bit higher cost due to the additional equipment and processing steps involved. We also have to consider the different PRP kit companies. Some sell direct to the physician and some only sell through their distributors. Some distributors that I have been in contact with and know to be trustworthy are Plymouth Medical and BioRich Medical. The companies that have reputable products are Emcyte, Arthrex, Apex, Zimmer Biomet, Harvest Technologies, Terumo BCT, Cervos, and ReGen Med. So what about the other companies? I'm sure there are other companies that I've left out. There are. And so knowing the basics will help you to compare apples to apples and know what to look for in each product. So in summary, single-spin systems are simple, time efficient, cost-effective, and yield out PRP with a lower platelet concentration. Double spin systems have a higher platelet concentration, may have enhanced therapeutic potentials are more technical, and require more technical expertise, longer processing times, and may be more expensive. So the choice really depends on the specific requirements of the treatment desired platelet concentration and available resources in your clinic. If you have limited resources, a single-spin product may be in your best interest. If you have all the resources in the world, then you have to think about what your desired platelet concentration is and the specific requirements of the treatment that you're planning. Let's also talk about ultrasound selection. Good questions. Do you already have one? If you already have one, please dust it off and use it. If you know somebody who is not using theirs and you would like to take it off their hands, please volunteer to take it off their hands and use that. Now, there are new versions, there are used versions, and really, the refurbished ultrasounds seem to work quite well. Brand new is always fun, but may not be required. Please, please, please try it out. If you have any ability to try these out, try them out. See what works for your eye and see what works for your hand. Don't skip on quality. And then understand that there are differences between handheld and machine-based systems. Usually, the handheld or portable systems are less expensive and may be of lower quality. Although in these most recent versions, the quality is coming along nicely, and maybe see all that you need. The machine-based or hospital, the big ultrasound systems are significantly more expensive, they're not portable and are of quite good, high quality and create very high-quality images. I also want you to understand that we have to save these images, so there has to be a way for these images to be either uploaded to a cloud or saved for future use and archiving. Ultrasound companies that have good products and quality products are Sonosite, GE, Wisonic, Mindray, and Konica Minolta. These are always cart-based. And then the handheld companies that have reasonable opportunities are Clarius, GE, Vscan, and Butterfly. There has been some discussion that Sonosite might also be portable depending on the style of product that you get. Next, we're going to talk about office supply companies. So you need an Amazon business account and a healthcare supply company. So medical supply companies. To get medical supplies, you can use Amazon, eBay, McKesson, Medline, Cardinal, and Henry Schein. Specifically for orthobiologic equipment, Plymouth Medical, BioRich Medical, Emcyte, and Arthrex. And then let's talk a little bit about medical equipment. A word to the wise. It usually costs 10 times what it would usually cost if you call it medical grade with no difference whatsoever. So as an example, stainless steel tables from culinary suppliers are quite a bit cheaper than stainless tables from medical suppliers. Additionally, medical cabinets from tool suppliers are much cheaper than the metal cabinets from medical supply companies. Vet supply companies are also quite good and the quality is not different, especially if you're looking for stainless steel tools or equipment. Really quite high quality from the veterinary world. Speaking of furniture and decor, I would also consider washability. This is in a medical setting and you are going to be drawing blood, so make sure that you have the ability to wash it off. If for whatever reason some sort of contaminant would be getting on your furniture. And then we have miscellaneous items. I have put together a checklist for all these items that you need for your orthobiologics clinic. While this is comprehensive, it does not mean that you cannot get started until you have every single piece of it. I recommend using everything already that you have first and then see what else you may need. That being said, there are some things I wish I would have done differently starting out. One thing is minimizing the technology you get at the outset. You don't need all of this technology. There are quite comprehensive cloud-based systems. You can use your iPhone, iPad, and only a laptop. Also, a good complement of a flexible CRM and file storage options can be switched out with too much hassle. So start thinking about Google Workspace. As you figure out what your needs are, then you can easily transfer that data to different more robust platforms that suit your needs as you go. This is not meant to be overwhelming, but something to think about. Your medical supplies obviously need gloves, masks, bandages, gauze, syringes, needles, alcohol swabs, cotton swabs, blood draw supplies, Coban, syringes from 60CCs down to 1CC, needles of 18, 21, 25, and 27 gauge, Betadine swabs, Chlorhexidine soap, ethyl chloride, 4x4 gauzes, ACE wraps, band-aids, injectable anesthetics such as 1% Lidocaine, Ropivacaine, 0.5%. And if you're going to be doing nerve blocks, consider the 0.25% Bupivacaine. Nerve block needles are helpful for atraumatic nerve blocks. When we talk about the orthobiologic equipment, the distributors will have a more comprehensive selection but may pass along a small fee to have it, which in my opinion is great, but you don't have to. So we're going to be talking about centrifuge, which sometimes it can be rolled into the price of the PRP kits, or they can consign it to you. We need PRP kits, a small fridge with a freezer, think dorm-like refrigerator with a freezer, a thermometer for the refrigerator if you're going to be storing medicines, and data collection tools to be able to track your outcomes. Now, when we talk about office supplies, you need a computer, you can have a desktop or you can use a laptop. You don't need a supercomputer. Go for the 3 to 500 range for a decent tower-top type computer. It will be plenty for your practice. If you already have a nice system and you're going to be adding this on to your current practice, just make sure that you separate out your cash-based practice or biologics practice from your standard insurance practice. So have a different sign-on or somehow be able to separate those out. It would be nice to have a tablet for sign-in, educational videos, X-ray pictures, and to have patients actually initial or sign all of your forms and consents. You need one multifunction type copier, printer, scanner, telephone, and some way for after-hours patient communication, such as a smartphone or answering service or any of those things. You will need some office furniture, you know, business cards, marketing materials. A little talk about administrative tools. This is going to be your electronic health record system or electronic medical system, scheduling software, billing software, accounting software, inventory management software, and customer relationship management, which is CRM. You may want a Dropbox account for online file storage, and then a radiology viewer and storage application. I will recommend safety and security measures. So if you are starting out and you are a small entity, you may want biometric access control systems, surveillance cameras, Nest or Ring, or any of those alarm systems for security because you're going to have some pretty high-end equipment that you want to keep and not donate to your local thief. Fire extinguishers, first aid kits, and AED is key. And then when we talk about furniture and decor, obviously, you have to think about a waiting room chair. Now, if you don't have a waiting room, then you do not need waiting room chairs, but you have to have somewhere for your patient to wait for you in the event that you may be running behind. I'm going to recommend the examination room, have an exam table and a chair for patients, artwork, plants, fountains, soothing music, a portable speaker, hospitality fridge with drinks and snacks for your patients during waiting or between when they have their blood drawn and they're waiting for injection. And then the last part is miscellaneous office supplies that sometimes are overlooked, such as a WiFi router and modem, internet service provider subscription, cleaning supplies, air purifiers, hand sanitizers, and disinfectants. So, to summarize, our equipment acquisition boiled down to its simplest form. Get a Centrifuge, get blood draw supply kits to draw the blood, make an inject PRP, and go home happy. "Success is stumbling from failure to failure with no loss for enthusiasm". Next, we'll delve into the world of how to talk about money. Thanks so much.

Outro

This has been "The Business of Orthobiologics" podcast. Thank you so much for joining us today. If you want to know more, please join us on the website, "PRP-Now.com" and click on the FREE Masterclass. Also, don't forget to "SUBSCRIBE" to this podcast to get more guidance on integrating PRP in your busy practice. Bye for now.