Angela Lorenzo MS, RRT, RPFT Adjunct Faculty, Respiratory Care Long Island University, Brooklyn
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1 Angela Lorenzo MS, RRT, RPFT Adjunct Faculty, Respiratory Care Long Island University, Brooklyn
2 Disclaimer The views in this lecture are those of the presenter and not those of the Department of Veterans Affairs or any other agency of the United States Government. I have no vested interests in any of the manufacturers of the equipment referenced in this presentation.
3 Objectives The participant will identify valid spirometry efforts through graphic analysis The participant will identify corrective actions based on graphic analysis
4 Pre-Test Errors Patient Proper identification Lab Ambient conditions Equipment calibration syringe Testing equipment Calibration Quality Control
5 Calibration Enter ambient conditions: Barometric pressure Temperature (lab temp should be between 17 o and 40 o C ATS PFLM&PM, 3rd Edition) Relative Humidity
6 Calibration Syringe 3-Liter syringe Syringe should be accurate to +/- 15ml for a 3 L syringe (+/- 0.5% volume) Calibrate syringe annually System volume calibration +/- 3.5% at varied flow rates Flow rates: L/sec which would equate to syringe strokes of <1 sec, 3 sec, 6 sec Dropped cal syringes should be removed and evaluated ATS PFLM&PM, 3rd Edition
7 Levy-Jennings Charts
8 Patient Pre-Test Preparation ATS PFLM&PM, 3 rd Edition Refrain from smoking 1 hour before test Clothing Reversibility testing: hold meds with MD approval: SABA 4-6 hours albuterol SAMA 6 hours ipratropium LABA 12 hours formoterol, salmeterol, arformoterol Ultra-long acting agents: 24 hours tiotropium, indacaterol, vilanterol
9 Patient Demographics Height: standing upright, foot ware removed, head upright, looking straight ahead Ht in cm to nearest 0.5 cm Ht in inches to nearest 0.25 inch Arm span: arms stretched out: tip of one middle finger to the tip of the other middle finger. Conversion varies gender/race Weight in kg to nearest 0.5kg Weight in lb to nearest lb ATS PFLM&PM, 3rd Edition
10 Patient Posture Patient should be seated or standing Children should stand Care when adults stand that they do not fall if they get lightheaded, dizzy. Head upright: not hyperextended or tilted down Arms resting at side: not folded against chest Feet flat on floor: legs not crossed ATS PFLM&PM, 3rd Edition
11 Language Barriers Most hospitals have interpretation services. Telephone interpretations, while available is not easy Family members should not be used when ever possible ATS PFLM&PM, 3rd Edition
12 Test Preparation Compliance When test prep has not been followed, note and when possible discuss with MD Record last Resp Med Record last smoke Record last meal To postpone or not to postpone ATS PFLM&PM, 3rd Edition
13 Spirometry: Flow-Volume Loop From:
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16 Scaling
17 Volume-Time Curve From:
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19 Acceptability Criteria Start of test End of test Reproducibility Smooth Curve
20 Spirometry: Start of Test Criteria Unsatisfactory start of tests resulting in back extrapolation result when the PEF is > 150 ml or 5% of the FVC whichever is greater. Preschool children: < 80ml or < 2.5%
21 Spirometry: Start of Test Criteria Problem: Unsatisfactory start of test, Back Extrapolation Corrective Action: Instruct patient to exhale more quickly after maximum inhalation
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24 Spirometry: End of Test Criteria There are two criteria for End of Test acceptability: The volume-time curve shows no change in volume (<0.025L) for at least > 1 second after > 6 seconds of exhalation The patient can not continue the expiratory effort due to discomfort or approaching syncope.
25 Spirometry: End of Test Criteria
26 Look also at the slope
27 Now look at this slope
28
29
30 Spirometry: Reproducibility When FVC > 1 L Reproducibility Criteria for FVC: Two largest values must not vary more than 0.15L Reproducibility Criteria for FEV1: Two largest values must not vary more than 0.15L
31 Spirometry: Reproducibility When FVC < 1 L Reproducibility Criteria for FVC: Two largest values must not vary more than 0.1 L Reproducibility Criteria for FEV1: Two largest values must not vary more than 0.1 L
32
33 Reproducibility
34 Evaluate Acceptability and Reproducibility
35 Evaluate Acceptability and Reproducibility
36 Evaluating Reproducibility Criteria
37
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39 Volume-Time Curve: Obstructive Pattern in Red From:
40
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42 Questions?
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