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RES 131

RES 131. Pulmonary Function Testing. Spirometric Technique. Patient preparation Begins when the patient is scheduled Medication discontinuation Smoking abstinence Purpose of test Determine contraindications Height and weight. Spirometric Technique.

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RES 131

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  1. RES 131 Pulmonary Function Testing

  2. Spirometric Technique • Patient preparation • Begins when the patient is scheduled • Medication discontinuation • Smoking abstinence • Purpose of test • Determine contraindications • Height and weight

  3. Spirometric Technique • Explaining and Demonstrating the maneuver • Demonstrate the noseclip and mouthpiece • help the patient get accustomed to the mouthpiece and noseclip • Lip seal

  4. Spirometric Technique • Tongue position • Dentures • Proper chin and neck position • Body position • Do not let the patient bend at the waist

  5. Spirometric Technique • Oxygen use • Stop the oxygen during testing • Attaching to the mouthpiece • Open mouth method • Preferable for infection control concerns • Requires patient to position and obtain seal while lungs are full

  6. Spirometric Techniques • Closed mouth method • Patient rebreathes on circuit • Allows for assessment of inspiratory flows • Often easier for the patient • Instructions • Give clear concise instructions • Demonstrate the maneuver

  7. Spirometric Techniques • Summary of Important points for Procedure Explanation • Keep the explanation simple and brief • Demonstrate the maneuver • Remind the patient of key points

  8. Patient Testing • Measurable results • Volumes • Capacities • Flowrates

  9. Volumes vs Capacities

  10. Flowrates

  11. Patient Testing • Vital Capacity

  12. Vital capacity

  13. Vital Capacity • Figure 2-1 (pg 40)

  14. Criteria for acceptability – VC • End-expiratory volume varies by less than 100 ml for three attempts • Volume plateau observed at maximal inspiration and expiration • Two acceptable VC maneuvers should be obtained; volumes within 200 ml • VS should be within 200 ml of FVC value

  15. Patient instructions and technique

  16. Patient Testing • Forced Vital Capacity (FVC)

  17. Forced Vital Capacity Measurable values

  18. Forced Vital Capacity • Patient inhales as deeply as possible and then blows out as hard and fast as possible.

  19. Patient Testing • Criteria for Acceptability • Must have a minimum of three (3) acceptable maneuvers • Allow the patient sufficient time to rest between trials • Coach the patient • Administer oxygen between trials if needed • No more than eight trials

  20. Patient Testing • Criteria for Acceptability • Four main criteria for acceptability • Good start of test • No coughing • No Variable Flow • No Early Terminations

  21. Patient Testing • Criteria for Acceptability • Good Start of Test • Start of test must be quick and forceful • No excessive hesitation • Best evaluated using the Flow-Volume tracing • No excessive back extrapolated volume

  22. Patient Testing • Start of Test

  23. Patient Testing • Criteria for Acceptability • No Coughing • Especially during the first 1 second of the maneuver • Best if no coughing present during maneuver, however: • Some patients cough near the end of each test, if present then document

  24. Patient Testing • Criteria for Acceptability • No Variable Flow • Flow rate should be maximal and consistent throughout testing • Volume-Time and Flow-Volume tracings should be smooth

  25. Patient Testing • Criteria for Acceptability • No Early Termination of Effort • Best if maneuver lasts at least six (6) seconds • Less than six seconds acceptable if a plateau of al least one (1) second is present • If patient is unable to meet the above criteria, document in comment section

  26. Patient Testing • Reproducibility • In addition to the criteria for acceptability discussed previously, the maneuvers must demonstrate reproducibility (consistency) of efforts.

  27. Reproducibility • After three acceptable maneuvers are obtained • End Expiratory Volume varies by less than 100 ml for three attempts • Volume plateau observed at maximal inspiration and expiration • Two largest FVC Maneuvers should agree within 200 ml • VC should be within 100 ml of FVC

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