Spirometry testing Flashcards
What does a refferal form include?
-patient demographics
-brief clinical details
-tests required
-infection risk
-signature of requesting physcian
What equiptment is needed for spirometry?
-spirometer
-calibration syringe
-consumables (mouthpiece, bacterial and viral filter
-nose clip
-room thermometer
What other/ extra equiptment may we need for spirometry?
-pulse oximeter
-disinfectant wipe
-alcohol gel
-tissues
How do we prepare the equiptment for a spirometry test?
-machine is working
-consumables prepared
-calibration checked
-room temp recorded
what are some patient instructions prior to the appointment?
-refrain from smoking for 24hrs
-refrain from consuming alcohol for at least 4hrs before test
-stop excersising at least 30mins before
-do not eat a large meal in the 2hrs before
-refrain from taking bronchodilators for the duration of their action
How do you prepare the patient for spirometry?
-introduction to patient
-patient ID
-contraindictions
-patient history
-influencing factors
-height and weight
What are contraindications and why do we need to check them?
-may be absolute or relative
-if contraindications are present, check with a senior member of staff before proceeding with the test
-spirometry could cause harm or discomfort to the patient
What are some examples of contraindications?
-unstable cardiac status
-haemoptysis of unknown origin
-Infectious disease
-pneumothorax
-pulmonary emboli
-recent thorax or abdomen surgery
-thoracic,abdominal, cerberal aneurysms
-eye surgery
-acute disease process
-extreme breathlessness
What could you test instead if the patient has an adverse reaction?
FEV1 but not FVC and using relaxed VC to calculate a FEV1/VC%
What should you check before the test- linked to the test?
-check compliance with pre test instructions
-drug history- inhaled medication
-smoking history
What questions should we be asking in regards to inhaled medication?
1-which drugs
-short or long acting? steroids?
2-what devices?
-metered dose inhaler, dry powder device
3-what dose and frequency?
-eg 2 puffs twice a day
4-when was it last taken?
-record time before test
Should we make a note of other medications the patient is using?
Yes- respiratory medicines
-oral steroids
-nebuliser/neubulising drugs
-oxygen
-otc medication
How do you calculate pack years?
Number of cigarettes a day /20 x number of years smoked
1 pack year= 20 cigarrettes every day for 1 year
what are some influencing factors of spirometry?
-heavy meal
-alcohol
-vigorous excersise
-restricting clothing
-false teeth
-continence
How long do we test Relaxed vital capacity and forced vital capacity form?
minimum 3 attempts
How do we perform relaxed vital capacity?
1-explain
2-gain consent
3-enter patient details into spirometer
4-attach mouthpiece to spirometer
5-nose clips on patient
6-get patient to breath normally- stable baseline
7-then ask patient to breath in until absolute full
8-patient breathe out at a rate thats comfortable, until completly empty
-remove mouthpiece
-wait at least 30 seconds between each test
-repeat until you obtain 3 acceptable and reproducible results
How do we perform FEV1 and FVC?
1-patient put mouthpiece into their mouth , tight seal with lips
2-patient breathe normally to obtain a stable baseline
3-patient breathe in until absolutely full
4-patient needs to blast out as hard and as fast as possible until completly empty
5-allow patient at least 30sec between tests
-repeat until you achieve 3 acceptable and reproducible results
What should we be doing during the test?
1-watch the patient closely
2-make sure they fully breathe in
3-make sure they put the mouthpiece in their mouth/tight seal
4-check no hesitation between inhaling and blasting out
5-ensure patient maintains good posture
6-watch the spirometer
7-enourage the patient
8-ensure plateau is achieved on spiromgram/FEV>15 seconds
How to check the results are within manoeuvre criteria?
1-rapid start to expiration
2-end of forced expiration
3-plateau achieved/ patient has exhaled for at least 6 seconds
4-patient has a FEV of >15 seconds
5-patient is unable to achieve a plateau
What is the critera for repeatibility?
-three acceptable and reproducible results
-no more than 100mls between each blow
-Highests FEV1 and FVC from 3 efforts meeting repeatibility critera or within 5% of each other- whatevers smaller (below 1l) or higher (above 1l)
Describe what the volume time spirogram curve looks like
-smooth curve, upward and free or irreggularities
-must reach a plateau
-expiration must last at least 6 seconds
Descirbe what a flow volume spirogram curve looks like
-almost vertical rise to PEF
-sharp point at PEF
-trace free of irregularities
-trace merges with y axis
What should you do once the test is complete?
1-allow the patient to rest before leaving
2-inform patient of how they will be told about the results of the test
3-select the best 3 tests to be reported
4-note any influencing factors
5-write technical report
6-produce a report of test
7-dispose of consumables
8-clean equiptment
9-hand hygiene
Describe the time for testing steps
pre test: 5min
-record height and weight
-ensure patient is comfortable
-record medication
record pulse oximetry
test: 10min
-set up equiptment
-patient details
-explain procedure
-test
report: 5min
-technical report and clinical interpretation
what are some considerations of spirometry for children?
-increased elastic recoil of the lungs in children so FVC results reached early expiration
-FEV1 is an insensitive measure in children
-ensure plateau is achieved
-back extrapolation and repeatability critera same as adults
-do not exclude data if only one acceptable test is recorded
What tests are better for children?
-peak flow is easier
-measure FEV1 , FVC and RVC from spirometry
-FEF 25-75% has a smaller coefficent of variation than in adults-can be used be a useful monitor of REF
-children under 5 are unlikely to be able to perform an accurate or repeatable spirometry
Describe a paediatric test environment
-child friendly area
-tv
-toys and books
-child sized furniture
-child safety
