ATS Pulmonary Function Laboratory Manual

chapter  10

Procedure

Pre-Test Preparation

Action

Step

1. Check patient identification. Ask the patient to state or spell his/her first and last names, and date of birth. Verify the spelling and date of birth against ID band, and/or requisition. IF THEN Patient unable to provide information • Get information from family member or caregiver, if present. • Notify person in charge, if a family member or caregiver is not present to provide the information

The identifiers do not match

• Contact registration • Resolve discrepancies before proceeding • Do not proceed. • Notify patient’s nurse or registration desk

The ID band is present but not attached to the patient

2. 3. 4.

Check for a complete physician’s order. Collect and record demographic information.

Explain and demonstrate test maneuver and have patient seated comfortably. Advise the patient they will have to remain seated throughout the test. Instruct the patient to keep a tight lip seal and to give maximum effort. A tight-fitting nose clip should be properly in place.

Test Procedure

Step Action 1.

Instruct the patient to put mouthpiece in mouth and nose clip on nose and breathe quietly.

2.

Activate computer software.

3. After at least three breaths, instruct patient to exhale slowly (unforced) to residual volume (RV). In obstructive lung disease, where exhalation to RV may require a prolonged period, a reasonable recom- mendation is that this portion of the maneuver must be limited to <12 s. 4. When at or near RV, activate the valves using computer and instruct patient to inhale rapidly to total lung capacity (TLC) with a sufficiently high flow so that 90% of the Vi is inspired in less than 4 seconds. Vi must be at least 90% of the largest VC in the same pulmonary function testing session. However, a maneuver may be deemed to be acceptable if Vi is within 85% of the largest VC and the VA is within 200 ml or 5% (whichever is greater) of the highest VA among acceptable Dl CO maneuvers. 5. Coach the patient to hold his/her breath with the lungs held full for 10 ±2 seconds. 6. Instruct the patient to exhale at a moderate speed. 7. After an appropriate washout volume has been expired to clear dead space (0.75 – 1.0 L in classical systems and in rapid gas analyzer systems determined by visual inspection or software objective algo- rithm), collect a gas sample (alveolar sample) or measure the mean exhaled gas concentration over a comparable volume change (rapid gas analyzer systems). 8. Instruct the patient to come off the mouthpiece, but remain seated. (continues on next page)

107