ATS Pulmonary Function Laboratory Manual

ATS Pulmonary Function Laboratory Management & Procedure Manual | 3rd Edition

PROCEDURE

Pre-Test Preparation

Check patient identification

Identify patient using an institutionally approved process.

Orders

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

Demographics

Test explanation and patient training

Review preparation guidelines, recording all drug therapy and time of last dose, and responses to questions about exposures and illnesses. A pre-test questionnaire may be used (Appendix 12.2). Explain the procedure to the patient and obtain informed consent. Remove methacholine solutions from the refrigerator and allow them to equilibrate to room temperature for at least 30 minutes. The solutions should be placed out of the view of patients, so they will not know which concentration they receive. Ensure that bronchodilators and O 2 are available and ready to use. Spirometry should be performed according to the most recent ATS/ERS recommendations (3) with at least three acceptable maneuvers and the two highest FVC values and two highest FEV 1 values agreeing within 0.150 L. For small children or patients who cannot perform spirometry, alternative assessment techniques include: forced oscillation, peak expira- tory flow (PEF), and body plethysmography. Determine if there are any absolute or relative contraindications, regarding airflow obstruction, to performing the test. If there are, notify the order- ing physician and obtain permission to proceed. It is not recommended to perform the challenge when the FEV 1 is less than 60% of predicted or less than 1.5 L (10). Select the nebulizer to be used for the diluent and methacholine steps (the same nebulizer should be used for all steps in a challenge test). The prac- tice of administering the diluent alone before the first methacholine stage has been questioned (26), but remains the preferred and recommended method (10). Withdraw 2–3 ml or appropriate amount of diluent and place it in the nebulizer. Connect the nebulizer tubing to the source of compressed air and assure nebulizer is working properly. Apply the nose clip and instruct the patient to relax and breathe quietly (tidal breathing) on the mouthpiece for the appro- priate time for the specific nebulizer (e.g., 2 minutes for a low output nebu- lizer or 60 seconds for a higher output nebulizer). Ask the patient to hold the nebulizer upright with the mouthpiece in his/her mouth. Start timer. (continues on next page) Test Procedure

Other

Baseline (Pre-Challenge) Step

Diluent Step

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