ATS Pulmonary Function Laboratory Manual

chapter  14

Pre-Test Preparation

Step Action 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 at- tached to the patient Check for a complete physician’s order. Collect and record demographic information.

2. 3. 4. 5.

Explain the test procedure and what will be required of the patient.

Place ECG electrodes • The modified 10-electrode (Mason-Likar) configuration is the preferred method (42, 43). • A modified 5-lead configuration may be used in patients under the age of 35 with no history of cardiovas- cular disease (a 3-lead system has also been reported in patients without cardiovascular risk) (6). • In some cases (young and otherwise healthy individuals), the pulse oximeter can be used to monitor heart rate. • Skin preparation is essential to reduce surface resistance and ensure a good ECG signal (37, 46, 51). • Shave hair when applicable. • Use an alcohol wipe to remove surface oils. • Abrade skin with fine emery cloth (sandpaper, 240 grid) or mechanical skin-preparation device (Note: commercial skin preps that include an abrasive and alcohol are available). • Implementing a method for cable stabilization is important to reduce motion artifact (46). 6. Discuss test performance with patient • Explain the purpose of the test. The patient will perform PF tests before and after exercise. The patient will exercise at a moderate to heavy intensity level for approximately 6 to 8 minutes. • Explain the end-points (5), which include but are not limited to: � Attainment of predetermined heart rate or ventilation level � Development of limiting symptoms (e.g., wheezing, chest tightness, and chest pain) � Severe blood pressure elevation or blood pressure fall � ECG abnormalities • Explain Borg scale. 7. Perform pre-exercise PF tests • Spirometry with the measurement of FEV 1 is considered the most useful and reproducible test (5, 6, 22, 30). It should be performed using ATS/ERS methodology with at least three acceptable forced vital capacity (FVC) maneuvers (67). • Static lung volumes to evaluate hyperinflation (air-trapping) may be useful in some cases (6). • Raw measured via plethysmography is more sensitive and less effort-dependent but may be more variable (5, 68). (continues on next page)

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