ATS Pulmonary Function Laboratory Manual

chapter  17

Test Procedure for Exercise Test for Assessment of Desaturation

Step Action 1.

Set-up and preparation: • Re-explain the test method, if necessary, and patients are then asked to repeat the gist of the instruc- tions to validate understanding. • Ask the patient not to talk during the exercise testing unless necessary to inform the technician of adverse symptoms. 2. Position patient on the treadmill, cycle, in the hallway, or at foot of stairs unit. • Hall corridor or stair unit ○ Define course end-points ○ Define rate or cadence of stair climbing ○ Treadmill ○ Explain or demonstrate treadmill-walking techniques. ○ A brief trial walk may be appropriate to familiarize the patient with the equipment • Cycle ergometer ○ Adjust handlebar and saddle height to the appropriate level ○ Give instructions to the recommended cycling rate (RPMs) 3. Place pulse oximeter • Select appropriate probe (e.g. finger, ear probe, or reflectance). • Prep the site according to oximeter manual instructions. • Physical rubbing to ensure good blood flow may be required when using a peripheral site probe (e.g., finger or ear). • Allow the instrument to search for and lock onto the pulsatile portion of the perfusion, then evaluate the accuracy of capture by comparing the palpated pulse to the reported heart rate on the device. • Lightweight pulse oximeters (e.g., finger clip-on units) can be used so the patient is not carrying any extra load. 4. Record resting (standing) parameters • Record a resting Borg or visual analog scale score. • Standing Sp O 2 (oximeter) • If resting Sp O 2 , is less than 88%, do not exercise on room air ○ Contact the ordering physician or laboratory medical director. ○ If O 2 titration is ordered, place patient on O 2 and titrate 1. Increase O 2 in 0.5–1.0 L/min increments until the Sp O 2 just exceeds 90% 2. Observe for Sp O 2 stability 3. Arterial blood gases may be warranted to correlate pulse oximeter readings and to rule out progressive hypercapnea. • Record Sp O 2 , whether on room air or on O 2 with liter flow, mode of delivery, time on O 2 , heart rate, and blood pressure, if measured. (continues on next page)

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