ATS Pulmonary Function Laboratory Manual

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

2. Mechanical simulators (32) are available for routine quality checks and reproducibility checks. However, these calibrators have not been extensively validated, do not add water vapor in “expired” gas, and do not change temperature from inspiration to expiration. Thus, they do not test the integrity of the gas-sample drying circuit and the ability to compensate for temperature difference of expired gas (31). They do, howev- er, test system accuracy and are capable of detecting smaller errors than can be detected by biologic calibra- tion. 3. Collection of exhaled gases: utilizing appropriate valving, a 1- to 2-minute collection of exhaled gas can be obtained while a subject is in the steady state of exercise. Assessment of gas sample for volume and fraction- al concentrations of O 2 and CO 2 can be used to calculate ˙ V o 2 , ˙ V co 2 , and ˙ V e. Though technically challeng- ing, this method may be considered the gold standard validation method (9). 4. Establish mean and SD by repeated testing and apply rules for adequate quality assurance responses.

Procedure

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 attached to the patient

2. 3. 4.

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

Explain the test: • The purpose of the test • That it is a maximum exercise stress test, and that the mouthpiece or mask must be in place for the duration of the test. • Explain the end-points (attainment of maximal heart rate, development of limiting symptoms, or blood pressure, ECG, or O 2 saturation out of range) and reassure the patient about safety. • Instruct the patient about the use of symptom scales: a. RPE (Borg scale) for rating perceived exertion b. Other symptom scales (e.g., visual analog scale to score breathlessness); chest pain, chest tight- ness, asthma score, lightheadedness, leg fatigue, and shortness of breath on a 0 to 4 scale with 1 being a slight presence and 4 being severe. (continues on next page)

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