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SPC Diag Procedures
SPC Diagnostic Procedures Units 3 & 4 Review
| Question | Answer |
|---|---|
| Which parameters does a blood gas analyzer measure & which does it calculate? | Measures: pH, PO2, PCO2 Calculates: HCO3, base excess, hemoglobin saturation |
| What does a co-oximeter measure? | Hemoglobin(hb), Oxyhemoglobin(HbO2), Methhemoglobin(MetHb), Carboxyhemoglobin(COHB) |
| Advantages of POC devices? | Small, portable,run multiple tests w/ small samples, |
| What does a Clark electrode measure? | PO2 |
| What does a Stowe Severinghaus electrode measure? | CO2 |
| Which electrode is a modified pH electrode? | |
| How does air bubbles in an ABG sample effect the CO2 & O2 of the sample? | Tends to lower CO2, and increase O2 |
| Factors that may effect ABG analysis | Inadequate sample mixing, air bubbles, venous blood, excess anticoagulant (heparin), excessive lag time in analyzing, general anesthesia can alter PO2 level |
| Which is the most popular blood gas sampling site? | Radial artery |
| What is capillary sampling used for? | To determine the acid/base status of an infant |
| How is a Modified Allen's Test performed? | Occlude the radial & ulnar arteries, have pt open/close hand, release ulnar artery, see white hand become pink again w/in 15secs = collateral circulation |
| ABG indications: | Dyspnea, cyanosis, heavy use of accessory muscles, CPR, changes in vent settings, metabolic conditions |
| ABG contraindications: | Negative result on a Modified Allen's Test, do not test through a lesion, scar, sore, distal to a dialysis or surgical shunt, coagulopathy or anticoagulation therapy |
| ABG complications: | Infection, arteriospasm, air or blood clot emboli, hematoma, hemorrhage, vessel trauma, vasovagal response, pain |
| What is the most important aspect of a Quality Assurance program? | Record keeping |
| How many levels of control should be run during each 8 hr shift? | At least one, but two or three can be run |
| How often should two point calibrations occur? | Every two hours |
| What are Levey-Jennings plots used for? | They provide a visual indicator of the performance of the ABG machine. One can determine whether a QC sample that is out of range is a random error, part of a trend, or systemic error (bias) that is trending out of range |
| What is a Correlation Study? | A study that compares results of one analyzer to another.Several samples are run on both machines 4x's/year to ensure results from both machines are similar. Results must be w/in 10% of each other. |
| What is Proficiency Testing? | Mandated by Federal Gov't. 4-5x's/yr 5 external samples are sent to lab, they are run w/in a 10 day period and the results are returned. All results must be correct. |
| Two agencies that accredit blood gas labs: | College of American Pathologists, Joint Commission for Healthcare Accreditation |
| What is the Fowler Method used for? | To determine a pt's FRC |
| What is another name for the Fowler method? | Single Breath Nitrogen Elimination Test |
| What test gas is used in the Fowler method/Single breath nitrogen elimination test? | 100% O2 |
| What does a closing volume indicate? | The point at which the airways in the pt’s lungs closed |
| What diseases would lead to an increased closing volume? | COPD, asthma, chronic bronchitis |
| What are closing volumes and capacities used for? | Can be used to identify small airway disorders even before they can be detected by simple spirometry |
| What does an increased closing volume indicate? | Obstruction |
| Is an elevated dead space percentage a good or bad thing? | Bad, because that means there is more deadspace = area with no gas exchange |
| What values must be known to determine VD/VT using the Bohr method? | PaCO2 (derived from an ABG) and the PeCO2 (derived from the pt exhaling into a Douglas Bag) |
| What disorders can be assessed using a ventilation scan? | The severity and extent or pulmonary disorders, especially bronchiectasis and bullous lung disease |
| What are V/Q scans normally ordered for? | To look for pulmonary emboli |
| How could a high or low level of hemoglobin affect a diffusion study? | It can affect the test results |
| Why is CO the ideal gas to use in diffusion studies? | Because it is not naturally produced as part of the body’s metabolic process, it diffuses across the AC pathway (just as O2 does), it has a significant affinity for hemoglobin, and little or no CO remains dissolved in the plasma during diffusion process |
| What is the principle that all 3 DLCO tests are based on? | The difference in the amount of CO inhaled and the amount of CO exhaled = the amount of CO that has diffused into the bloodstream |
| How would you coach a pt to perform the breathing maneuver for a DLCO single breath test? | Mouth piece in mouth, nose clips, blow out as much air as possible (get down to the pt’s RV), take max inspiration (special gas mixture), hold breath for 10 secs, exhale back to RV level |
| What gas mixture is used in the single breath DLCO test? | 0.3% CO, 10% He, O2, N2 |
| What are some disadvantages of the single breath DLCO test? | It may be difficult for some pts, very effort dependant |
| How does a steady state DLCO test differ from a single breath DLCO study? | Pt performs relatively normal tidal breathing |
| What is the advantage of using the DLCO rebreathing technique? | The results are less affected by V/Q abnormalities or by changes in the pt’s lung volumes during the test |
| Which DLCO test method is most commonly used? | Single Breath |
| What are 3 steps that must be taken before a DLCO study to ensure valid results? | No smoking at least 24 hrs(smoking increases (CO) levels), No alcohol at least 4 hrs prior to test(alcohol can reduce DLCO), No eating at least 2 hrs prior to test(a full stomach affects the VC maneuver) |
| Name 3 things that must happen for a DLCO test to be considered an acceptable test: | Initial inspiratory volume must be> or = 90% of the pt’s previously measured VC, Inspiration must be performed within 4 secs of the pts max exhalation, Pt must maintain a stable inspiratory breath hold for 9 to 11 secs w/ no evidence of leaks |
| What does DLCO measure? | The diffusing capacity of the lungs for carbon monoxide (CO) |
| What effects does emphysema have on a subject’s DLCO? Why? | Decreases DLCO due to decreased alveolar-capillary (AC) surface area |
| How would fibrosis cause a decreased DLCO? | It causes an increased thickness of the membrane in the a-c wall |
| Does asthma increase or decrease a DLCO? | May result in a normal or increased DLCO, it is thought to result from increased pulmonary blood volume |
| Why would a physician want to measure a subject’s exhaled nitric oxide? | To determine the severity of asthma and the success of asthma treatment – it measures the amount of inflammation in the airways – the higher the NO, the greater amount of inflammation |
| After starting a subject on an inhaled corticosteroid, a repeat FeNO measurement is obtained. The exhaled NO level has decreased significantly. What does this indicate? | That the corticosteroid is reducing the amount of airway inflammation |
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