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RTT 215 - Ch. 11 (2)
Ch. 11 - Quality Assurance in the Pulmonary Function Laboratory
| Question | Answer |
|---|---|
| _______ _______ is one aspect of quality assurance. | quality control |
| what often determines the specific procedures that are required for calibration and QC? | type of equipment used |
| what does the type and complexity of instrumentation for a specific test determine? | long/short term maintenance (replacing disposable items) |
| what are 2 other kinds of maintenance? | preventative and corrective |
| what are essential for a comprehensive maintenance program? | procedure manual; accurate records |
| a _______ is any known test signal for an instrument that can be used to determine its accuracy and precision. _________ _______ are test subjects for whom specific variables have been determined. | control; biologic controls |
| what is a primary means of ensuring data quality? | control procedures by which data are obtained |
| what are the 2 concepts that are central to quality assurance? | accuracy; precision |
| _______is defined as the extent to which measurements of a known quantity results in a value approximating that quantity. | accuracy |
| _______ is defined as the extent to which repeated measurements of the same quantity can be reproduced. | precision |
| the _______ observed value, rather than the _____, is often reported as the best test. | largest; mean |
| _________ _______is accuracy determined by measuring an unknown control and comparing the results with a large number of laboratories using similar equipment and methods. | proficiency testing |
| _________ is the process in which the output signal from an instrument is adjusted to match a known input. | calibration |
| in computerized systems, th signal produced by the spirometer is often corrected by applying a software __________ ______. | calibration factor |
| syringes used for calibration should be accurate to within +/-___ ml or +/-___% of the stated volume. | 15; 0.5 |
| what is an important distinction of QC with calibration? | calibration may not be needed, QC always is |
| a syringe of at least __-L volume should be used to generate a control signal for checking spirometers. | 3 |
| what is maximum acceptable error for spirometers? | +/- 3.5% or +/- 65 ml (whichever is larger) |
| volume-displacement spirometers should be checked in __-L increments across their volume range. | 1 |
| ___________ ________ are also available for assessing the accuracy of commonly measured parameters such as FEV1 and FEF 25%-75%. | computerized spirometry |
| ________ _______ are healthy subjects who are available for repeated tests. | biologic controls (lab personnel or others) |
| what is a disadvantage of biologic controls? | pulmonary function varies from day to day |
| to provide useful statistics, ___-___ sets of measurements should be recorded. | 10-20 |
| the __________ ___ _________ may be calculated by dividing the SD by the mean; __________ ___ __________ may also be calculated. | coefficient of variation; coefficient of repeatability |
| ____-____ ______ _____ produce a biphasic volume signal. what does it do? | sine-wave rotary pumps; checks volume/flow accuracy for I and E |
| what devices incorporate large-volume syringes with a computer-controlled motor drive? | computer-driven syringes |
| _________ ___________ _______ simulates the exponential flow pattern of a forced expiratory maneuver. what is a the primary advantage? | explosive decompression devices; flow/volume signals reproduced |
| _____ ______ should also be performed on volume-based spirometers daily before assessing volume accuracy. | leak checks (>30 mL/min significant) |
| the _____ _______ from a spirometer should be <1.5 cmH2O up to flows of 14 L/sec. | back pressure |
| __________ ________ refers to the spirometer's ability to produce accurate volume and flow measurements across a wide range of frequencies. what is this most critical for? | frequency response; PEF and MVV maneuvers |
| a ________ may be used in conjunction with an adjustable compressed gas source to supply a gas at a known flow to the device. | rotameter (water-seal type does this too) |
| ______ _______ or _________-__________ ______ of spirometry are required for diagnostic functions, validation, or when waveforms are to be measured manually. | printed records; computer-generated displays |
| analyzers should be calibrated to match the __________ _______ over which measurements will be made. | physiologic range |
| what is the most common technique for analyzer calibration and what does it involve? | two-point calibration; introducing 2 known gases |
| what are the two points for? | 1. "zero" - low end 2. "span" - high end |
| the nonlinearity of each of the analyzers should be ___% or less of the full scale. | 0.5 |
| what must be included when calculating the dilution of the test gas? | volume of air in the syringe connectors (dead space) |
| what are 2 methods for verifying analyzer performance? | 1. as dilution is analyzed, meter reading recorded, plotted against expected % 2. simulate lung volume or DLCO tests |
| a _____ _______ is simply an airtight container of known volume. | lung analog |
| a _____ ________ uses precision gas mixtures to allow repeatable DLCO measurements at different levels. | DLCO simulator (3rd method) |
| what is the 4th method of evaluating gas analyzers? | testing biologic controls (simplest means of checking systems that depend on accurate analysis) |
| how is calibration of mouth pressure transducer done? | connect it to water manometer or similar device that generates accurate pressure (+/-50 cmH2O, freq 8 hz or mroe) |
| what is an accurate measure of pressure in a box pressure transducer? | +/- 0.2 cmH2O |
| what is ideal for box calibration? | adjustable sine-wave pump connected to small syringe |
| how may the pneumotachometer (flow sensor) be calibrated? | apply known flow or known volume |
| with what is QC of plethysmographs accomplished? | isothermal lung analog, fixed resistors, biologic controls |
| what is measured to have a simple but effective mean of checking plethysmograph function? | VTG, RAW, both from biologic control subjects |
| what is another method of checking plethysmograph accuracy? | compare VTG w/ FRC determined by gas dilution (0.90; >10% - equipment malfunction) |
| a "____" gas is used to zero or balance each electrode. a "____" gas is used to adjust the gain of the electrode's amplifier. | low; high |
| the PO2 electrode is usually calibrated over a range of ______ mmHg. PCO2 range: _______; pH uses buffers with values or _____ (low) and _____ (high). | 0-150; 40-80; 6.84; 7.38 |
| the difference in calibration is termed ____ and indicates an electrode's stability. | drift |
| systemic errors can sometimes be masked by _________ _________. ___________ of the calibration gases or buffers is a common example. | automatic calibration; contamination |
| ________ ______ are sufficient for ensuring proper functioning of sensors such as optodes, spectrophotometers, or fluorescence quenching devices. | electronic checks |
| what are the 2 methods of QC for blood gas analysis? | 1. tonometry of whole blood 2. commercially preparded controls |
| ______ is ideal for QC of gas electrodes because its viscosity and gas exchange properties are the same as those of pt samples. | blood |
| tonometry is the most precise control of the ____ _______. | PO2 electrode |
| what are the complications of tonometry? | contamination, improper temp control, inadequate gas flow |
| what are the 2 types of commercially prepared controls? | 1. aqueous 2. fluorocarbon-based emulsions |
| what is one problem with aqueous controls? | poor precision of PO2 |
| what is necessary to detect blood gas analyzer malfunction? | interpreting "control runs" |
| a QC value that falls within +/-__ SDs of the mean is usually considered to be "in control." | 2 |
| the normal variability that occurs when multiple measurements are performed is called _______ _____. | random error |
| a widely used set of rules is that proposed by ________. this approach to QC is termed the _________-____ ______. | westgard (detects errors); multiple-rule method |
| rules 1 and 2 detect marked changes in electrode performance, sometimes called a _____, by examining how far from the mean a single control value falls. | shift |
| when using the multiple-rule method, always keep a ________ _______. | Control history |
| how many levels of control materials are normally used to provide adequate QC for a blood gas analyzer? | 3 |
| _____________ _________ _________ consists of comparing unknown control specimens from a single source in multiple laboratories. | interlaboratory proficiency testing |
| what is the three primary uses of criteria of acceptability of PFT? | 1. basis for decision making 2. evaluate validity 3. score/evaluate technologist |
| how should you examine tracings or graphics? | compare the observed tracing with the characteristics of acceptable curve/pattern |
| the decision to perform additional maneuvers is usually based on __________. | Repeatability |
| what are the key indicators for spirometry? | start-of-test and duration of effort |
| what are the key indicators for gas dilution lung volumes? | absence of leaks and test duration |
| what are key indicators for DLCOsb? | inspired vols and breath-hold times |
| what is an important component of quality assurance for PFT? | scoring/grading the quality of the test |
| what is a key component for obtaining valid data, particularly in tests that require pt instruction and encouragement? | well-trained and high motivated technologist |
| what also should be provided from the technologist? | feedback |
| what are the standard precautions that should be applied in the pulmonary function and/or blood gas lab? | 1. treat ALL as contaminated 2. exercise care to prevent injuries 3. protective barriers 4. wear gloves 5. wash hands |
Created by:
christa_2008
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