ATS Pulmonary Function Laboratory Manual

chapter  6

Procedure Notes 1.

Technologist’s qualifications and role 1.1.

Individuals performing spirometry should be high school graduates, with at least 6 months super- vised training. Individuals responsible for troubleshooting problems should have at least 1 year of training (5, 20). 1.2. Interaction between the technologist and patient are important in obtaining acceptable and repeat- able data; technologists should display a high level of motivation in regard to eliciting maximal effort from the patient. 1.3. The laboratory quality assurance program should provide feedback to individual technologists re- garding the quality of the data; feedback should include the nature and extent of unacceptable FVC maneuvers, corrective actions to improve quality, and recognition of superior performance (5, 16). Spirometry (VC, FVC, and MVV) is an effort-dependent test. It requires cooperation, motivation, and understanding by the patient; appropriate patient effort depends on instruction and communica- tion with the technologist. 2.2. Physical and mental impairment, or other conditions may limit the patient’s ability to adequately perform the test in an acceptable and repeatable manner. 3. Infection control; there is some risk of infection related to performance of spirometry. 3.1. Cross-contamination between patient and technologist and between patients can occur if the use of gloves, hand washing, and equipment-decontamination procedures are not followed (17). 3.2. Spirometry equipment (e.g., mouthpieces, etc.) contaminated with blood should be handled using universal precautions (UP) (21). 3.3. Patients with known or suspected transmissible diseases (e.g., tuberculosis or TB) should be tested using dedicated equipment or at the end of the day to reduce risk of cross contamination (22). 3.4. The use of in-line bacteria filters may be indicated on multi-use spirometers employing complex valves and circuits. The use of filters may influence the measurement of flows (23). 4. Unacceptable data; it may be necessary to report data which do not meet all criteria for acceptability and repeatability. 4.1. Final report should include technologist’s comments regarding unacceptable or non-reproducible data, including a description of the problem (e.g., poor effort, large volume of back extrapolation, and early termination). 4.2. Spirometry data should be reported if at least one acceptable maneuver is obtained after eight at- tempts; appropriate comments concerning the effect of using data from a single test should be included. 4.3. Spirometry data that are not repeatable (i.e., largest FVC or FEV 1 values not within 0.150 L) may be reported; appropriate comments concerning the possible consequences of the non-repeatable data should be included. 5. Choice of reference equations may affect the final interpretation. 2. Effort dependence of spirometry 2.1.

References

1. Crapo RO. Pulmonary function testing. N Engl J Med 1994;331:25–30. 2. Burrows B. Airway obstructive diseases: pathogenetic mechanisms and natural histories of the disor- ders. Med Clin N Am 1990;74:547–559. 3. Quanjer PH, Weiner DJ, Pretto JJ, et al . Measurement of FEF25-75% and FEF75% does not contrib- ute to clinical decision making. Eur Respir J 2014;43:1051–1058.

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