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PCU MCMC June 2011 Equipment Status report.doc Size : 50 Kb Type : doc |
07 July 2021
MCMC PULMONARY CARE UNIT
GENERAL JOB DESCRIPTION OF A RESPIRATORY THERAPIST
1. Perform extraction for arterial blood gas analysis and interpretation;
2. Administer various inhalation therapy like compressor-driven nebulization, ultrasonic nebulization (USN), intermittent positive pressure breathing therapy (IPPBT), in-line nebulization including instruction on proper technique;
3. Administer respirator to patients needing ventilatory support, including non-invasive ventilation;
4. Determine spontaneous breathing parameters (SBP), Peak End Expiratory Pressure (PEEP), pulse oximetry and peak expiratory flow rates (PEFR);
5. Assist the physician and nursesin weaning of patients from mechanical ventilators;
6. Observe and evaluate immediate response and reaction of patients undergoing ventilation therapy;
7. Administer oxygen therapy either by low flow delivery devices or high flow devices, including new modalities like high-flow nasal cannula;
8. Assume responsibility for proper functioning and care of respirators and other respiratory therapy equipments;
9. Administer the proper technique on chest physiotherapies;
10. Perform and assist the patient during Pulmonary Function Testing (PFT);
11. Assist in performing cardio-pulmonary resuscitation (CPR);and,
12. Assumes responsibility for proper disinfections/sterilization of all respiratory therapy equipments.
STAFF RESPIRATORY THERAPIST/S
Brief description of the general functions of the position:
Performs pulmonary services to in and out – patients.
SPECIFIC DUTIES AND RESPONSIBILITIES:
o Sets up ventilators and adjust its setting according to the attending physician’s orders.
o Makes rounds of patients hooked to ventilators at least 2-3 times during tour of duty;
o Extract Arterial Blood Gases (ABG) and relays the result immediately;
o Delivers Aerosol Therapy to in and out-patients;
o Performs non-invasive monitoring to critically ill patients (02 saturation monitoring and Capnography);
o Perform Chest Physiotherapies to patients with retained secretions;
o Performs Intermittent Positive Pressure Breathing to in and out-patients;
o Prepares charge slips for all pulmonary services done;
o Accompanies the ambulance conduction team for patient transport when need arises;
o Responds to Emergency Codes being ready for STAT ABGs, assist in manual resuscitation and intubation of the patient;
o Keeps work area clean and orderly; and
o Performs other duties as maybe assigned by superiors.
Qualification Standards – FOR Revision
Graduated of any paramedical course.
3-6 months training in Respiratory Therapy
1year continuous service
Civil service eligible (Professional Level)
SUBJECT: ORGANIZATIONAL SET-UP (PULMONARY CARE UNIT)
I. PERSONNEL COMPLIMENT
Presently, the Pulmonary Care Unit is composed of a Section Chief Pulmonologist, one Chief Respiratory Therapist, and Three Respiratory Therapist Staff.
II. DUTIES AND RESPONSIBILITIES.
A. SECTION CHIEF /PCU HEAD
· Coordinates and supervises all activities of the section;
· Acts as the liaison between the section and the management;
· Recommends the appointment and promotion of Respiratory Therapist;
· Recommend the implementation of disciplinary and administrative sanctions against employees who commit grave misconduct in the performance his/her duties and responsibilities;
· Implements the Department of Medicine training, research and service programs in relation to the activities of the section; and,
· Prepares the budget, reports development plans of the section.
Qualification Standard
Licensed medical practitioner
3-5years practice in Pulmonary Medicine
CHIEF RESPIRATORY THERAPIST - Assists the section chief in the management and supervision of the section, is responsible for the education and training of the Respiratory Therapist and student interns, sees to it that all pulmonary services are done efficiently.
Specific duties and responsibilities:
· Assist the section chief in the management and supervision of the section.
· Makes spot check rounds to units where pulmonary services are being delivered.
· Records and updates the daily services rendered.
· Prepares the schedule of duties of the section
· Monitors the purchases and issuances of supplies.
· Performs regular inventory of drugs and supplies received and issued.
· Performs daily preventive maintenance of all equipments.
· Checks the daily attendances of personnel and student interns.
· Prepares the monthly, annual and other reports of the section.
· Supervises the daily activities of Respiratory Therapist and student interns.
· Presides over the monthly meetings of the section.
· Conducts regular lectures to Respiratory Therapists and student interns.
· Conducts in-service training to other departments whenever requested.
· Represents the section in hospital conferences and meetings.
· Is a member of the Infection Control Committee and is responsible for the section’s compliance to the hospital’s policies regarding infection control.
· Assist in the conduct of research in Pulmonary Medicine by way of data collection, analysis and interpretation.
· Takes over the duties and responsibilities of the Respiratory Therapist when the need arises.
· Perform other duties as maybe assigned by superiors.
Qualification Standards:
Graduated of any paramedical course (preferably graduate of B.S Respiratory Therapy).
Has undergone intensive training in Respiratory Therapy.
Five -year continuous services
Civil Service eligible (Career Professional Level)
MANDALUYONG CITY MEDICAL CENTER
PULMONARY CARE UNIT
POLICIES AND PROCEDURES
SUBJECT: RESPIRATORY CARE ORDERS
PURPOSE: To assure respiratory therapy is ordered appropriately.
POLICY: Respiratory care staff will verify respiratory prescriptions specifies the type, frequency, and duration of treatment and as, appropriate, the type and dose of medication, the type of diluents, and the oxygen concentration and other respiratory services on the patient’s chart. The therapist will ask for an official request from as prepared by the nurse-on-duty per physician’s order.
The therapist will only perform the specified treatment or order based on physician’s request written on the patient’s chart. If the order is only verbalized by the physician, the therapist will ask the nurse/ physician to write it down on patient’s chart.
RESPONSIBILITY:
- Will verify that PHYSICIAN’S prescription specifies the type, frequency and duration of treatment and, as appropriate, the type and dose of medication, the type of diluent’s, and the oxygen concentration, etc.
- Will document the above for verbal orders from a physician.
- Will implement emergency orders immediately during an emergency situation and transcribe as a verbal order upon resolution of the emergency (in case of STAT orders).
- Will contact the physician for all orders that are incomplete or provide potential harm to the patient.
- Will follow hospital approved respiratory care Protocols when appropriate.
SUBJECT: MEDICATION NEBULIZER (Hand held & In-line )
PURPOSE: 1. To deliver aerosolized medication to the patients who can voluntarily initiate and maintain moderate to large tidal volume.
2. To deliver in-line aerosolized medication to mechanically ventilated patients.
POLICY: Respiratory Care Unit will administer the medication using the small-volume medication nebulizer upon notification of an appropriate physician order. The physician order should include: frequency, medication and dosage. If dosage of the medication is not ordered, unit dose will be given one time, the physician will contacted for clarification prior to any further therapy.
SYNONYMS:
Aerosol Therapy, Inhalation Therapy, Nebulization
TECHNIQUE/ RESPONSIBILITY
1. The NOD/ Physician will notify the therapist of any order or change of current order received via telephone call/ direct verbal communication.
2. Obtain appropriate equipment and medications necessary to perform therapy.
3. Verify physicians written order on the chart. Notify NOD if there are any errors for immediate correction.
4. Review patient’s chart to gather pertinent information such as indication and contra-indication of therapy.
5. Wash hands before and after treatment. Strictly follow infection control protocol (see infection control manual).
6. Identify patients (ID band) and introduce himself/ herself to patients.
7. Position the patients, auscultate, monitor pulse and respiration before, during, and treatment.
8. Assemble equipment:
a. Med. Neb disposable set-up with appropriate delivery device (mouthpiece, nose clip, aerosol mask, T-piece, face tent, or trachea collar with reservoir tubing).
b. Instill appropriate medication.
c. Connect to appropriate pneumatic source, (oxygen flow meter, air flow meter, for suspected CO2 retainers, or ventilator nebulizer connection for in- line nebs), and set appropriate flow to produce reasonable aerosol mist.
9. Explain procedure and goals of therapy to patient.
10. Administer treatment. Monitor patients for complications (tachycardia, paradoxical bronchospasm ect).
11. Discontinue therapy upon complete nebulization of medication unless adverse reactions occur.
12. Encourage the patient to cough and expectorate. Document the characteristics of sputum (i.e., color, consistency, and amount).
13. Empty nebulizer cup, shake dry, and keep in appropriate place.
14. Documentation on the flow sheet form to include: medication (concentration and volume) nebulized, duration of therapy, and the source gas utilized; heart rate, resp. rate, and breath sound (before and after therapy); and cough and sputum characteristics, patient’s subjective response to therapy.
15. Document the number of treatment given and the time on the desk copy of the master schedule (patient’s cardex) for charging purpose.
SUBJECT: VENTILATORY CARE
PURPOSE: To provide guidelines for managing the patient/ ventilator system and documenting in the medical record or ventilator flow sheets.
POLICY: All mechanical ventilators are set-up, monitored and maintained by Respiratory Care Personnel (assigned respiratory therapist). All patient related interventions are documented in the medical record/ ventilator flow sheets. The Respiratory Therapist will also do the charging.
RESPONSIBILITY:
1. Obtain the ventilator. Test the ventilator, humidifier and the circuit function. Check ordered setting’s on patient chart and notify physician or NOD if any errors in orders are present.
2. Wash hands before and after all interventions with patient /ventilator system. Follow applicable infection control guidelines.
3. Verbally re-assure and comfort the patient. Place patient on ordered settings. Activate and set humidifier as appropriate.
4. Notify physician as necessary for order clarification, suggested modifications, or to communicate significant changes in patient’s status.
5. Optimize ventilator settings and alarm to maximize patient comfort and safety while adhering to physician ordered ventilators parameters. Activate appropriate external monitors alarm.
6. Check patient/ventilator system. Document on the ventilator flow sheet.
AREAS OF CLARIFICATION:
Any therapist who observes what appears to be some aspect of ventilator/ humidifier malfunction is responsible to promptly report the occurrence to his/her supervisor. If the occurrence is potentially life threatening, the patient is placed on alternative manual or mechanical ventilation. The supervisor is responsible to promptly assess the situation, document and remove the ventilator as applicable. An equipment malfunction report is filled out describing order what circumstances and at what settings the malfunction occurred.
VENTILATOR CHECKS
Ventilator checks are documented every two to four hours as possible and otherwise to reflect changes in ventilator’s parameters and changes in oxygen concentration. Respiratory Care Department ventilator Flow Sheet is stamped with the patient’s respirator (bedside). All applicable spaces are completed as part of each check.
GUIDE FOR CHARTING ON VENTILATOR FLOW SHEET
CATEGORY DESCRIPTION
Ventilator type ( No.) Type/ model of ventilator
Number assigned by departmental biomedical personnel
DATE Date of ventilator check/ setting change, circuitry change.
TIME Time of ventilator check/ setting change, circuitry change.
MODE Indicates type of mechanical ventilation employed.
FIO2 Ordered oxygen concentration. FIO2 must be analyzed at least once per shift and with each change in O2 concentration.
SET TIDAL VOLUME Physician prescribed tidal volume as set by machine control (s).
RETURNED TIDAL VOLUME Returned tidal volume for all machine assisted breaths in A/C, IMV, and/ or PCV. Acceptable Vt is defined as one within 100mls of Vt when ordered Vt is one liter or less. Volume within 10% of ordered Vt are acceptable for Vt >1000mls.
SPONTANEOUS TIDAL VOL. Returned Vt for all breaths in PS and CPAP modes.
SET FREQUENCY Frequency ordered by physician. Set by adjusting and verifying the position of the rate control.
SPONTANEOUS FREQUENCY Number of spontaneous breaths/min generated in the IMV or CPAP modes. Number of PS bpm.
TOTAL FREQUENCY Total breaths recorded per minute.
FLOW Flow rate set in volume control modes and adjusted on ventilator control panel.
SENSITIVITY Pressure below baseline observed on manometer required to initiate a patient generated breath.
PEAK PRESSURE Maximum system pressure observed during a typical Vt delivery during a machine generated breath.
PLATEAU PRESSURE System pressure observed during a successful breath hold maneuver.
PEEP The amount of set end-pressure. When auto-peep is detected, chart set peep over the total peep.
STATIC COMPLIANCE Returned Vt + Plateau P – PEEP
DYNAMIC COMPLIANCE Returned Vt + Peak P – PEEP
HIGH PRESSURE ALARM Set 10-15cwp higher than a patient’s PIP on a typical Vt.
LOW PRESSURE ALARM Set 5-10cwp below the PIP on a typical Vt.
DELAY An alarm should activate 3-4 sec. After a prescribed breath is missed. If an external P alarm is utilized, the number of seconds until alarm activation is recorded.
SYSTEM TEMPERATURE Should be maintained between 30-37 degrees C as measured at the patient wye and presented on the digital display on the Fisher & Paykel humidifier.
SIGH VOLUME Physician ordered Vs (factory preset or set at bedside by RCP).
SIGH RATE MULTIPLES Rate (sighs/hr, sighs/100 breaths);Indicate multiple sigh demonstrated in the following example (e.g. 3x2, where 3 is the sigh rate and 2 is the multiple).
VOLUME ALARMS Chart volume alarms as follows:
( Vt or Vminute) Bear-low Vt; Siemens 900C-High minute volume over low minute volume; PB 7200ae and Infrasonics Star 2000-low Vt over low minute volume.
SpO2/ HR Record O2 saturation (measured via pulse oximetry) over heart rate.
ABGs Document as to relect associated ventilator setting.
SET PRESSURE LEVEL Record in PS modes. Document amount of positive inspiratory pressure ordered by physician.
I:E RATIO Chart when this ratio is used as a therapeutic ventilator parameter manipulated by the RCP or by physician order.
BLANK ROW May be used to record the inspiratory waveform, events of suctioning, or otherwise be used at the RCPs discretion.
SIGNATURE First initial, last name, and credential.
THERAPIST NOTES (Back Document baseline/subsequent
Of Ventilator Flow) assessment to include breath sound.
Sheet tube size and placement; use of MLT or MOV technique; number, placement and status of chest tubes; verification of FIO2; calibration of ETCO2 monitor, presence and function of bag, mask and flow meter system; closed suction, filter, circuit change outs; apnea parameters; and ventilator parameters.
NOTE:
A new one is replaces breathing circuitry to each patient every two days (48 hrs).
SUBJECT: WEANING FROM MECHANICAL VENTILATION
PURPOSE: To enhance the transmission from the reliance on mechanical ventilation to spontaneous ventilation.
POLICY: Respiratory care will be responsible for making ventilator changes during weaning procedure as per physician order.
NOTE: When weaning parameters are ordered, the patient’s spontaneous RR. Vt, Min. volume, SVC, and MIP will be measured unless other specific tests are ordered. See “Ventilator Parameters” Policy.
TECHNIQUE / RESPONSIBILITY:
1. Verify physician’s written order on the chart.
2. Identify patient and introduce yourself, and explain the procedure.
3. Initiate parameter change as per physician’s order.
4. Observe the patient for any clinical and physiological instability.
5. Assess the patient for the effect of the procedure.
6. Document on the weaning flow sheet your observations and the results. Documentation should include the patient’s vital signs before and after the change, what the change in parameter was, and the patient’s Sp02, and/or ABG before and half hour after the changes.
SUBJECT: ARTERIAL BLOOD GAS SAMPLING
PURPOSE: To obtain arterial blood for analysis of the patient’s respiratory and metabolic status.
POLICY: An arterial blood gas sample will be obtained only in the written order of a physician. The respiratory therapist on –duty (RTOD) is allowed to perform a radial arterial puncture. After two unsuccessful attempts, the RTOD should contact another qualified staff member to perform the procedure. If there is no other available staff, the RTOD will have the discretion to choose the next site of choice, which is the brachial arterial site. If the RTOD still fails, and still there is no qualified staff to do the sampling, the RTTOD should notify the nurse staff on duty (NOD) or the physician on duty. This procedure is a shared responsibility of the therapist, nursing staff and the physician. The assigned physician will give the final approval if the therapist can try other sites of puncture such as femoral or dorsalis pedis arteries or if the procedure can be deferred.
TECHNIQUE/ RESPONSIBILITY:
1. The nurse-on-duty/ physician-on-duty will notify the RTOD for arterial blood sampling via phone or direct communication.
2. Collect all necessary equipments.
3. The therapist must verify physician’s written order in the patient’s chart. Notify he physician and the nurse if the is error in the order. Review the chart for contraindications or precautions to procedure.
4. Wash hands and follow appropriate Infection Control process.
5. Enter room and identify himself/herself by name and department to patient and/or visitors.
6. Identify patient verbally and by identification bracelet.
7. Perform assessment and evaluation. Take necessary data such as patient’s respiratory rate, FIO2 and type of O2 device attached (if any), aged and other important data, which can affect the respiratory/ metabolic result of the ABG.
8. Explain procedure to patient.
9. Assemble equipment. Do non- sterile gloves.
10. Palpate radial artery site.
Perform Allen’s Test: This is to determine the patency of the radial-ulnar loop. Occlude the ulnar and radial arteries. Have the patient clench his/her first until blanching occurs. Release the ulnar artery; if the entire hand returns to normal color within 5secs, the radial-ulnar loop is patent, and the site maybe chosen for an arterial puncture. If the entire hand does not return to its normal color, the patency is questionable, and the artery should not be used for puncture
11. Scrub the puncture with an antiseptic
12. Palpate the radial artery with the tips of the first two fingers on the non-dominant hand, and locate the exact puncture site.
13. Hold the heparinized syringe in the dominant hand, with the bevel of the needle up; puncture the radial artery at a 45 -degree angle, with the needle pointing upstream.
14. When there is a flash of the arterial blood in the hub of the needle, aspirate 1-2cc for adults or 0.5-1cc for pediatric/neonate of blood into the syringe.
15. Withdraw the syringe and apply pressure to the site for minimum of 5 minutes, (10 mis. For patients receiving anticoagulants, Persantin Dextran, or aspirin in large doses) or until the bleeding stops. The patient should be instructed to call the nurse immediately if the bleeding resumes or a hematoma forms. Tape the punctured site with dry cotton.
16. Expel air bubbles from syringe, and carefully remove and discard needle appropriately, Cap the syringe with the stopper provider. Mix blood sample properly by rotating/rolling the syringe between two palms or fingers. Don’t mix blood by shaking.
17. Label the syringe with the patient’s name/ID sticker. Place green IDP(infectious disease precautions) label on the specimen of all patients with infectious diseases.
18. Place the labeled syringe on ice in the appropriate specimen container along with the lab. Requisition slip taken from the NOD. Complete appropriate charting and charging.
19. Check puncture site again and reassure patient by answering any questions they may have. Discard any trash before leaving patient’s room and wash hands.
20. Analyzed blood sample through the ABG machine without any further delay, nut mix well before feeding through the machine. Record the results in the laboratory logbook and relay to NOD/physician via phone or direct issuance. The result should correlate with patient’s condition.
AREAS OF CLARIFICATION:
Indications for ABG sampling:
To assess oxygenation
To assess ventilation
To assess acid-base status
Hazards and Precautions:
Patient on anticoagulant therapy
Patient w/ hemodialysis
Hematoma
Nerve spasm
Severing of the artery/arteriospasm
Infection
Thrombosis
Loss of limb
PROTOCOLS FOR RELAYING ABG RESULTS:
A. For In-patients
-The result will be delayed via phone or direct communication (release of “wet reading” from the print out paper of the ABG machine). The results will be relayed only to the nurse-on-duty or the physician-on-duty and properly identified by the therapist.
B. For Out-patients
-The therapist can release the official result after entering data on the laboratory logbook and playing the appropriate charge by the sender of the specimen on the cashier section and the official receipt number is returned to the pulmonary laboratory. The official result form of the ABG (out-patient) can be released even without the interpretation of the pulmonologist. If the sender ot the center which sends the ABG sample demands for the official interpretation, the therapist can still release the official result provided that she/he will give the assurance that the interpretation will be relayed to the center as soon as possible.
PROTOCOLS FOR ‘SEND-OUT” SPECIMEN
In case the ABG machine of the hospital is not available due to some unavoidable reasons i.e. the ABG machine is busted, and there are some needed request for ABG sampling, the respiratory therapist must notify the NOD or the physician immediately and wait for further orders.
If the ABG sampling is really needed and insisted by the physician, the therapist must coordinate with the NOD to ask for immediate relative if he/she agrees for the send-out ABG. If the patient has no immediate relative beside the patient or if the relative is too old or too young for send out ABG, the physician on duty or the attending physician will have to decide for deferment of the request and the therapist will wait for any further orders. The respiratory therapist on duty is not allowed to send out ABG samples.
RELEASE OF ABG RESULTS FOR IN-PATIENTS:
OFFICIAL ABG RESULTS WITH INTERPRETATION WILL BE RELEASED AFTER CHECKED/SIGNED BY THE PULMONOLOGIST AND PROPERLY TYPEWRITTEN BY THE RESPIRATORY THERAPIST.
SUBJECT: CHEST PHYSIOTHERAPIES
PURPOSE: To loosen and aid in the removal of lung secretions, and to promote re-expansion of lung tissues.
POLICY: Respiratory care practitioners are responsible for performing one or more of the aspects of chest physiotherapies to pediatric and adult patients as prescribed by the physician’s written order. If a specific location is specified per physician’s order, the equal and opposite area of the chest will be percussed and/or drained also. All positions are modified according to patient’s condition and tolerance. The physician will be contacted if the patient is determined to have contraindications for the procedure.
TECHNIQUE/RESPONSIBILITY:
1. The nurse-on-duty/physician-on-duty will notify the therapist on duty of any orders received from patient care area via phone or direct communication.
2. Verify physician’s order on chart
3. Review patient’s chart for pertinent information necessary to complete the patient evaluation. Review recent chest x-ray reports if pulmonary involvement was not specified in physician’s order.
4. Wash hands, and follow universal precautions.
5. Identify patient verbally with ID bracelet, and introduce self to patients and visitors by name and department.
6. Explain procedure and goals of the therapy.
7. Perform evaluation and assessment (breath sounds, HR, RR, etc.)
8. If contraindications are presents, notify the physician.
9. Position patient appropriately as designated by physicians’ order or chest x-ray. Every patient is to be placed in each position for percussions or drainage for 3-5 minutes. The entire procedure should take approximately twenty minutes.
10. Have patient sit-up and cough after each position change.
11. Assess patient for sputum production, and possible increase work of breathing frequently. Assure that the patient uses oxygen during therapy if ordered.
12. Wash hands and follow universal precautions.
13. Document all pertinent data (HR,RR, position, duration of therapy, lung, fields treated, sputum production and adverse affects) on the respiratory staff notes and complete appropriate department charting and charges.
14. Notify physician if patient would benefit form other forms of therapy.
AREAS OF CLARIFICATION:
CONTRAINDICATIONS AND HAZARDS OF THERAPY (AS SPECIFIED BY THE AARC CLINICAL PRACTICE GUIDELINES):
A. All positions are contraindicated for:
Intracranial pressure >20 mmHg
Head and neck injury until stabilized
Active hemorrhage with hemodynamic instability
Recent spinal surgery or acute spinal injury
Bronchopleural fistula
Pulmonary edema with CHF
Pulmonary embolism
Patients who do not tolerate position changes
Rib fracture, with or without flail chest
Surgical wound or healing
B. Trendelenburg position is contraindicated for:
Intracranial pressure >20 mmHG
Patients in whom increased intracranial pressure is to be avoided
Uncontrolled hypertension
Distended abdomen
Esophageal surgery
Recent gross hemoptysis related to lung cancer
Uncontrolled airway at risk for aspiration
C. Reverse trendelenburg is contraindicated for:
the presence of hypotension or vasoactive medication.
D. Percussion or vibration is contraindicated as described above and additionally:
Recent epidural spinal infusion anesthesia.
Recent skin grafts, or flaps on the thorax.
Burns, open wounds and skin infections of the thorax.
Recently placed transvenous pacemaker or subcutaneous pacemaker.
Osteomyelitis of the ribs.
Osteoporosis
Coagulopathy
Complained of the chest wall pain.
NOTES: Chest physiotherapies may consist of chest percussion and/or vibrations, postural drainage, positioning, and turning. If the patient is ordered for aerosol therapy also, the patient should receive the nebulizer first. This will allow wetting of secretions and dilution to assist the CPT.
If complication arises, stop therapy, position patient in the resting position and notify physician.
SUBJECT: PEAK FLOW
PURPOSE: To provide a consistent method/tool to estimate the patient’s ventilatory
Status, and for early recognition of deterioration and/or improvement in
the patient’s respiratory condition.
POLICY: Peak flow measurements will be performed as specified by physician order’s, and/ or as part of the therapist assessment. Also called Peak Expiratory Flow Rate (PEFR).
TECHNIQUE/ RESPONSIBILITY:
1. The NOD/ physician will notify Therapist of order, from a phone call, received from patient care area.
2. The RTOD will verify physician’s written order in the patient’s chart.
Notify the nurse and the physician if there is an error in the order.
3. Collect all necessary equipment (Peak Flow Meter and Mouthpiece).
4. Wash hands and follow appropriate Infection Control process.
5. Do non-sterile gloves (optional).
6. Identify patient verbally and with identification band.
7. Introduce himself/herself to the patient and visitors by name and department.
8. Assemble appropriate equipment.
9. Assure patients posture is optimal for procedure (standing). Perform patient evaluation and assessment (HR, RR, BP).
10. Instruct the patient on goals of therapy and the correct procedure. Family members of pediatric patients should also be instructed.
11. Attach a disposable mouthpiece to the Peak Flow meter and place marker at the bottom of the scale.
12. Instruct the patient to hold the peak flow meter vertically, but do not obstruct the opening or the path of the marker.
13. Instruct the patient to take deep breath as possible, close lip tightly around mouthpiece to make a tight seal, use nose clips if necessary.
14. Instruct patient to blow out as hard as fast as they can into the mouthpiece, this will cause the marker to move up the scale. The final position of the marker is the patients Peak Flow.
15. Repeat steps 10-12 of three measurements. Continuously instruct and coach the patient on the correct procedure. Allow the patient to rest between each procedure.
16. Record the patient’s best effort (highest value) as their Peak Flow in liters per minute.
17. Record any and all pertinent clinical data [HR, RR, BS, Peak Flow values (achieved and predicted), and any adverse effects] in the patient’s chart.
18. Complete appropriate charting and charging.
19. Leave area clean and neat.
20. Wash hands after exiting patient’s room.
AREA OF CLARIFICATION
NOTES:
In some cases, Peak Flows will be obtained before and after bronchodilator therapy for all patients admitted with Reactive Airway disease and asthma. Unless specified by the physician, Peak flows will be measured TID, both on adult/ pediatric wards.
Normal predicted Peak Flow values are based on se, age, and height. These values are listed in the instructions of the Peak Flow Meter.
SUBJECT: INCENTIVE SPIROMETRY
PURPOSE: To encourage patient’s sustained maximal inspiration, for aid in augmentation of their lung value, to prevent or reverse atelectasis and its sequela. IS may also be performed to determine the pre-operative “baseline” inspiratory capacity.
POLICY: Respiratory care will supply the Incentive Spirometer and perform the therapy along with patient teaching upon physician’s order.
TECHNIQUE/ RESPONSIBILITY
1. The NOD/Physician will communicate all new orders of IS to the respiratory therapy department via phone or direct verbal communication.
2. Upon notification of IS order, verify the correctness of the order with the physician’s written order.
3. Review patient’s chart for indications and possible contraindications.
4. Obtain Incentive Spirometer and deliver to patient.
5. Identify the patient. Identify yourself to patient/visitors.
6. Explain the procedure and clinical objectives.
7. Assemble apparatus and determine patient’s predicted Inspiratory Capacity using a nomogram (if Available).
8. Position and instruct the patient.
9. Coach the patient to achieve the best results possible and to teach them so that they can perform the task by themselves.
10. Duration of therapy should be at least 10 successful inspiratory efforts.
Successful efforts= patient exhale normally, place mouthpiece between teth and seals with lips, inhale slowly through mouthpiece maximally, holds inspiration for 1-3 seconds, then exhale slowly to FRC and relaxes before next effort.
Note: Therapy may be modified if patient is unable to make seal with mouthpiece.
11. Monitor patient’s HR, RR, breathe sounds before during and after the procedure. Evaluate that the goals of the therapy are met.
12. Have the patient cough periodically throughout the procedure and at the end of the procedure.
13. Notify the physician and nurse promptly ASAP in the presence of any of the following unexpected situations:
a. The HR changes the baseline by 20% or becomes >/= 120 bpm.
b. Onset of wheezing.
c. Significant worsening of dyspnea.
d. Decrease in patient sensorium, or decreased patient cooperation.
e. Sudden onset of chest pain.
14. When finished, leave the incentive spirometer where the patient can easily reach it.
15. Document patient’s HR,RR,BS before, during and after the treatment, their position, their IC, breath hold if utilized, characteristics of their cough, patient teaching performed and patient subjective response to the therapy.
AREAS OF CLARIFICATION:
Indications for Incentive Spirometry (IS)
Prevent atelectasis
Existing atelectasis
SUBJECT SUCTIONING
PURPOSE: To assist in the removal of secretions or foreign material fro a patient’s airway, when they are unable to do so for themselves.
POLICY: Suctioning is a responsibility respiratory care shares with nursing personnel. Suctioning will be the responsibility of the Respiratory Care Unit during therapies and in conjunction with ventilator inspections. Respiratory care will observe universal precautions when performing this procedure.
RESPONSIBILITY:
1. Assign Respiratory therapist to patient care area.
2. Identify patient and determine if suctioning is indicated.
3. Determine method of suctioning (whether tracheal, nasotracheal, etc.)/
4. Assemble equipment and supplies.
a. Suction regulator and tubing (nursing personnel should obtain this equipment)
b. Appropriate sterile catheter.
c. Gloves (sterile or non-sterile).
d. Water based lubricant.
e. Appropriate oxygen delivery system and/or resuscitation bag/mask, (oxygen must be available in the event the patient suffers an adverse reaction).
f. Nasal trumpet (if indicated).
g. (Personal protection equipment).
h. Normal saline (without preservatives).
5. Wash hands.
6. Explain procedure to patient and family.
7. Select appropriate vacuum for suctioning:
a. ADULTS = 100 to 150mmhg
b. PEDIATRICS = 80 to 100mmhg
c. INFANTS = 60 to 80mmhg
8. Place lubricant on sterile surface.
9. Evaluate patient for HR, RR, color, accessory muscle use, etc.
10. Position patient.
A. NASOTRACHEAL PROCEDURE:
1. Pre-oxygenate patient.
2. Adjust regulator to desired vacuum.
3. Apply P.P.E and sterile gloves.
4. Lubricate nasal trumpet and gently insert into nares (if indicated)
5. Lubricate catheter and introduce it into the nares / nasal trumpet (use normal saline to lubricate pediatrics catheters).
6. Advance the catheter till breath sounds are heard through the catheter vent port.
7. Connect the suction tubing to the catheter.
8. Applying intermittent suction, rotate and widraw the catheter.
9. Oxygenate patient.
10. Evaluate patient for adverse reactions.
11. Complete charting.
12. Assure patient comfort.
13. Discard equipment..
NOTE: The patient should be monitored for adverse reactions during suctioning.
B. TRACHEAL AND ENDOTRACHEAL SUCTIO:
1. Pre-oxygenate patient.
2. Adjust regulator to desired vacuum.
3. Apply P.P.E. and sterile gloves.
4. Connect the suction tubing to the catheter.
5. The patient may be lavaged with 2-5ml naCl (without preservatives) if secretions are tenacious.
6. Introduce sterile suction catheter into the patient’s artificial airway.
7. Applying intermittent suction, rotate and withdraw the catheter.
8. Oxygenate/ ventilate patient as necessary.
9. Evaluate patient for adverse reactions.
10. Repeat procedure if necessary.
11. Complete charting.
12. Assure patient comfort.
13. Discard equipment.
NOTE: The patient should be monitored for adverse reactions during suctioning.
C. CLOSED SYSTEM IN-LINE SUCTION:
1. Connect in-line suction system to patient circuit (ventilator or T-bar).
2. Affix expiration date system.
3. Pre-oxygenate patient.
4. Adjust regulator to desired vacuum.
5. Adjust P.P.E. and non-sterile gloves.
6. Connect the suction tubing to the catheters’ control valve.
7. Unlock the control valve.
8. Grip system T-Piece and advance catheter until resistance is met.
9. Apply intermittent suction and withdraw the catheter.
10. To lavage the airway, introduce the catheter several centimeters and instill normal saline through the irrigation port (do not apply suction until after normal saline has been delivered).
11. Apply intermittent suction and withdraw the catheter.
12. Oxygenate/ ventilate patient.
13. Evaluate patient for adverse reactions.
14. Repeat procedure if necessary.
15. When suction procedure is completed, flush the catheter by instilling normal saline through the irrigation port and applying suction.
16. Lock control vale.
17. Assure patient comfort.
18. Complete charting.
NOTE: The patient should be monitored for adverse reactions during suctioning.
ASSOCIATED COMPLICATIONS OF SUCTIONING
The complications of pulmonary suction include he following:
a. Hypoxia/ Hypoxemia
b. Vagal stimulation/ bradycardia
c. Cardiac arrhythmia
d. Laryngospasm/ bronchospasm
e. Tissue damage
f. Infection
g. Tachycardia
SUBJECT: TRANSPORT PATIENT WITH OXYGEN
PURPOSE: To ensure adequate oxygenation and safety of patient on 02 therapy/ respirator during transport.
POLICY: Transport of patient on O2 therapy.
The following hospital personnel should be present when transporting patient.
A. At least one (1) ER/ICU nurse.
B. At least one (1) Respiratory Therapist if the patient to be transported is hooked to M.V.
C. Resident physician-on-duty and/or attending physician.
D. One (1) Nursing Aide.
RESPONSIBILITY:
1. Wash hands before and after the procedure.
2. Collect and assemble equipment.
3. Identify yourself to the patient and visitors.
4. Identify patient by wristband.
5. Explain procedure to patients/relative.
6. Assist patient’s respiration and heart rate.
7. Turn cylinder on and open flow meter to desired flow.
8. Disconnect patient’s 02 tubing from wall outlet and attach to transport flow meter.
9. Assist with transport of patient to designated room or location.
10. Disconnect 02 tubing from transport cylinder, connect to wall 02 outlet/ cylinder, and check liter flow.
11. Observe patient for changed in respiratory and/ or heart rate.
12. Resume other duties after checking patient and/or oxygen source.
13. Assist with patient transport back to patient care area with requested to do so.
14. Document transport in patients medical chart and complete necessary charge documents.
NOTE: The respiratory therapist on duty stays with patient during the procedure if the patient is critically ill or upon request by the physician.
Computation for duration of flow:
DOF (mins) = (0.28 x PSIG) / liter flow
FACTORS FOR DURATION OF FLOW:
Size D= 0.16
E= 0.28
G= 2.41
H/K= 3.14
SUBJECT: PREVENTIVE MAINTENANCE FOR RESPIRATORY EQUIPMENT
PURPOSE: To ensure the safety and optimum performance of our respiratory equipments and maximize its useful life.
POLICY: To Respiratory Care Department will perform preventive maintenance on respiratory equipment.
RESPONSIBILITY:
MANAGERS/ SUPERVISORS
1. Cooperate with the respiratory biomedical technician to locate and secure equipment for maintenance.
2. Inform the biomedical technician about observations concerning about usage that could be helpful when performing preventive maintenance.
BIOMEDICAL TECHNICIAN
3. Perform the following preventive maintenance tasks in accordance with the established work standards:
· Functional operation inspections.
· Complete electrical safety inspection.
· Mechanical conditions and damage inspection.
· Replacement of parts recommended by manufacturer, user or biomedical observation.
· Corrected maintenance as necessary.
· Additional required testing, calibration, or service specified by equipment manufacturer.
· Documentation of worked performed as required.
4. Assure all preventive maintenance work maintain current status.
5. Review any new department equipment for inclusion in the preventive maintenance program.
6. Report excessively unclean or abused equipment to a manager.
7. Review service manuals and keep up to date on the latest technical bulletins from manufacturers, government agencies, and independent research groups concerning equipment maintenance procedures.
AREA OF CLARIFICATION:
NOTES
1. The equipment inventory and tracking system is to be kept current in order to effectively manage and maintain our equipment.
2. The interval preventive maintenance is determined at the initial inspection. The formula used is based upon function, risk, and required maintenance. A copy of a formula and the maintenance number assigned to each type of equipment is to be kept current and on file in the respiratory biomedical department. At minimum, required safety inspections will be performed on an annual basis.
SUBJECT: PROCESSING AND STERILIZATION OF RESPIRATORY EQUIPMENTS
PURPOSE: To assure that all non-disposable equipment will be sterilized and/ or disinfected to prevent contamination of cross- contamination of infectious causing micro-organisms to patients.
POLICY: All equipment will be changed as designated per procedures. Permanent equipment will be returned to the Respiratory Care processing Room by the therapist responsible for the area and placed in the room for the equipment technicians to disinfect.
The equipment technicians will disassemble, wash place through cold sterilization on procedure, rinse, dry, reassemble, and place in appropriate closure. “Soiled” and “Clean” areas in both rooms are designated and specific tasks should be carried out in those areas only.
TECHNIQUE/ RESPONSIBILITY
1. Wear appropriate “Personal protective Equipment” (PPE), when handling any contaminated equipment at all times. PPE equipment includes resistant gown, gloves and protective eyewear.
2. Send all permanent canisters in appropriate bag for “steam autoclave” to Central Stores as per manufacturers recommendations.
3. Change Glutaraldehyde solution every four weeks. The solution wikll be monitored daily, prior to use, by testing the strength of solution with indicator strips. Should the test strip indicate that the solution is no longer effective, the solution will be changed and the manager informed.
4. Monitor glutaraldehyde vapor annually to assure the safety of the area for the employees. The information will be reported to the Medical Director and the Director of Respiratory Care/ Pulmonary Diagnostics Services.
5. Place permanent equipment discontinued from patient use in clear plastic bag to return to the department. If contaminated with blood or bloody secretions, place equipment in plastic bag and label with isolation tape.
6. Discard all disposable items in the appropriate containers in the patient’s room.
7. Return all equipment to the Respiratory Care Department, place inside the equipment room in the appropriate area or counter.
8. Break equipment down into appropriate parts for washing and disinfecting.
9. Wash all visible contaminant from surfaces.
10. Submerse equipment in glutaraldehyde solution Metricide for overnight.
11. Equipment surfaces, electronic equipment, and equipment that cannot be immersed will be disinfected with glutaraldehyde solution.
12. Place equipment in dryer appropriately from soiled equipment area.
13. No equipment should touch the bottom of the dryer floor.
14. Hang all tubing from tubing side appropriately.
15. Remove equipment from dryer side in room.
16. Assemble equipment when it is thoroughly dry (visible inspection).
17. Make ready and assemble on clean counter top designated for such purposes.
18. Package, label and place on shelf in appropriate area for use.
19. Clean all surfaces of equipment and carts with wexcide & alcohol.
20. Wipe the surface with the solution and allow to air dry.
21. Return monitors to the Respiratory Care storage room.
22. Push ventilators to make ready area for calibration.
23. Calibrate and check ventilators. Assure they are ready for operation.
24. Set up and cover with plastic bags all portable Birds ventilators, CPAP & Bi-PAP equipment. This includes replacing air and bacteria filters.
25. Place all “ready to use” equipment in the storage area.
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MCMC PCU Job Description Duties Responsibilities 2010.doc Size : 0.118 Kb Type : doc |
Mid-2006 - Mid 2007 :With emphasis on Professional Development (Lectures to Nursing, PCU and IM Staff by ICU-PCU Head Dr. Nazario A. Macalintal Jr.)
· June 2006 – Oxygenation Options for the Breathless Patient
· July 2006 - Arterial Blood Gas Interpretation
· August 2006 – Mechanical Ventilation – Basics
· September 2006 – European Respiratory Society Congress – (to be participated by Dr. MAcalintal in Munich, Germany)
· October 2006 – Trouble Shooting Mechanically Ventilated Patients – Part I
· November 2006 - Trouble Shooting Mechanically Ventilated Patients – Part II
· December 2006 – Weaning from the Respirator
· January 2007 – The Flu Pandemic Update
· February 2007 – Nosocomial Pneumonia
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Ventilator Provision Policy MCMC 2010.docx Size : 14.083 Kb Type : docx |