RC 232 - Respiratory Care Special Procedures II

Credit Hours: 3

Utilizing lecture and laboratory format, this course will explore the more advanced procedures often performed by respiratory therapists. These include the following: arterial punctures; analysis of arterial, venous, and capillary blood; hemodynamic monitoring; pulmonary function testing; electrocardiography; chest drainage systems; and advanced assessment of oxygenation and ventilation in critical care.

Course Outcomes
Part I: Arterial Puncture and Advanced Cardiopulmonary Assessment

describe the purpose of arterial puncture;
list arterial blood gas sample requirements;
identify the radical, brachial, ulnar, and femoral artery;
describe the advantages, disadvantages, and order of preference associated with the site arterial blood can be drawn from;
describe the significance of and properly perform the modified Allen’s test;
describe hazards associated with an arterial puncture;
list equipment needed to perform an arterial puncture;
properly perform an arterial puncture on a laboratory practice arm;
describe common errors associated with arterial blood gas sampling;
describe the chemical principles which are utilized in the operation of the following: pH electrode, PCO2 electrode, PO2 electrode;
describe the importance of calibrating a blood gas machine;
describe arterial line insertion and point of care;
describe quality control in ABG analysis;
list normal blood and body fluid values used in assessment and the significance associated with each value. Included in this would be, but not limited to: ABG, CBC, urinalysis and electrolytes;
state the indications for pulse oximetry (single and overnight use), co-oximetry, capnography, transcutaneous PO2 and PCO2 and apnea monitors;
safely setup, use and troubleshoot various devices including capnography, transcutaneous monitoring, and apnea monitoring;
determine how to interpret the complete blood count and other hematology tests; and
determine how to interpret blood chemistry tests such as electrolytes, renal function, serum enzymes, and serum glucose.

Part II: Hemodynamic Monitoring

describe the roles of arteries, arterioles, capillaries, and veins in contributing to vascular resistance, cardiac output, oxygen delivery and cardiac function;
calculate vascular resistance in the pulmonary and central circulation;
list the normals for pulmonary and systemic vascular resistance;
list the normals of pulmonary vascular pressures; compare to systemic circulation;
correlate elevated pulmonary vascular pressure with left or right heart failure;
describe the procedures involved for each of the invasive cardiac function tests:
- arterial mixed venous samples;
- arterial pressure monitoring;
- central venous pressures;
- pulmonary artery pressures; and
- cardiac output.
describe normal and abnormal values, indications, contraindications and complications of the above texts;
calculate the following given the appropriate variables:
- cardiac output;
- cardiac index;
- stroke volume;
- stroke index;
- C_aO₂, C_vO₂, CaO2-C_vO₂ ; and
- Q_s / Q_T.

Part III: Pulmonary Function Testing (PFT)

describe the value of pulmonary function testing;
identify and define the following volumes and capacities: VT, IRV, ERV, RV, TLC, VC, IC, and FRC;
use a nomogram to obtain normal predicted values;
perform and calculate percent predicted for the following tests of pulmonary function via spirometry: FVC FEV₁, FEV₁ / FVC, FEF 25 – 75;
demonstrate correction of volume measurements from ATPS to BTPS and describe the purpose for this;
perform calibration of the laboratory spirometers using a 3 liter calibration syringe;
explain reasons why PFT may need to be postponed;
recognize specific details of improper performance technique;
describe the criteria for acceptable trials of the FVC and FEV₁;
identify normal, obstructive, restrictive, and mixed ventilatory patterns from a spirogram and spirogram values;
determine the degree of obstruction and restriction;
state the effort dependent and independent portions of the spirogram;
describe the nitrogen wash out, helium dilution, and body plethysmography methods for determining FRC;
describe the plethysmographic method for determining Raw;
list advantages of the flow volume loop curve;
describe the significance of the Viso V;
describe the single breath nitrogen elimination test;
discuss the clinical significance of closing volume;
describe the diffusion capacity test;
list the factors that affect diffusion capacity;
state normal values for Viso V, CV, Raw, and DLCO;
describe the analyzers used in PFT: nitrogen, helium, and CO; and
describe quality control in PFT.

Part IV: Electrocardiography

describe the clinical uses of the EKG;
describe the structure and function of the following anatomical components of the heart: sinoatrial node, altrioventricular node, bundle of His, bundle branches, purkinje fibers;
describe the electrochemical and mechanical events that occur during a single cardiac cycle as seen on an EKG;
describe the significance of the following: P wave, PR interval, QRS complex, ST segment, and T wave;
define the items listed on the EKG terminology handout;
state what the horizontal and vertical axis on the EKG paper represent;
determine the following: PR interval, QRS interval, and cardiac rate and rhythm from an EKG tracing;
describe the function EKG machine controls;
demonstrate electrode placement and EKG performance;
list common causes of artifact; and
identify and state the treatment of the following arrhythmias: sinus arrhythmia, atrial fibrillation, PAC, PNC, unit and multi-focal PVC, bigeminy, trigeminy, quadrigeminy, SVT, PVT, atrial flutter, ventricular flutter, atrial fibrillation, ventricular fibrillation, and heart blocks.

Part V: Chest Drainage Systems and Thoracentesis

describe the main reason for chest drainage;
identify normal intrapleural pressures;
write two reasons why air, blood, or pus in the pleural space causes the lung to collapse;
define the following terms: pneumothorax, hemothorax, empyema, subcutaneous emphysema, thoracentesis, transudate, exudates;
list physical findings in pneumothorax and pleural effusion;
state the proper location for chest tubes to drain air or fluid;
describe the functions and drawbacks of one, two, and three bottle chest drainage systems;
describe the proper care of chest drainage tubing;
describe normal findings in a postoperative thoracotomy patient;
explain findings in the water seal chamber that indicate presence or absence of a leak in the chest drainage system;
explain the proper set-up of chest drainage suction;
describe the proper actions to take if chest drainage becomes disrupted;
state the indications for thoracentesis; and
describe the technique for performing a thoracentesis.

Prerequisites: Matriculation in the Respiratory Care Program or permission of department. Successful completion of all first year Respiratory Care coursework. All Respiratory Care coursework must be taken in sequential order.
F (N)