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Equipment Application and Cleanliness

Equipment Application and Cleanliness. Manipulate Equipment by Order or Protocol. The single largest section of the NBRC CRT exam with the greatest number of analysis-level questions One of the areas with which candidates have the most difficulty

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Equipment Application and Cleanliness

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  1. Equipment Application and Cleanliness Manipulate Equipment by Order or Protocol

  2. The single largest section of the NBRC CRT exam with the greatest number of analysis-level questions • One of the areas with which candidates have the most difficulty • Section covers a very broad scope of equipment, some of which you may not use on a daily basis • The focus of this section is on selecting, adjusting, and troubleshooting equipment • Important areas to study in your equipment text and Egan’s Fundamentals: • Selection of device appropriate to the patient’s needs • How to properly assemble and use the devices • Identify common cause of equipment / device failure and be able to correct

  3. Common Errors to Avoid on the Exam • Never use a Thorpe tube to meter O2 during patient transport; instead, use a gravity-independent device such as a Bourdon gauge. • Avoid selecting or using an air-entrainment device when the patient needs a high FiO2; use a nonrebreathing mask or blended high-flow system instead. • Never heat the gas used to deliver bland aerosols into pediatric mist tents; these systems must always run cool

  4. More Common Errors to Avoid on the Exam • Never use a gas-powered resuscitator on an infant or child • Avoid regular changing of ventilator circuits; change them only when absolutely necessary • Never cover a heated-wire ventilator circuit with towels, drapes, or linens • Avoid using oronasal (full-face) masks as the noninvasive interface for ventilating patients with hypercapnic respiratory failure • Avoid using oropharyngeal airways in conscious patients

  5. More Common Errors to Avoid on the Exam • Never plug a fenestrated tracheostomy tube with the cuff inflated • Never clamp a patient’s chest tube during transport; the one-way seal must be maintained • Never use a mechanical vane-type respirometer (i.e. Halosphere or Wright’s respirometers) to measure forced expiratory volumes; use a portable electronic spirometer instead • Never accept an FEV maneuver obtained during bedside spirometry that lasts for less than 6 seconds

  6. More Common Errors to Avoid on the Exam • Avoid using transcutaneous O2/CO2 monitors in emergency situations or on patients in shock or with poor peripheral circulation • Never wash or rinse a dry powder inhaler in water • Never forcefully bend or twist the insertion tube portion of a fiberoptic bronchoscope • Avoid using petroleum-based lubricants for bronchoscope insertion

  7. Exam Sure Bets • Although estimated FiO2’s are important, always rely on evaluating the patient’s actual response to O2 therapy, ideally by ABG or pulse oximetry. • Always deliver the highest possible FiO2 (via nonrebreathing mask or high-flow cannula) to patients in emergency settings suspected of being hypoxemic. • Always have home-care patients who experience problems with an O2-conserving device switch to a nasal cannula at an equivalent liter flow (2 – 3x)

  8. More Exam Sure Bets • To avoid overinflation, always select the appropriate manual resuscitator with the correct stroke volume and mask size. • Whenever any major problem occurs during mechanical ventilation, always remove the patient from the ventilator and provide appropriate support using a manual resuscitator connected to an O2 source • Always treat a combined low-volume and high-pressure alarm condition during mechanical ventilation as signaling an obstruction

  9. More Exam Sure Bets • To ensure adequate humidification in a ventilator circuit, always confirm that a few drops of condensation remain at or near the patient connection • If using an active humidification system in a ventilator circuit, always be sure that the HEPA filter is positioned proximal to or upstream form the humidifier • When providing aerosol drug therapy through a ventilator circuit, always remove the HME before the procedure and replace it afterward

  10. More Exam Sure Bets • Always check the position of an endotracheal tube by breath sounds – but confirm with a chest x-ray • To positively identify the contents of a medical gas cylinder, always read the cylinder label • Always verify the prescribed O2% provided by a blender using a calibrated oxygen analyzer • Before using any computerized electronic device, always verify that it passes its power-on self test. • Always send flagged point-of-care test results to the central laboratory for analysis

  11. More Exam Sure Bets • Always check a pulse oximeter’s displayed rate against an ECG monitor or count the actual pulse rate • Always use a bite block when inserting a fiberoptic bronchoscope via the mouth or through an oral ET tube

  12. Reference: Certified Respiratory Therapist Exam Review Guide, Craig Scanlon, Albert Heuer, and Louis Sinopoli Jones and Bartlett Publishers

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