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Spirometry Including Peak Expiratory Flow Rate (3.28)

Spirometry Including Peak Expiratory Flow Rate (3.28) - Policies, Clinical, UWHC Clinical, Department Specific, Respiratory Care Services, Patient Assessment

3.28

3.28 Spirometry Including Peak Expiratory Flow Rate
Category: UWHC Patient Care Policy
Effective Date: September 24, 2017
Version: Revision
Manual: Respiratory Care Services

I. PURPOSE:
To ensure appropriate monitoring and assessment of all patients who require evaluation of their
pulmonary status as it pertains to lung volume and flow.

Spirometry is used to assess ventilatory function in the following situations:
A. Detect the presence or absence of lung dysfunction suggested by physical signs and symptoms,
and/or the presence of other abnormal diagnostic tests.
B. Quantify the severity of known lung disease.
C. Assess the change in lung function over time or following administration of or change in therapy.
D. Assess the potential effects or response to environmental or occupational exposure.
E. Assess impairment and/or disability (e.g., rehabilitation, legal reasons).
F. Monitor post lung transplant for changes in lung function which may be an indication of
rejection.
Peak Expiratory Flow Rate (PEVR) is one of the variables obtained during a spirometry maneuver. This
value may also be obtained using a peak flow meter. PEFR values are used in the home setting to
monitor airway hyper-responsiveness.

II. CONTRAINDICATIONS: The only absolute contraindication is an unstable cardiovascular status.
Consideration may need to be given to patients who have impaired cognition or whose disease state may make
the execution of a maximal inhalation/ exhalation effort impossible, as these patients may not be able to perform
spirometry.

III. POLICY:

A. All patients will be assessed by the Respiratory Care Practitioner (RCP) to determine if the
appropriate indications for the therapy are present. If the patient has difficulty following
commands or has recently had surgery of the eye, thorax or abdomen, they may not be able to
perform optimal or repeatable tests.
B. Therapy will be provided in accordance with the provider’s order.
C. Inpatient spirometry may be scheduled Monday through Friday in the Pulmonary Function Lab.
D. Spirometry in the Emergency Room is performed by an RCP.
E. Spirometry performed by an RCP at UWHC includes the measurement of forced vital capacity
(FVC), forced expiratory in the first second (FEV1), forced expiratory flow 25-75% (FEF 25-75),
and the peak expiratory flowrate (PEFR).
F. When performing pre and post bronchodilator PFR maneuvers, the posttest should be done a
minimum of 10 minutes after drug administration.
G. Lung transplant patients at UWHC are taught how to perform and self-monitor their spirometry
results at home for rejection.
H. RCP’s will instruct the patient on proper use and recording of peak flow measurements when
ordered.
I. Appropriate Health Facts for You (HFFY) will be given.






IV. EQUIPMENT:

A. A properly calibrated spirometer that meets ATS requirements and is maintained per
manufacturers recommendations.
B. Peak expiratory flow meter obtained from Central Services.

V. PROCEDURE:

A. Review and acknowledge provider’s order.
B. Review the patient’s chart.
C. Obtain the appropriate equipment.
D. Introduce yourself to the patient and family and explain the reason for the test.
E. Obtain the patient’s age and height to determine predicted values.
F. Spirometry Procedure
1. Review and demonstrate the correct procedure for the spirometer you are using with the
patient. Refer to the Spiro Pro and AM1 related links.
2. Instruct the patient to sit as upright as possible, and loosen any tight, restricting clothing.
3. Explain that the mouthpiece is to be placed between the teeth with lips forming a
complete seal around it. Removal of dentures may be necessary.
4. Stress the importance of inspiring and/or expiring as forcefully as possible, using the
chest and abdominal muscles for maximal effort.
5. The FVC maneuver should be done at least three times or as many times as necessary to
have three acceptable FVC maneuvers, with the two best tests within plus or minus 5
percent of each other.
6. A nose clip should be used for every patient as tolerated.
7. When performing pre and post bronchodilator spirometry, the post-test should be done a
minimum of twenty minutes after drug administration.
8. If spirometry is performed using the Spiro Pro or another approved print-to-paper
spirometer, a copy should be printed and sent to Medical Records for scanning into the
electronic medical record (EMR). 9. The AM1 spirometry results for inpatient lung
transplant recipients are documented on the RT general flowsheet and the patient’s
tracking sheet.
G. Peak Flow Procedure
1. Assure that the peak flow indicator is at the bottom of the scale (0 liters per minute) and
can move freely.
2. Hold the meter horizontally, making sure the fingers do not touch the scale area or block
the expiratory port.
3. Have the patient sit upright and loosen any tight or restrictive clothing.
4. The patient should inhale as deeply as possible, completely filling the lungs. Once the
lungs are full, the patient should place the mouthpiece between the teeth, forming a tight
seal with the lips, and exhale as hard and fast as possible, using the chest and abdominal
muscles for maximum effort.
5. Note where the indicator stops.
6. The maneuver should be done at least three times, or as many times as is necessary to
duplicate the measurement within plus or minus 5 percent, or 100 ml. Record the highest
of the three values. If the patient is an outpatient, teach them how to record the value on
their Peak Flow Log.
7. Instruct the patient to monitor their peak flow every day at the frequency and times
recommended by their provider. Generally this is a minimum of one to two times per
day. Stress the importance of consistency in effort and position.

8. Instruct the patient to bring their peak flow record and meter with them to their follow-up
appointments and all subsequent clinic or emergency visits.

VI. REFERENCES:

A. HFFY #5020 Peak Flow Meter (retired guideline)
B. HFFY #6747 Peak Flow Meter – Spanish Version
C. HFFY #5863 AM1 Plus
D. Series “ATS/ERS Task Force: Standardization of Lung Function Testing,” European Respiratory
Journal 2005:26:319-338.
E. Mottram, C. D. (2017). Ruppel's Manual of Pulmonary Function Testing (11th ed.). St. Louis , MO:
Elsevier.











Approved by Director and Medical Director of Respiratory Care: