Equipment Application and Cleanliness

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