RT 135 - Diagnostics and Special Procedures

Credits: 4

Presents the theory and application of skills required to perform arterial and mixed venous blood sampling and analysis, basic pulmonary function testing, and to interpret the results of and make recommendations for care based on these diagnostic procedures. Emphasizes the respiratory therapist's role in chest and lateral neck x-ray evaluation, bronchoscopy, and chest tube drainage.

Prerequisite(s): RT 117, RT 118, RT 121, RT 126, and RT 131 each with a minimum grade of “C”
Corequisite(s): RT 132, RT 146, RT 149
Lecture Hours: 54 Lab Hours: 12
Meets MTA Requirement: None
Pass/NoCredit: No

Outcomes and Objectives

Demonstrate, through successful completion of written examination and/or return demonstration, the ability to:
1. Compare and contrast the role of body buffer systems, lungs and kidneys, in normal acid - base homeostasis.
2. Apply the Henderson - Hasselbalch Equation to the determination of plasma pH.
3. Employ the following to differentiate among compensated and uncompensated status of acid - base imbalance:
  1. pH
  2. pco2
  3. HCO3-
  4. Base Excess
4. Compare the four primary states of acid - base imbalance according to underlying causes, and mechanisms of compensation and correction.
5. Explain the interrelationships between renal regulation of electrolytes (sodium, potassium, chloride) and acid - base states.
6. Describe the measurement of standard bicarbonate and base excess.
7. Identif mixed acid - base imbalances.
8. Identify acute on chronic acid - base imbalances.
9. Define ventilatory and respiratory insufficiency and failure.
10. Identify typical blood gas values for specific acute and chronic disease states.
11. Estimate changes in PaO2, PaCO2, and pH as a result of changes in therapy.
12. Make appropriate recommendations for modifications in the respiratory care plan based on ABG results.
1. Discuss the clinical importance of blood gas analysis.
2. List in order the most desirable sites for arterial puncture and discuss why each is more desirable than the next.
3. Describe and demonstrate the modified Allen’s Test and state the clinical application.
4. Select appropriate equipment for the obtaining of each type of sample (arterial puncture and indwelling catheter), and arterial samples from various types of patients.
5. Demonstrate the ability to select an appropriate site and draw an arterial blood sample from the arterial lab arm, employing proper technique.
6. Demonstrate the ability to draw blood from an indwelling catheter.
7. Discuss the potential hazards of arterial puncture and of inappropriate arterial puncture technique.
8. Discuss the feeling of the patient having an arterial puncture, and mannerisms to reassure the patient.
9. Describe other sources for obtaining arterialized blood sample from ICU patients and neonates, other than an arterial puncture.
10. Describe the technique for obtaining arterialized capillary sample from an infant; state the average size of the sample; demonstrate handling of the sample until it is analyzed.
11. Discuss the variations in values between an arterial sample and an arterialized capillary sample.
12. State the type of heparin to use with arterial samples and discuss why other types are not utilized.
13. Discuss the possible causes and results of pre-analytic error in blood gas samples.
14. Demonstrate the appropriate handling of an arterial blood sample after it is obtained until it is analyzed.
15. Describe the function of the Swanz, Severinghous, and Clark electrodes and the various parts of the blood gas analyzer.
16. Demonstrate the ability to change the electrodes and the electrode membranes.
17. Demonstrate the ability to calibrate the blood gas analyzer; compute the partial pressures of the calibration gases.
18. Demonstrate the ability to analyze a normal size sample, micro sample, and gas sample.
19. Perform maintenance and demonstrate proper storage procedures of the blood gas analyzers.
20. Describe the process of co-oximetry and discuss the clinical significance of carbon monoxide in the blood.
1. Explain each of the following terms:
  1. Tidal volume (Vt)
  2. Inspiratory reserve volume (IRV)
  3. Expiratory reserve volume (ERV)
  4. Residual volume (RV)
  5. Inspiratory capacity (IC)
  6. Functional residual capacity (FRC)
  7. Vital capacity (VC)
  8. Total lung capacity (TLC)
2. Identify each of the above on a simple spirogram.
3. Describe the technique for measuring each of the volumes and capacities.
4. Explain the significance of each of the volumes and capacities.
5. Explain how predicted values for each of the above