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What should you do before handling equipment?
wash your hands
What type of equipment should not be sterilized and reused between patients?
How often should equipment be cleaned?
Every 24 hours
Name a low level and high level disinfectant that can be used to clean equipment. What items require being high level disinfectants?
Low-level : acetic acid (1:2) or bleach (1:10 may be caustic-not best choice)
High-level : activated glutaraldehyde
All permanent equipment, such as Ventilator circuits, O2 delivery equipment, and aerosol systems be sterilized or receive high level disinfection before being supplied to another patient.
What should you do before storing equipment?
rinse & dry equipment
How should you handle/store medications?
By manufactures recommendations. Normally requires that home care patients and caregivers receive verbal and written instructions about cleaning and infection control measures for their product.
What temperature should you store multi-dose vials of meds that contain preservatives?
Store at room temperature
What are the 2 options for using water for using humidification or nebulization in the home setting ?
Distilled water be used as first choice.
Or boiled water, cooled in a refrigerator and discarded after 24 hours is also acceptable.
Where should you dispose of infectious waste?
disposal by sanitary sewer
What are 4 important things about infection control that you should educated your home care patient about?
1. Mouth care
2. Educate on signs & symptoms of infection
- 3. Routine immunizations
- *Pneumococcal pneumonia
What is the process for cleaning a patients equipment? (7)
1. Completely disassemble
2. Wash in water
3. Soak in warm soapy water for several minuets
4. Scrub PRN to remove organic material
5. Rinse again thoroughly to remove residual soap
6. Drain it of any excess water
7. Air dry on a clean surface or rack to minimize recontamination
What 3 things must be considered by the provider and patient before selecting best disinfectant technique?
Infection risk, cost, and safety
Medicare introduced PPS in the 1990's. What does PPS stand for?
Prospective Payment System
Where is most post acute care provided ?
In the home
Name 5 of the most common clinical conditions that are treated within the home setting.
3. Chronic neuromuscular diseases
4. Chronic restrictive disease
5. Carcinoma of the lung
What is the NOTT study?
Nocturnal oxygen therapy trial study.
Studies have shown that oxygen therapy can improve nocturnal O2 saturations.
What must O2 prescriptions be based upon according to CPG?
Documented hypoxemia, as determined by a ABG analysis or oximetry.
They can no longer be based upon patient diagnosis, or signs and symptoms.
What are four things that are considered evidence of advanced COPD?
2. Pulmonary hypertension
3. Rt heart failure
4. Polycythemia ( too many RBCs)
Name 4 therapeutic goals of O2 in the home?
1. Improved hypoxemia
2. Decreased pulmonary vascular resistance
3. Improved cardiac function
4. Decreased polycythemia (restored toward normal)
What 6 things must a O2 therapy prescription include?
1. Flow rate in L/min and or concentration
2. Frequency of use in hours/day and min/hour (if applicable)
3. Duration of need
5. Laboratory evidence (ABGs or oximetry under appropriate testing conditions)
6. Additional medical documentation ( no acceptable alt to home O2 therapy)
Home O2 is normally stored in one of these following 3 sources
1. Compressed O2 cylinders
2. Liquid O2 systems
3. O2 concentrators
Name 2 reservoir conserving devices. How do they operate? and what is the benefit of using them?
1. Pendant nasal cannula
2. mustache nasal cannula (aka: reservoir cannula)
Operates by storing approx. 20 ml of O2 in a small reservoir that fills during exhalation.
At low flow they reduce O2 use 50%-75%.
(side note: they have to be replaced every 3 weeks, so the replacement cost offsets the amount saved by using less O2)
Reservoir cannulas are designed to conserve O2 and they are an alternative to what 2 other O2 systems?
alt to the pulse-dose or demand-flow O2 systems.
What do "Pulsed-dose" O2 delivery systems do? What can they be used with? (3) and what 2 things are used to detect inspiration?
They deliver a fixed or variable volume of O2 at the end of exhalation or early inspiration.
Can be used with nasal cannulas, reservoir cannulas, and transtracheal catheter.
Thermistor or pressure are used to detect inspiration
What is the benefit to using a "Pulsed-dose" O2 delivery system? and what are the 4 limitations?
Benefit: Provides 50%-80% O2 savings
Limitations: cost, tech problems, cant increase flow, varies w/ manufacturer.
What are the 4 benefits to the transtracheal O2 catheter? and names four types of trans trach catheters.
Benefits: reduced tissue trauma (because it avoids nasal drying)and flow rates, increased mobility and compliance.
4 types: SCOOP, Trachette, Oxycath, Intratracheal O2 Catheter.
What are the 5 EARLY and 3 LATE hazards with the Transtracheal O2 Catheter?
Early: bleeding, abscess, subcutaneous emphysema (air under the skin that crackles), pneumothorax, cephalad catheters (catheter pointing up instead of down).
Late: mucus plugging (most common), infections, and loss of tract
What is the "Passy-Muir Valve"? what 5 things does it help with?
Its a one-way valve that eliminates the need for finger occlusion.
Helps facilitate cough effort, speech, olfaction, swallowing and weaning.
To receive the "Passy-Muir Valve" the patient must be : (5)
2. Medically stable
3. Able to tolerate cuff deflation (because passy is a one way valve so they need to be able to breath out)
4. Manage secretions
5. Able to exhale around tube
What types of people can the "Passy-Muir Valve" be used with? (4) (age groups? vent? no vent? )
4. Ventilated and non ventilated patients
How much auto PEEP does the "Passy-Muir Valve"? generate?
2-3 cm of auto PEEP so the ventilator settings may require changes.
Compressed oxygen cylinders provide ___% O2 at high flow rates. They have ___ (high or low?) pressure. Their duration is ______. And they are ____ (heavy or light?).
What is the duration of flow formula for compressed oxygen cylinders?
- Gauge Pressure X Cylinder factor
- Liter Flow
E cylinder: .28
H & K cylinder : 3.14
Why are Liquid oxygen systems beneficial? What 2 parts does it consist of?
They can store large quantities of O2 in small spaces. ( ideal for a high volume user)
consists of a bilk storage reservoir unit and a portable refillable unit.
Liquid oxygen systems provides ___% O2 at high flow rates. Periodic ____ occurs. They have a ___ (high/low?) pressure range of __-__ psig. The __________ keeps liquid at -__degrees Celsius.
Periodic VENTING occurs.
LOW pressure range of 20-90 psig
insulated container keeps liquid at -170 degrees Celsius.
A typical Liquid O2 system reservoir has about how many liters of liquid O2?
1 Liter of Liquid O2 weighs _____lbs
1 Liter of liquid O2 = ____ L of gas O2
1 lb of liquid O2 = ____ L of gas O2
860 Liters of gas O2
344 Liters of gas O2
Liquid O2 calculation:
Liquid cylinder is weighed and it is 2 lbs, and they want to run it at a flow of 2 LPM. How long will this cylinder last?
1 lb of liquid O2 = 344 liters of gas O2
344 liters X 2 lbs = 688 liters
688 liters / 2 LPM = 344 min
344 min / 60 min = 5.73
5 hours and 73 min
What is a oxygen concentrator?
devices remove O2 from room air
fixed units that rely on electricity
uses a molecular sieve to extract O2
explain the moelcular sieves?
*they are most commonly used
*uses granular zeolite that traps nitrogen,carbon dioxide, carbon monoxide, water and hydrocrabons
*O2 passes through
*O2 delivery inversely proportional to liter flow (means that the higher the flow, the less pure the O2 will be)
Is O2 combustible?
no, but it supports combustion. That's why patients should not smoke while receiving supplemental O2.
Oxygen concentrators have oxygen enricher (membrane types) name 4 things about it
(what type of membrane does it use? what does it extract? what is the O2 concentration and LPM? does it need a humidifier?)
1. uses a premeable plastic membrane
2. O2 and water are extracted
3. O2 concentration stays at about 40-45% at flows up tp 10 LPM
Humidifier is not needed.
Most hospitals consider a cylinder empty when it reaches what PSI?