Although negative consequences are rare when performing spirometry, they can occur. Poorly- or under-trained staff can also broaden the spectrum of risk for patients.

Spirometry is overall a very safe diagnostic tool performed in pulmonary labs, clinics, emergency rooms and physician offices. Although negative consequences are rare when performing spirometry, they can occur. Additionally, spirometry performed poorly- or under-trained staff can broaden the spectrum of risk for patients. This article will discuss some of the risks associated with improper pulmonary function testing using spirometers.

Syncope / Temporary Loss of Consciousness

Experienced staff have all witnessed the patient who demonstrates a temporary fog or glazes over toward the end of a forced expiratory maneuver; some even slump over a bit as they try their best to blow all the way out. Staff often develop a cadence or auctioneer quality when coaching a patient. "Keep pushing, push, push ... dont stop ... all the way out now." For most patients with moderate to severe chronic obstructive lung disease, they can exhale for six seconds with ease and 15 seconds is often no problem. Remember that blowing longer will increase the FVC, decrease the [FEV.sub.1]/FVC ratio and make the [FEF.sub.25-75] smaller and smaller. At my facility, we recently had two patients lose consciousness for just a moment, while performing spirometry, sitting in the plethysmograph, and both tumbled forward requiring a visit to the ER for stiches. The bottom line is, don't overcoach your patients. Pay close attention to them during forced maneuvers and stop the maneuver if it looks like the lights are going dim. Consider using [FEV.sub.6] and [FEV.sub.1]/[FEV.sub.6] parameters or reference equations recommended by the National Lung Health Education Program (NLHEP). (1-2) Expirations longer than 15 seconds seldom change clinical decisions. (3)

Infection Control and Prevention

Protecting patients from cross contamination should be a priority in all healthcare environments. Regardless of how busy you are, you need to adhere to a standardized workflow when initiating patients for spirometry testing.

1. What is your patient's status: Respiratory Isolation, protective isolation, contact precautions, MRSA, MDR, CRE, c-diff or cystic fibrosis? Review the patient's electronic medical record (EMR) for status, allergies and medication list prior to testing.

2. Proper hand sanitization. Gel-in or washing your hands in the presence of the patient are a good demonstration that you care about this important step. Not every spirometry testing area may have a sink, so hand gel or foam sanitizers are a great choice.

Offering patients to gel-in is also acceptable.

3. Place the filter on spirometer adaptor or flow-sensor, being careful to not touch the patient side of the filter/mouthpiece. If you do this carefully you can use the plastic wrap the filter comes in to act as a barrier, otherwise wearing gloves is an alternative. If a filter drops the floor it should be replaced (no five-second rule).

4. Watch your patient. What are they touching during testing? Did 'Johnny' enter the body box and place his mouth directly on the filter adaptor? If...