Learning Curves Spirometry Video: 2: Training for Spirometry Testing Personnel

Spirometry is a technically demanding medical test. It requires cooperation and a maximum effort from each test participant. A well-trained technician is the key to ensuring valid and accurate spirometry test results. This video is intended to supplement the curriculum content of the NIOSH approved spirometry training course. It reviews the selection of equipment, procedures for checking the calibration of spirometry systems, spirometry test administration, error recognition and correction, and how to report test results. A number of technical factors can influence the accuracy of the spirometry results reported to the occupational health care professional. The spirometry technician should be able to recognize and correct performance problems during a test to ensure accurate and valid results. These results can have important impacts on workers. For example, a new worker is hired for a job with exposure to substances that may cause lung impairment. A baseline spirometry is performed, but the technical quality is poor. Because this first test is not accurate, the health care provider cannot compare later test results with the flawed measurement of the worker's baseline lung function. As a result, early detection of lung impairment may be missed. In another example, an inaccurate spirometry test falsely shows that a worker has lung impairment. Test values are lower than the normal range of values expected for the worker's height, age, sex and race. This can lead to unnecessary further testing or medication. False diagnoses could also lead to work restrictions such as not being able to use a respirator or changes in medical treatment. Training courses for spirometry technicians must have a balance between lecture and practicum time. Let's spend a few minutes reviewing the contents of an effective training program. The content of our courses tend to be basic lung anatomy and physiology, the instruments that are required to perform adequate and successful calibration checks, and procedures and troubleshooting. We also really go through extensively coaching and actually recognition of improper maneuvers and how to correct those maneuvers. That's one thing you get within the practicum setting. Data quality is the emphasis of these courses. In order to get data quality, you actually have to be able to, number one, repeat the maneuvers of the test, but number two, have a high-quality spirogram. And that's up to you. We also make sure that the volumes that you're looking at are correct. So calibration checks of the equipment is imperative. With the practicum this afternoon, what you'll undergo is a series of maneuvers and you'll actually have to perform for the course directors and our instructors within the program. Proper training for a spirometry technician should include an understanding of respiratory anatomy and physiology. Spirometry testing is the primary screening tool used to determine baseline lung health of an individual. It is important that the spirometry technician have a basic understanding of the various lung conditions that can cause airflow limitation or reduced expiratory volume. Students need to choose a quality spirometry training course that develops a fundamental knowledge of normal spirometry patterns and their key features. So overview of spirometry. What does spirometry measure? It measures volumes of air that can be blown out maximally from a maximal inspiration. The speed of the air and the blast during exhalation is really important and it's really important for you guys to make sure that these workers blast and they create and they perform a maximal effort. There are two different types of spirometers. There's called volume spirometers, as you see over here. These very large spirometers, they were the initial spirometers. They measure volume directly. And so these volume spirometers you blow out and there's a big bellows in there and it measures the volume directly. Then there's apparatus or spirometers known as flow spirometers. These actually measure the flow. Where you see in your books, where you're open to, is you have what's called volume time graphics and that's very important for you to identify as the technician the quality of the maneuver that not only you are coaching but the quality of the maneuver that that worker is performing when they're performing spirometry. Both graphs look at one specific maneuver just in a different way and provides a little bit different information. So with the volume time graphic, we're measuring volume and we're measuring time. Within that time, when a person blows out as hard as they can, they should be able to get about 70-80% of their maximum volume out within the first second. So what you want to see is a big long peak and then a plateau which shows that all the volume is out. Within the flow type, what we're doing is we're looking at flow and we're looking at how hard the person blasts out that maneuver. Now it's really important as you as technicians to identify, here you see this is a beautiful graph, here you see the flow out and it's a real blast. It goes shooting straight up and then they kind of lose a little bit of velocity and continue to blow, blow, blow, blow, blow, blow until they get all the volume of air out. But this blast shows you that you're doing a great job, that that worker is doing a great job, that that worker is giving you the maximum performance he can. Training courses need to outline the limitations of spirometry in the occupational setting. Curriculum content should review instrumentation requirements, calibration check procedures, requirements of an acceptable test, sources of error, and how to correct errors. Within any spirometry program, quality assurance is extremely important. And quality assurance is multifactorial. We tend to look at it as, you know, do we have our records accurate? Do we have this accurate? But no, there's a lot more to quality performance. And what our main goal here in NIOSH and what we want to instill upon you guys is how important it is for you guys to get a high quality spirogram so that we can actually measure accurately and with precision. Quality control, make sure that you have the accurate records that we tend to emphasize, and infection control procedures, because we don't want to make our workers sick. We want to keep them healthy so they can work for many decades to go. But another, as you see, another important leg of this in order to reduce the errors of spirometry and provide accurate quality spirograms is technician training, review, and feedback. And here at NIOSH, we really take that seriously. And that's why you're here, and that's why you're performing these tests, and that's why you're making the commitment that you are so you can do a high quality job. So it's really important that you're engaged, engage the workers so we can help protect their lungs as they go through their career. Technician training is extremely important. You guys are really at the base of good quality, occupational lung function surveillance out there in the workforce. We really depend upon you, and we really need your buy-in, and we really need your commitment. You guys are like trainers. You have to get the best blast, the best effort from those workers who are coming in to be tested by you. And that entails careful instruction. You have to engage them. You have to give them clear, concise instruction so they can perform at their best. Also, we want you to be enthusiastic. We don't want you to yell at workers, but we want you to be enthusiastic as you're performing the test. So when you tell them to blast it out, it's not like, blast it out, go, come on, more, more, more, more, more. We want you to say, come on, blast it out, blast, blast, blast, blast, blast. Keep going, keep going, keep going. We want you to be engaged. And that has been shown over time that your engagement, your enthusiasm actually helps to engage the worker and give us a better quality spirometry. Also, you should be able to notice those errors and correct those errors right as you're performing that spirometry. So the key to reliable pulmonary function testing is the technician's way of guiding the employee through a series of rather technically difficult respiratory maneuvers. And the most important contribution that the spirometry technician makes is the motivation that you get from that employee. It's really vital. You're protecting the worker's health, you're protecting their lungs, and we're able to identify earlier on loss of lung function within the workforce. Viewing this video does not replace appropriate hands-on spirometry training. Practicum training for student technicians includes how to instruct and motivate subjects and correct common test errors. Therefore, students should make sure that spirometry training course practicum instructors have extensive knowledge and experience with spirometry testing. And you can take the plastic off of your mouthpiece. Hold it to the side of your mouth. To the side. To the side. Now fill your lungs completely with air. Deep breath in. And blast the air out. Good job. Keep blowing, keep blowing. You're doing a good job. Let the air come out. You've got lots of air in your lungs. Keep it going, keep it going, keep it going. You're almost there. And stop. You all right? Yep. Take a breather. Very good. Good job. So the only thing, maybe if you waited for him to put that in his mouth all the way, you were waiting for her to say put it in. Right. Yeah, yeah. So it's just a matter of timing to coordinate that. As soon as you're full, put that in, and then blast. And don't wait. And as soon as you see him getting it in there, then you can say blast. And there will be no hesitation. No hesitation. So there won't be any hesitation. So fill your lungs completely with air, then put it in your mouth and blast it out. Otherwise, that was really good. Because you remembered that his posture needed to be appropriate with your chin up and everything. And then you also remembered to tell him to keep blowing until you told him to stop. So that was good. Good job. Thank you. Quality assurance must be part of practicum training. Expect to perform calibration checks and learn how to identify and troubleshoot problems using various types of spirometers. The goal for the person being tested is to perform multiple acceptable maneuvers with repeatable results. Testing errors must be identified and corrected by the technician. This means that the technician must be engaged and attentive throughout the procedure. Errors are covered in detail in Module 6, Common Testing Errors. Students need to understand how a subject's age, height, sex, and race are used to determine normal values for spirometry. Our next module reviews spirometry testing equipment.