http://cacpt.ca/bbpress/ CACPT Members Forum en-US Sat, 19 May 2012 05:49:36 +0000 http://bbpress.org/?v=1.0.2 q http://cacpt.ca/bbpress/search.php http://cacpt.ca/bbpress/topic/is-anybody-checking-this-bulletin-board#post-124 Mon, 26 Mar 2012 09:45:40 +0000 Tony Kajnar 124@http://cacpt.ca/bbpress/ <p>Hi Jamey,</p> <p>Yes, I also believe that this forum could be a very important method of communication but I am uncertain how comfortable everyone is with this medium.</p> <p>I will keep checking back...</p> <p>Tony </p> http://cacpt.ca/bbpress/topic/is-anybody-checking-this-bulletin-board#post-123 Mon, 05 Mar 2012 08:33:02 +0000 jamey.cacpt 123@http://cacpt.ca/bbpress/ <p>i do think there is value in this forum<br /> i believe it could go a long way in making the CACPT members feel connected...<br /> jamey, halifax </p> http://cacpt.ca/bbpress/topic/eucapnic-voluntary-hyperventilation#post-122 Thu, 28 Apr 2011 20:52:59 +0000 CarolCollins 122@http://cacpt.ca/bbpress/ <p>Our lab is looking at eucapnic voluntary hyperventilation testing for those individual who are fit but are having SOB while or after exercise. It is not unusual for negative meth tests, and minimal response to BD therapy. Often the treadmill and bike don't produce the results needed.<br /> Is anyone doing this testing and if so what type of equipment and the protocols are you using?<br /> Carol </p> http://cacpt.ca/bbpress/topic/infection-control-for-pft-labs#post-121 Mon, 25 Apr 2011 13:20:57 +0000 Tony Kajnar 121@http://cacpt.ca/bbpress/ <p>Hi everyone,</p> <p>we are all aware of the PIDAC, CDC and NiOSH standards for infection control and routine practices. All references can be found online for free and are used by our infection control departments when they develop your specific local policies.</p> <p>I was wondering what others are doing for their routine precautions and if anyone is performing testing on patients with contact or droplet percautions. </p> <p>We use the Roxon BodyBox (medi-soft) and do not routinely perform testing on patients in anything beyond routine percautions. As a result I do get challenged on why we are not able to accomodate these cleints and I wanted to start a discussion on this.</p> <p>Our PFT lab performs a variety of testing protocols, complete PFT testing with body plethysmography, ABG's, 6MWT, exersice oximetry as well as methacholine provocation testing using the 2 minute tidal breathing protocol.</p> <p>Any "aerosol generating" procedures require the use of proper room ventilation as well as the use of a surgical mask if within 2 meters of the patient as part of our local routine percautions. We have recently moved into a new facility with better air exchange, and our local policies have recently been updated by our infection control team.</p> <p>The documention varies for recommendations between the resources I have listed, ranging from minimum 2 room air exchanges per hour (MSDS for methacholine) up to 12/hr for droplet percautions. Methacholine provocation testing does generate aerosol particles, induce couging in many and may even be considered by some to increase the risk of those in the same room, much like for sputum inductions. </p> <p>We are in the process of installing fume extraction arms that can be directed over a patient undergoing methacholine provocations that is tied into the operating room scavenging system. I am still waiting to get the quote for what my rooms are able to exchange per hour with and without the arms installed.</p> <p>So, I see a few issues with accomodating patients under droplet or contact percautions and I will try to list most of them here (off the top of my head).<br /> 1) Proper patient screening, health questionaire to identify those with FRI or ILI (febrile respiratory illness, influenza like illness)<br /> 2) PPE required for staff, patient, family or volunteers<br /> 3) air exchange required during testing<br /> 4) housekeeping requirements after testing, both routine and contact percautions...need to book as last case of day if patient under droplet percautions<br /> 5) equipment decontamination and disinfection - (virox 1:16 is recommended for cleaning after treating patients under droplet percautions)</p> <p>I look forward to hearing from others to see what sort of issues and policies you have.</p> <p>Regards,</p> <p>Tony </p> http://cacpt.ca/bbpress/topic/nebulizers-for-methacholine#post-120 Thu, 07 Apr 2011 13:41:15 +0000 jamey.cacpt 120@http://cacpt.ca/bbpress/ <p>tony, thank you, i should be able to find those articles<br /> this is most helpful and may save our lab on meth. cost<br /> i too have cal'd my neb with 1cc and found no change in output, but could not comment on particle size<br /> actually, i have no idea how one would do that, seems like it would be a very complicated task?? </p> http://cacpt.ca/bbpress/topic/nebulizers-for-methacholine#post-119 Sat, 02 Apr 2011 17:56:06 +0000 Tony Kajnar 119@http://cacpt.ca/bbpress/ <p>The 1999 ATS guideline for methacholine provocation does outline nebulizer performance.</p> <p>- at least .13 ml/min output within 10%<br /> - nebulizers need to produce particle size with a mass median diameter between 1.0 and 3.6 um<br /> - 3 mls of diluent.</p> <p>Dr. Donald W. Cockcroft has published several trails and studies and seems to be the leader in nebulizer analysis. If you do and article search you will find hours of reading. </p> <p>Dr. Cockcroft did publish articles that outline methacholine protocols designed to minimize waste of methacholione, one used 1.5ml of diluent instead of 3 and showed no change in outcome with their 2 min tidal method. Several are linked from the ATS website and I can email you a few from work. I have calibrated my wright neb with 3, 1.5 and 1.0mls and found no difference in output. Not sure if the change in surface tension would alter particle size.</p> <p>His article "Methacholine Challenge Methods" mentions that when the particle size falls below 1.0 um the deposition and patient response falls significantly.</p> <p>Many of the articles we base our current model on are quite old and reference parent articles from the 1970's. Technology has changed significantly and I would like to see nebulizer manufactures quote the particle size as well as output required specifically for methacholine provocation testing. </p> <p>Tony </p> http://cacpt.ca/bbpress/topic/nebulizers-for-methacholine#post-118 Wed, 30 Mar 2011 08:45:29 +0000 jamey.cacpt 118@http://cacpt.ca/bbpress/ <p>hi tony, jamey here in hlfx<br /> we use the wright from roxon, and seem to have no prob. with cal x 2 per year (.13mg/ml +/- 0.026)<br /> as for particle size, i was always under the impression that as long as the flow was more than 6 and less than 10 we were o.k., but speaking of particle size - our med. director will not sanction the use of the vial with the 1cc well???<br /> i do wonder if and when the APS system of meth. challenge will be researched and adopted? i think hamilton ont. are doing a comparison study and i thougt edmonton was too?? </p> http://cacpt.ca/bbpress/topic/nebulizers-for-methacholine#post-117 Mon, 28 Mar 2011 21:33:05 +0000 Tony Kajnar 117@http://cacpt.ca/bbpress/ <p>I was wondering what you are using for your methacholine provocations (2 minute tidal breathing method).</p> <p>When it comes to nebulizers, ATS has little to offer in specific models and selection criteria. As long as they can be calibrated to achieve the minimum .13mg/min output you could potentially use any nebulizer on the market.</p> <p>We use the Canadian Wright nebulizer but I have read that Dr. Cockcroft uses the Bennet Twin Jet for research and patient testing in Sask. It has taken some time but I was finally able to locate its product information</p> <p>We have been under tremendous pressure to adapt a disposable nebulizer but is that really the best option? There have been a few studies on disposable nebulizers that claim they can be adapted to use for methacholine provocations but most don't seem well suited for the 2 minute tidal breathing method. I have tried to calibrate a couple without success, their output is way too high that 1.5cc is nebulized in 45-60 seconds when you run them continuously (one at flows less than 4 lpm). Some only nebulizer during inspiration but that would make it more difficult to calibrate.</p> <p>I would like to see some comparison trial done that not only list the output at various flow rates but the actual particle size at the expected flow rates required to achieve the .13mg/min spec. </p> <p>Thoughts?</p> <p>Regards,</p> <p>Tony </p> http://cacpt.ca/bbpress/topic/cacpt-educational-sessions-funvouver-2011#post-116 Tue, 22 Feb 2011 08:30:55 +0000 jamey.cacpt 116@http://cacpt.ca/bbpress/ <p>hey folks, it is not too early to think aoubt a trip to vancouver and get some buzz going about CCC this coming fall, oct. 22-26 (<a href="http://www.cardiocongress.org/english/home_EN.html)" rel="nofollow">http://www.cardiocongress.org/english/home_EN.html)</a>, our education chair laura seed would agree as she is knee deep and planning already! thanks laura!! </p> http://cacpt.ca/bbpress/topic/please-read-before-posting-1#post-115 Wed, 02 Feb 2011 14:17:28 +0000 Admin@CACPT forum 115@http://cacpt.ca/bbpress/ <p>Welcome to the CACPT forum and bulletin board!</p> <p>In an effort to maintain our system all posts are subject to our general rules of conduct which are currently in development. </p> <p>Please be respectful when posting.<br /> Copy written material should not be posted.<br /> All posted comments are unedited except in the case of inappropriate or offensive language.<br /> All content posted on this Bulletin Board does not necessarily reflect the opinions and recommendations of the CACPT. </p> <p>In an effort to prevent unauthorized posts or spam, all new users will only be able to view discussions. In order to participate in the discussion groups send an email to the administrator with your user name, contact information and institution. The email is: cacptforum"at"gmail"dot"com. (Substitute the "at" and "dot" properly)</p> <p>All posts are subject to approval by the administrators. Any issues and concerns can be forwarded to the administrator, email is listed in profile.</p> <p>Administrator </p> http://cacpt.ca/bbpress/topic/3l-syringes#post-98 Sun, 30 Jan 2011 11:37:17 +0000 Tony Kajnar 98@http://cacpt.ca/bbpress/ <p>Hi Jamey,</p> <p>Mary Ann is right, you can calibrate your "pre-calibrated" syringe with water. You will need water that is room temperature, and graduated beakers or cylinders of different sizes. </p> <p>Most suppliers of PFT equipment should be able to point you to services that will calibrate your syringe for you. They charge somewhere around $100 to do it. </p> <p>Tony </p> http://cacpt.ca/bbpress/topic/methacholine-challenge#post-71 Fri, 28 Jan 2011 14:35:21 +0000 jamey.cacpt 71@http://cacpt.ca/bbpress/ <p>in halifax tony... i feel for you... personally i think all this use of disposable equipment is ridiculous and huge waste fo money! when i started my career we used cardboard mouth pieces and no filters! and, what bugs are traveling upstream of 8 or so LPM to get to the nebulizer?? </p> http://cacpt.ca/bbpress/topic/methacholine-challenge#post-70 Fri, 28 Jan 2011 13:08:30 +0000 Tony Kajnar 70@http://cacpt.ca/bbpress/ <p>Hi Jamey,</p> <p>Sault Area Hospital...and you?</p> <p>I am in for a challenge with our new hosptial. Best practice guidelines for infection control mandates that any decontamination/sterilization only occur in centralized processing areas, any staff involved with equipment decontamination must be certified with the CSAO (including manager and director). This means that we will no longer be allowed to cold soak any equipment in our new area. The nebulizers are going to be processed by our SPD department, resulting in daily transport and increased risk of damage. </p> <p>Our plan includes processing trays, same ones used by the OR, where the nebs are disassembled and enclosed into these trays. The nebs are to be soaked and rinsed in these trays, which are designed for soaking. The entire tray returns clean for re-assembly and use.</p> <p>My challenge is that I will need to double my nebulizer inventory because SPD can't assure their turn-around time. There are several issues in infection control and we face more resistance to operations in the future. We are under a lot of pressure to use single-use devices, that is why I am curious to see if anyone has been able to validate their use.</p> <p>All the best,</p> <p>Tony </p> http://cacpt.ca/bbpress/topic/methacholine-challenge#post-56 Thu, 27 Jan 2011 13:46:48 +0000 jamey.cacpt 56@http://cacpt.ca/bbpress/ <p>tony, we use the roxon made neb, and cal it every 6 mos<br /> thanks for your comments<br /> ps - where do you work? </p> http://cacpt.ca/bbpress/topic/methacholine-challenge#post-55 Thu, 27 Jan 2011 13:21:50 +0000 Tony Kajnar 55@http://cacpt.ca/bbpress/ <p>Hi Jamey,</p> <p>we have been using 1cc for our methacholine for a long time now. We used to use 3cc when we were able to purchase the english-made wrights which had the larger glass vials.</p> <p>As far as I know the use of 1cc has not been validated in the published literature despite the fact many labs use less than 1cc. Is anyone aware of such validation?</p> <p>This is an interesting topic which raises several questions. What nebulizers are you using? We use the Canadian made wrights available only through Roxon Meditech. Most literature suggests that the english made wrights was far superior but is no longer in production leaving few options. I hope the upcoming ATS guideline update will be more specific with regards to particle size and output of various nebulizers. </p> <p>Anyone using disposable nebulizers?</p> <p>Tony </p> http://cacpt.ca/bbpress/topic/methacholine-challenge#post-27 Mon, 24 Jan 2011 20:34:05 +0000 Laurie Allan 27@http://cacpt.ca/bbpress/ <p>Hi Jamey<br /> We use the bevelled container that now comes with the Wright nebulizer and actually use 1.5 ml of provocholine in it. I unfortunately do not have the research to back this up. This was something John Prost had us switch to when he was our manager. Since we are using 1.5 ml in it, our cost is now half. We also buy in bulk and make up our own provocholine under the fume hood.<br /> Laurie Allan<br /> Say hi to everyone out there for us!! </p> http://cacpt.ca/bbpress/topic/methacholine-challenge#post-26 Mon, 24 Jan 2011 10:38:44 +0000 jamey.cacpt 26@http://cacpt.ca/bbpress/ <p>hey pft people out there, if you are using the tidal breathing method, do you use the vial with the 1cc well with your (wright) nebulizer? our medical director will not allow us to use it unless there is research to show that the particle size is not affected by it???? this of course triples our methacholine cost! thanks, jamey </p> http://cacpt.ca/bbpress/topic/3l-syringes#post-25 Mon, 17 Jan 2011 10:47:08 +0000 Mary Ann Forsyth 25@http://cacpt.ca/bbpress/ <p>Here's what I know for what it's worth: it's more of a verification than a calibration. Using water, measure the deadspace ( where the hose attaches to the cylinder ) by pulling the plunger back, filling with water and emptying it into a graduated cylinder to determine DS. Then with plunger at max, fill with 3 liters of water and empty into a graduated cylinder.Measure total volume and subtract volume of DS and the remainder is the 3 L (or close to it ). Thus far in our lab, it's been pretty accurate. </p> http://cacpt.ca/bbpress/topic/bio-controls#post-24 Fri, 14 Jan 2011 09:02:01 +0000 jamey.cacpt 24@http://cacpt.ca/bbpress/ <p>pf tech question here... so bio control for cario-pulm. stress testing: how often are you doing it? how are you doing it? what parameters do you compare/trend? how much is an acceptable variance?</p> <p>ps, i wish this forum had spell check!! </p> http://cacpt.ca/bbpress/topic/3l-syringes#post-22 Wed, 05 Jan 2011 16:03:30 +0000 CarolCollins 22@http://cacpt.ca/bbpress/ <p>You know what Jamey,if I remember correctly, Toronto hospital does. I don't remember the particulars on the how to. But, I am sure I read something along the way somewhere(sorry to say I don't do it). </p> http://cacpt.ca/bbpress/topic/3l-syringes#post-21 Tue, 14 Dec 2010 14:41:04 +0000 jamey.cacpt 21@http://cacpt.ca/bbpress/ <p>who out there calibates their cal syringes? and how do you do it? </p> http://cacpt.ca/bbpress/topic/general-discussion#post-20 Wed, 08 Dec 2010 10:37:49 +0000 jamey.cacpt 20@http://cacpt.ca/bbpress/ <p>hi, jamey here in halifax - i'm going to clarify the first question: at times when a pt. is ordered spirometry only and if they have complaints of SOBOE we will throw in a DCO... our logic is that it may save them a trip back to the lab and maybe tweak the dr. to investigate further??? </p> http://cacpt.ca/bbpress/topic/please-note#post-18 Tue, 07 Dec 2010 21:21:19 +0000 CarolCollins 18@http://cacpt.ca/bbpress/ <p>All posted comments are unedited except in the case of inappropriate or offensive language.<br /> All content posted on this bulletin board does not necessarily reflect the opinions and recommendations of the CACPT. </p> http://cacpt.ca/bbpress/topic/general-discussion#post-17 Sun, 14 Nov 2010 21:38:22 +0000 CarolCollins 17@http://cacpt.ca/bbpress/ <p>Here is a few topics which were discussed at the Fireside Chat in Montreal.<br /> Do you as a technologist do what the requistion requests?<br /> Do other PF labs have a close association with their provincial Lung Association?<br /> Walk tests who does them and how ? Is there a common problem with having access to a measured hallway?<br /> How do you as a technologist get teenagers to participate in PFTs?</p> <p>This is a start on the bulletin board, comments and suggests are welcome.<br /> Carol </p> http://cacpt.ca/bbpress/topic/general-topics#post-9 Tue, 31 Aug 2010 19:43:23 +0000 Tony Kajnar 9@http://cacpt.ca/bbpress/ <br /> http://cacpt.ca/bbpress/topic/who-will-be-authorized-to-delete-a-post#post-8 Tue, 31 Aug 2010 19:39:02 +0000 Tony Kajnar 8@http://cacpt.ca/bbpress/ <p>Can the entire thread be deleted? </p> http://cacpt.ca/bbpress/topic/read-before-posting#post-6 Tue, 31 Aug 2010 19:35:27 +0000 Tony Kajnar 6@http://cacpt.ca/bbpress/ <p>Forum rules of conduct, guidelines on posting coming soon </p> http://cacpt.ca/bbpress/topic/spirometry#post-5 Tue, 31 Aug 2010 17:36:01 +0000 CarolCollins 5@http://cacpt.ca/bbpress/ <p>THE ANSWER IS BLOWIN IN THE WIND </p> http://cacpt.ca/bbpress/topic/your-first-topic#post-4 Tue, 31 Aug 2010 17:33:37 +0000 CarolCollins 4@http://cacpt.ca/bbpress/ <p>I read this </p> http://cacpt.ca/bbpress/topic/topic-1#post-3 Tue, 31 Aug 2010 08:39:34 +0000 cacptforum 3@http://cacpt.ca/bbpress/ <p>I don't think so. This is a reply. </p> http://cacpt.ca/bbpress/topic/topic-1#post-2 Tue, 31 Aug 2010 08:39:20 +0000 cacptforum 2@http://cacpt.ca/bbpress/ <p>This topic is about.... </p> http://cacpt.ca/bbpress/topic/your-first-topic#post-1 Tue, 31 Aug 2010 08:35:19 +0000 cacptforum 1@http://cacpt.ca/bbpress/ <p>First Post! w00t. </p>