RESPIRATORY PROCEDURES

I. ARTERIAL BLOOD GAS (ABG)

Purposes
o detect acid-base balance
o assess ventilation
o monitor clients response to O2
treatment
Allens Test
o If ABG is to be monitored to assess
circulation of ulnar (hand) blood supply
Radial Artery
o common site to withdraw arterial blood
specimen
Nursing Alert!
o Avoid suctioning client prior drawing
blood specimen
Nursing Care
o Assess site for bleeding or hematoma
o Apply firm pressure for 5 10 minutes
o 10 ml pre-heparanized syringe to
prevent clotting of specimen
o Place specimen on ice to prevent
hemolysis of specimen
o Client with diarrhea observe
metabolic acidosis
o Client with vomiting observe
metabolic alkalosis
ABG Component Normal Values
pH 7.35 7.45
pCO 35 45 mmHg
HCO 22 26 mEq/L
O2 Sat >90%
PO2 >60 mmHg

II. BRONCHOSCOPY
Purpose
o direct inspection of larynx, trachea, and
bronchi using lighted bronchoscope
Diagnostic Uses
o collect secretions
o determine location of pathology and
collect specimen for biopsy
Therapeutic Uses
o remove aspirated foreign objects
o excise lesions
Pre-op Interventions
o Verify Informed Consent
o NPO to prevent vomiting and aspiration
o Atropine Sulfate to decrease secretions
o Valium to relieve anxiety
o Position: Supine w/ hyper extended neck
Post Op Interventions
o NPO
o Position: Side-lying (to promote drainage
from mouth) or Semi-Fowler
o Check return of cough and gag reflex
o Prepare suction equipment @ bedside
o Notify Physician if fever or DOB occurs
after procedure



III. CHEST XRAY (CXR)
Radiographic exam of lungs
Non invasive, minimal radiation
Purpose
o detect abnormalities of thoracic organs
Nursing Care
o Rule out pregnancy first
o Instruct to remove metals (jewelries)
o Instruct client to hold breath and do
deep breathing

IV. FLUORSOCOPY
Purpose: test for lung and chest in motion

V. MANTOUX TEST / SKIN TEST (PPD PURIFIED
PROTEIN DERIVATIVE)
Purpose
o determine exposure to
MYCOBACTERIUM TUBERCULOSIS
ID injection inner aspect of lower arm 4
inches below antecubital space
Positive Results
o 10mm or more for children <4 y/o
o 5mm or more
client with HIV positive
client with healed TB
had contact with a client with
active TB
Nursing Care
o BCG vaccine may cause FALSE (+) result
o Result is read after 48 72 hours
o Assess client if with history of TB and
report history to Physician

VI. SPUTUM EXAM
Purposes
o Gross Appearance
o Sputum C & S to detect actual microbes
causing infection; collected prior 1
st
dose
of antimicrobial
o AFB staining collected 3 consecutive
mornings; assist in dx of TB
o Cytologic Exam / Papanicolaou exam to
detect CA cells
Nursing Care
o Early morning sputum specimen
(expectoration or suctioned)
o Rinse mouth with plain water.
o Use sterile container
o Instruct client to take several deep
breaths then cough deeply

VII. PULSE OXIMETER
Purposes
o Non invasive procedure
o determines amount of oxyhemoglobin
saturation of arterial blood
o also measures Pulse Rate
Indications
o Patients receiving O2 therapy or home
oxygen therapy
o Risk for hypoxia
o Post operative
o Unstable patient who may experience
sudden changes in blood 02 levels
Nursing Alerts
o This does not replace ABG
Probe or sensor is attached to:
o fingertip
o foot of infants
o earlobe
o bridge of nose
SpO2 Results
o Normal: 95% - 100%
o If <85% - tissues not receiving enough
o2
Results unreliable in
o Cardiac arrest
o Shock
o Severe Anemia
o High Carbon Monoxide level
o Use of dyes or vasoconstrictors

VIII. LUNG SCAN
Purpose
o to determine lung perfusion when
pulmonary embolism and infarction
are suspected
Nursing Alert
o Verify consent
o Involves injection of radioactive
isotope, scans taken via scintillation
camera
Nursing Care
o Assess for allergies to dye, iodine, and
sea food.
o Remove jewelries from chest area
o Administer sedatives as prescribed
o Wear clean gloves when urine is being
discarded within 24h after procedure.

IX. LUNG BIOPSY
Purposes: to detect CA cells
o Transbronchoscopic biopsy done
during bronchoscopy
o Percutaneous needle biopsy
o Open lung biopsy
Pre-op Nursing Care
o NPO
o Verify consent
Post-op Nursing Care
o Observe signs of pneumothorax, air
embolism and RDS
o check for hemoptysis and hemorrhage
o check site for bleeding

X. LYMPH NODE BIOPSY
Purpose: to assess metastasis of lung CA








XI. PULMONARY FUNCTION TEST
Non invasive test
Document bronchodilators or narcotics used
prior test
Purpose: To measure lung volume and airflow
Tidal Volume volume of air inhaled and
exhaled 500ml
Inspiratory Reserve Volume (IRV) max
volume inhaled
Expiratory Reserve Volume (ERV) max
volume exhaled
Residual Volume volume of air remains in
lungs after forceful exhalation, 1200ml
Vital Capacity IRV + ERV + TV; maximum
volume of air that can be exhaled after
maximum inhalation
Functional Residual Capacity ERV + RV

XII. THORACENTESIS
Purposes
o To aspirate pleural fluid and/or air from
pleural space
Preop Nursing Care
o Verify consent
o Position: Sitting on the side of bed with feet
on chair, leaning over a bedside table
o Note that no > 1200 ml of fluid should be
removed at a time
o Avoid to cough, breathe deeply, or move
during procedure
Postop Nursing Care
o Apply pressure to puncture site to
prevent bleeding
o Position: SEMI-FOWLER or ensure
PUNCTURE SITE IS UP (LIE ON
UNAFFACTED SIDE)- to prevent leakage
of fluid in thoracic cavity
o Bed Rest until V/S stable to prevent
orthostatic hypotension
o Check for complications and notify
physician
expectoration of blood
indicates trauma
hypotension indicates
hypovolemic shock
shock
pneumothorax
respiratory arrest
subcutaneous emphysema











CHEST TUBES (CLOSED CHEST DRAINAGE) / CTT /
THORACOTOMY TUBE
Purposes
o to remove air and/or fluids from pleural
space
o to restore negative pressure within
thoracic cavity and reexpand lungs
Nursing Alert
o Anterior chest tube to drain air
o Posterior chest tube to drain fluids

One Way Bottle System
serves as drainage bottle and water seal
bottle
immerse tip of tube in 2-3cm NSS to create
water seal
keep bottle 2 3 ft below chest level to allow
drainage from pleura by gravity
never raise bottle above chest level to prevent
reflux of air or fluid
Assess patency of device
o observe fluctuation of fluid along tube
o observe intermittent bubbling of fluid
o If continuous, rapid bubbling verify
presence of air leak in the system TAPE
THE LEAK!
Absence of fluctuation
o Check obstruction of device
o Check for Kinks along tubing
o Milk tubing towards bottle
o Auscultate breath sounds
o If no obstruction, Notify Physician, lung
may have reexpand validated by CXR

TWO-WAY BOTTLE SYSTEM
Not connected to suction apparatus
o 1
st
bottle drainage bottle
o 2
nd
bottle water seal bottle
o check fluctuation and intermittent
bubbling
Connected to suction apparatus
o 1
st
bottle drainage and water-seal
bottle
o 2
nd
bottle suction control bottle
o N: intermittent fluctuation and bubbling
in water seal bottle
o N: expect continuous bubbling in suction
control bottle * If absent bubbling,
adjust the amount of suction control
bottle within prescribed level until
gentle, continuous bubbling occur
o Immerse tip of tube in 1
st
bottle in 2-3cm
of NSS
o Immerse tip of tube of suction control
bottle in 15-20cm NSS to stabilize
pressure in lungs and prevent trauma in
pleura

THREE-WAY BOTTLE SYSTEM
1
ST
bottle drainage bottle
2
nd
bottle water seal bottle; check
intermittent fluctuation and bubbling
3
rd
bottle suction control bottle; check
continuous bubbling
o excessive suction pressure results in
excessive bubbling
o a pressure of 15-20cm of NSS is used to
ensure suction is adequate

Note:
Broken bottle / Broken drainage system
o clamp end part of tube OR
o insert tubing into sterile h20 until bottle
can be replaced
Chest tube accidentally removed by client
o If in clients room apply VASELINIZED
GAUZE
o If outside clients room apply cleanest
material available to prevent entry of air
in lungs
Encourage client deep breathing, coughing
exercises, and ambulation to promote
drainage (if tolerated and depending on
condition)
ROM of exercises of arms
Always mark the amount of drainage at
regular intervals
Avoid frequent milking and clamping of tube
to prevent tension pneumothorax
Removal of tube done by Physician
* Semi-fowlers
* CXR done after tube is removed
* assess complications: emphysema and RD