CRT RRT NBRC UPDATED CORE REVIEW QUESTIONS
AND ANSWERS SURE A+
✔✔Positive Expiratory Pressure (PEP) Therapy - ✔✔-applying positive pressure using a
one-way inspiratory valve and a one-way expiratory resistor
-expiratory pressure from 10 - 20 cmH20 at mid-exhalation
-used for 15-20 mins 3-4x/day
-improve secretion expectoration, reduce RV (decrease hyperinflation) and improve
airway maintenance (CF, pneumonia)
-discontinue if sinusitis, epistaxis or ear infection occurs
-inspire larger than normal VT and exhale actively but NOT forcefully. exhalation 2-3x
longer than inspiration
✔✔Autogenic Drainage - ✔✔-primarily for CF and bronchiectasis
-breathe at low lung volumes to loosen secretions from the small airways
-helps to accumulate secretions in the middle airways
-during the last stage the patient breathes at high lung volumes
✔✔Intrapulmonary Percussive Ventilation - ✔✔-Combination of high frequency pulse
delivery (100-250 cycles/min of a sub-tidal colume and a dense aerosol
-percussive effect of gas delivery improves ventilation past obstructions in the airway
thereby delivering more aerosol to the distal airways.
-Dense aerosol delivery promotes bronchial hygiene, reduces edema, and relieves
bronchospasm with the appropriate medications
-starting source pressure is 30 psi
✔✔Discontinuing bronchial hygiene - ✔✔-clear breath sounds and x-ray
-ambulating well
-strong cough
-afebrile for 24 hours
-hazards occur (dizziness, SOB, cyanosis, etc.)
,✔✔iatrogenic hypoxemia - ✔✔induced by a physician's words or therapy (used
especially of a complication resulting from treatment)
can be caused by suctioning
✔✔Suction Pressures - ✔✔Adult: 100 - 120 mm Hg
Child: 80 - 100 mm Hg
Infant: 60 - 80 mm Hg
✔✔Coude tip catheter - ✔✔suction catheter angles to help suction the LEFT main stem
bronchus
✔✔Closed system/inline suction catheter (Ballard) - ✔✔-allows patient to recieve
ventilation and oxygenation during suctioning
-for pt with high oxygen/PEEP requirements, pulmonary infections, frequent suctioning
and hemodynamic instability
✔✔Catheter sizes - ✔✔-ideal length is 20 - 22 inches
-external diameter of the suction catheter should be no greater than 1/2 the inside
diameter of ET/trach tube
✔✔Lukens trap/sterile suction trap - ✔✔-collect sputum specimen
-placed in an upright position between the suction catheter and the suction tubing
-flush catheter with sterile water or isotonic saline
-saline for cytology samples
✔✔Change size and type of catheter if - ✔✔-difficulty removing secretions (verify
appropriate size for airway)
-change to Coude Catheter for LEFT main stem bronchus
-change to closed system if pt has an infection, PEEP, or frequent desaturation
✔✔Altering negative pressure - ✔✔-increase negative pressure to remove thick
tenacious secretions
-do not exceed appropriate pressures
✔✔Instill irrigating solutions - ✔✔-5-10 mL of normal saline to dilute secretions too thick
to aspirate
-5-10 mL of 10% solution of Acetylcysteine (Mucomyst) can be used for thick tenacious
secretions + bronchodilator
✔✔Troubleshooting Suctioning procedure - ✔✔-check catheter for patency
-assure vacuum is working/appropriate pressure
-change or empty a full collection bottle
-check all connections
, ✔✔Bubble humidiifier - ✔✔-incorporates pressure pop-pff valves set at 2 psig/40 mm
Hg
-check by occluding or pinching the connection tubing and listen for whistling sound
-if no sound = leak
✔✔Troubleshooting bubble humidifiers - ✔✔-efficiency depends of water level in the
reservoir = replace or refill if non disposable
-if whistling = flow too high or obstructed tubing
✔✔Passover or blow-by humidifer - ✔✔-evaporation occurs as gas passes over the
water container/reservoir
-least effective in humidifying an artificial airway unless heated
-commonly used in conjunction with infant ventilators and circuits
✔✔Heat Moisture Exchanger (HME) - ✔✔-should be located in the vent circuit between
the wye and the patient (where deadspace is located)
-creates a small VD
-can cause increased delivery pressure = replace HME
-removed during aerosol therapy
-not as effective as humidifiers and increase/thicken secretions = change to heated
humidifiers
✔✔Wick Humidifers - ✔✔-can deliver 100% body humidity (44mg/L)
-low risk of cross contamination (nosocomial infection) because no particles are being
produced
-for vents, CPAP, etc
✔✔Heated Wire Circuits - ✔✔-minimizes circuit condensation
-wire like structure inside the vent circuit to maintain a set gas temperature thru the
entire circuit
-can be both limbs or just inspiratory limb
✔✔Jet Nebulizers - ✔✔-utilize Bernoulli's principle to create an aerosol then encounter
a baffle
-creates particles within therapeutic size range (1-10 microns)
✔✔HHN/SVN - ✔✔-1 to 3 second breath hold is important to enhance medication
delivery
-sputtering sounds indicates that all of the solution has been nebulized
✔✔Large Volume Nebulizers - ✔✔-deliver bland aerosol to upper airway
-output: 1-2 mL/min
-heating element for thick secretions
-FiO2 decreased = air entrainment is increased. lower mist density, total flow or mist
output increases (vice-versa)
AND ANSWERS SURE A+
✔✔Positive Expiratory Pressure (PEP) Therapy - ✔✔-applying positive pressure using a
one-way inspiratory valve and a one-way expiratory resistor
-expiratory pressure from 10 - 20 cmH20 at mid-exhalation
-used for 15-20 mins 3-4x/day
-improve secretion expectoration, reduce RV (decrease hyperinflation) and improve
airway maintenance (CF, pneumonia)
-discontinue if sinusitis, epistaxis or ear infection occurs
-inspire larger than normal VT and exhale actively but NOT forcefully. exhalation 2-3x
longer than inspiration
✔✔Autogenic Drainage - ✔✔-primarily for CF and bronchiectasis
-breathe at low lung volumes to loosen secretions from the small airways
-helps to accumulate secretions in the middle airways
-during the last stage the patient breathes at high lung volumes
✔✔Intrapulmonary Percussive Ventilation - ✔✔-Combination of high frequency pulse
delivery (100-250 cycles/min of a sub-tidal colume and a dense aerosol
-percussive effect of gas delivery improves ventilation past obstructions in the airway
thereby delivering more aerosol to the distal airways.
-Dense aerosol delivery promotes bronchial hygiene, reduces edema, and relieves
bronchospasm with the appropriate medications
-starting source pressure is 30 psi
✔✔Discontinuing bronchial hygiene - ✔✔-clear breath sounds and x-ray
-ambulating well
-strong cough
-afebrile for 24 hours
-hazards occur (dizziness, SOB, cyanosis, etc.)
,✔✔iatrogenic hypoxemia - ✔✔induced by a physician's words or therapy (used
especially of a complication resulting from treatment)
can be caused by suctioning
✔✔Suction Pressures - ✔✔Adult: 100 - 120 mm Hg
Child: 80 - 100 mm Hg
Infant: 60 - 80 mm Hg
✔✔Coude tip catheter - ✔✔suction catheter angles to help suction the LEFT main stem
bronchus
✔✔Closed system/inline suction catheter (Ballard) - ✔✔-allows patient to recieve
ventilation and oxygenation during suctioning
-for pt with high oxygen/PEEP requirements, pulmonary infections, frequent suctioning
and hemodynamic instability
✔✔Catheter sizes - ✔✔-ideal length is 20 - 22 inches
-external diameter of the suction catheter should be no greater than 1/2 the inside
diameter of ET/trach tube
✔✔Lukens trap/sterile suction trap - ✔✔-collect sputum specimen
-placed in an upright position between the suction catheter and the suction tubing
-flush catheter with sterile water or isotonic saline
-saline for cytology samples
✔✔Change size and type of catheter if - ✔✔-difficulty removing secretions (verify
appropriate size for airway)
-change to Coude Catheter for LEFT main stem bronchus
-change to closed system if pt has an infection, PEEP, or frequent desaturation
✔✔Altering negative pressure - ✔✔-increase negative pressure to remove thick
tenacious secretions
-do not exceed appropriate pressures
✔✔Instill irrigating solutions - ✔✔-5-10 mL of normal saline to dilute secretions too thick
to aspirate
-5-10 mL of 10% solution of Acetylcysteine (Mucomyst) can be used for thick tenacious
secretions + bronchodilator
✔✔Troubleshooting Suctioning procedure - ✔✔-check catheter for patency
-assure vacuum is working/appropriate pressure
-change or empty a full collection bottle
-check all connections
, ✔✔Bubble humidiifier - ✔✔-incorporates pressure pop-pff valves set at 2 psig/40 mm
Hg
-check by occluding or pinching the connection tubing and listen for whistling sound
-if no sound = leak
✔✔Troubleshooting bubble humidifiers - ✔✔-efficiency depends of water level in the
reservoir = replace or refill if non disposable
-if whistling = flow too high or obstructed tubing
✔✔Passover or blow-by humidifer - ✔✔-evaporation occurs as gas passes over the
water container/reservoir
-least effective in humidifying an artificial airway unless heated
-commonly used in conjunction with infant ventilators and circuits
✔✔Heat Moisture Exchanger (HME) - ✔✔-should be located in the vent circuit between
the wye and the patient (where deadspace is located)
-creates a small VD
-can cause increased delivery pressure = replace HME
-removed during aerosol therapy
-not as effective as humidifiers and increase/thicken secretions = change to heated
humidifiers
✔✔Wick Humidifers - ✔✔-can deliver 100% body humidity (44mg/L)
-low risk of cross contamination (nosocomial infection) because no particles are being
produced
-for vents, CPAP, etc
✔✔Heated Wire Circuits - ✔✔-minimizes circuit condensation
-wire like structure inside the vent circuit to maintain a set gas temperature thru the
entire circuit
-can be both limbs or just inspiratory limb
✔✔Jet Nebulizers - ✔✔-utilize Bernoulli's principle to create an aerosol then encounter
a baffle
-creates particles within therapeutic size range (1-10 microns)
✔✔HHN/SVN - ✔✔-1 to 3 second breath hold is important to enhance medication
delivery
-sputtering sounds indicates that all of the solution has been nebulized
✔✔Large Volume Nebulizers - ✔✔-deliver bland aerosol to upper airway
-output: 1-2 mL/min
-heating element for thick secretions
-FiO2 decreased = air entrainment is increased. lower mist density, total flow or mist
output increases (vice-versa)
