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Respiratory Therapy Apparatus

Respiratory Therapy Apparatus

Definition

Respiratory therapy apparatus refers to a group of different inhalation devices and equipment used to treat a variety of respiratory ailments.

Purpose

Respiratory therapy apparatus is used to aid a patient's breathing or heal damage to a patient's lungs and bronchial tubes due to infection and disease.

Description

Simply put, respiratory therapists help patients breathe more effectively. Patients may have mechanical difficulties within the lungs and trachea that make it difficult to get enough oxygen. Often these instances are life threatening and must be treated immediately. Obstructions (e.g., When a child swallows an object) and injury (automobile accidents, sports injuries, natural disasters, etc.) are common situations in which breathing assistance is necessary. In these cases, intubation (the insertion of a tube into the trachea) is necessary to open the airway so that oxygen can be administered. Ventilators regulate the amount of oxygen that the patient receives and even how often the patient breathes. Disease and atrophy of the lungs may require the use of a ventilator to help a patient breathe.

Premature infants and some other newborns may not have lungs that are mature enough to allow them to breathe on their own. Oxygen is often administered as a life-support measure. In some cases, oxygen is given to ease the burden on the lungs until the baby is strong enough to breathe on its own.

Some patients may be suffering from chronic obstructive pulmonary disease (COPD), a group of diseases that affect the lungs, and which includes emphysema, bronchitis, and asthma. Other patients may have cystic fibrosis, lung cancer, pneumonia, or AIDS. In these cases, the respiratory therapist may administer medications through an inhaler or a handheld nebulizer.

Other patients may have heart disease. The therapist may administer oxygen and also provide rehabilitation devices and techniques to increase lung capacity.

Nebulizers and inhalers

Nebulizers and inhalers provide medications in a fine mist that the patient breathes. Inhalers provide metered doses of medication and come prepackaged. They are portable and can be tucked into a pocket or handbag. So-called "rescue" inhalers are often carried by people with asthma and used when they have an episode. Special dry powder inhalers provide medications that do not work well in liquid form. These inhalers deliver the medication in fine, dry particles that are inhaled.

Metered-dose inhalers dispense specific medications and can be grouped according to type of medication. They are usually bronchodilators, inhaled steroids, cromolyn, nedrocromil, and ipratropium bromide.

Nebulizers are hand-held machines with an airflow meter that measures oxygen flow. These machines administer a variety of medications. The respiratory therapist must prepare a mixture of medication and saline solution according to the physician's written order. Nebulizers vaporize this mixture and deliver it as a fine mist or steam. Nebulizers are usually used in the hospital or nursing home setting. Disposable nebulizers are often sent home with a patient and are cleaned and reused for a limited time. There are three types of nebulizers: large volume, small volume, and ultrasonic.

Intubation catheters and ventilators

Intubation catheters are inserted into the airway and fill the lungs with oxygen at a specific respiratory rate. Ventilators provide mechanical breathing though the catheters and are said to "breathe" for the patient. The amount of oxygen can be varied as well as the breathing rate.

Oxygen masks, nasal cannulas, and oxygen tanks

Oxygen masks, nasal cannulas, and oxygen tanks provide oxygen therapy and assistance in maintaining specific oxygen levels within the lungs. Oxygen masks fit over the mouth and nose, whereas cannulas are thin tubes inserted into the nasal openings. Tubing connects the mask or cannula to the oxygen tank from which oxygen is delivered.

Oxygen masks come in a variety of sizes. There are very small ones used to fit premature infants' faces. Adult-size masks come in small, medium, and large. Masks usually provide high flow and a high concentration of oxygen within a range to the patient. Ventilator masks come with a series of different adaptors that allow a specific percentage of oxygen flow. These adaptors are preset and can be installed on the mask to provide oxygen at a specific rate (e.g., 50% oxygen).

Nasal cannulas provide low flow and a lower concentration of oxygen. Cannulas deliver oxygen within a range. These are usually used in home health situations because of their ease of use.

Operation

The respiratory therapist will need to make sure that the equipment is running efficiently and that the medication formula is properly mixed. Masks must be of the correct size and must fit the patient snugly. Since therapy often involves patient cooperation, the therapist should instruct conscious patients clearly about the procedure and what is expected of them during treatment. For example, when using inhalers, the patient should be instructed in creating a tight seal around the inhaler nozzle with the lips and to hold the inhalation for a few seconds.

For unconscious patients, the therapist will need to make sure that oxygen masks fit properly or that intubation and ventilation is done correctly.

Maintenance

Most respiratory therapy devices are one-use only and disposable. Only in the case of pocket inhalers and take-home nebulizers does the therapist need to instruct the patient in proper cleaning of the devices. Inhalers often just need rinsing with soap and water and drying after use. Nebulizers will need to be cleaned with distilled water and vinegar, or other approved disinfectant solution. Even in hospital settings, nebulizers are changed every day, though they may be reused several times during that day. Some nebulizers may be cleaned by running them through a cycle in a dishwasher, but the therapist should check with the manufacturer first.

Intubation catheters need to be as sterile as possible in order to prevent infection or sepsis. Therefore, they are one-use disposable products.

Nebulizers will need to be inspected for wear to insure their proper working. Machines with an air compressor or motor often have air filters; these filters will need to be replaced regularly.

Health care team roles

The respiratory therapist is a member of a large medical team that treats a patient's specific diseases and injuries; and can work in hospitals, nursing homes, out-patient clinics, physicians' offices, and in homes. Since respiratory therapy requires trust and cooperation from the patient, the therapist will need to be able to instruct patients clearly and in a friendly manner. The therapist will also need to be adaptable and able to deal with a variety of people across a wide age range.

The respiratory therapist is responsible for maintaining the respiratory therapy equipment, cleaning it if necessary, and requisitioning parts and apparatus (masks, catheters, etc.). The therapist also administers treatment via this equipment and monitors patient performance and response.

KEY TERMS

Bronchodilators— Medications that expand the bronchial tubes so that patients can breathe better.

Intubation— The insertion of a tube into the trachea.

Nasal cannula— A tube placed inside the nostrils to bring oxygen to the patient's lungs.

Nebulizer— A hand-held device that distributes medication to the lungs via a steam or mist derived from a mixture of medication and saline solution. The respiratory therapist prepares the mix per the physician's written order.

Trachea— Windpipe; the airway by which oxygen passes to the lungs and carbon dioxide is expelled from the body.

Training

Formal training and licensure by the state in which the therapist works is necessary for these professionals. Training programs graduate registered or certified respiratory therapists. According to the Commission on accreditation of Allied Health Education, 329 advanced respiratory therapy programs and 51 entry-level programs were accredited in the United States and Puerto Rico in 2005. Registered respiratory therapists usually study for two years and earn an associate degree, though some receive a bachelor's degree after four years of coursework. Respiratory therapists take courses in physiology and anatomy, chemistry, microbiology, physics, and mathematics. They are also trained in the use and maintenance of respiratory therapy apparatus. Apart from formal education, many therapists are receiving additional on-the-job training to administer stress tests and electrocardiograms, or draw blood.

Resources

BOOKS

Scanlan, Craig L., Robert L. Wilkins, and James K. Stoller. Egan's Fundamentals of Respiratory Care. St. Louis: Mosby, 1999.

PERIODICALS

Bureau of Labor Statistics. "Respiratory Therapists." Occupational Outlook Handbook, 2006–07 ed. 〈http://www.bls.gov/oco/home.htm〉.

ORGANIZATIONS

American Association for Respiratory Care. 11030 Ables Lane, Dallas, TX 75229. (972) 243-2272.

National Board for Respiratory Care. 8310 Nieman Road, Lenexa, KS 66214-1579. (913) 599-4200.

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