Equipment

Question 1

Infrared absorption analyzer

1. What gases are measured & what test is it most commonly used for?
2. What other 4 terms could be used to refer to this analyzer?

Answer 1

1. Carbon monoxide
   -carbon dioxide
   -methane.
   Most commonly used for DLCO.
2. chopper motor
   chopper blade
   infrared source
   Radiation beam

Question 2

INFRARED ABSORPTION ANALYZER

1. What are the gas concentrations used for calibration?
2. What is the process for calibration?
3. What should the non-linear display be?
4. What is an acceptable phase delay?

Answer 2

1. Low end 0%. High end 0.3%.
   Use room air for low end calibration.
2. Zero
   Adjust the gain to match the known concentration.
   Re-zero
3. 0.5% or less
4. 0.4 seconds

Question 3

INFRARED ABSORPTION ANALYZER

1. How does it work?
2. What are 4 key features?

Answer 3

1. A small motor rotates an interrupter or chopper.
   Which interprets the radiation beam in rhythmic pattern.
   Which is proportional to the percentage of gas.
2. Allows for breath to breath analysis.
   -Very fast.
   -Not affected by partial pressure (altitude).
   -Need to use a scrubber in line before the gas reaches the analyzer so CO2 does not affect the results.

Question 4

INFRARED ABSORPTION ANALYZER TROUBLESHOOTING

1. What are 2 causes of inconsistent readings?
2. What tubing should be changed that will stabilize water vapor?
3. What would a chattering noise indicate?
4. What could a long sample line cause?

Answer 4

1. Moisture issues. Moisture affects the radiation beam.
   -Failing chopper motor and bearings.
2. Nafion tubing.
3. Sticky demand valve.
4. Delayed response time.

Question 5

GAS CHROMATOGRAPHY
(ABSORPTION TYPE ANALYZER)

1. What gases does it measure?
2. How does it work?
3. What type of analyzer measures the gas concentrations as they exit?

Answer 5

1. Neon
   -oxygen
   -Nitrogen
   -Carbon monoxide
2. The sample gas moves through a separator column
   -each gas molecule has differing sizes
   -the molecules for the individual gases exit through the column at different rates.
3. Thermal conductive type analyzer.
   -measured as a gas concentration

Question 6

GAS CHROMATOGRAPHY
(ABSORPTION TYPE)

1. What are advantages of this analyzer?
2. What are disadvantages?
3. Does it require the use of a scrubber and Nafion tubing and why?
4. What 3 factors does the analysis time depend upon?

Answer 6

1. It can analyze many gases at one time.
2. Requires more time for analysis
   -cannot measure breath to breath. -Not fast.
3. Yes, it needs a scrubber and Nafion tubing as it is affected by water and CO2.
4. Carrier gas flow.
   -column length
   -column temperature

Question 7

MASS SPECTROMETRY

1. What gases does it measure?
2. How does it work?
3. What are other terms that can refer to this analyzer?

Answer 7

1. Helium.
   -Nitrogen
   -oxygen
   -carbon dioxide
2. Sample is drawn in to an ionization chamber by a vacuum.
   -the individual gases are separated and analyzed
   -measured as a gas concentration
3. Ionization chamber.
   -vacuum pump

Question 8

MASS SPECTROMETRY

1. What are the advantages?
2. What are the disadvantages?

Answer 8

1. Capable of breath by breath analysis
   -allows for multiple gas analysis
   -Fast
2. Very expensive.
   -Large in size
   -Requires a high degree of maintenanc
   -can be affected by condensation
   -used mainly in research

Question 9

MASS SPECTROMETRY
(TROUBLESHOOTING)

1. When used during stress testing, what causes a delayed response time for oxygen?
2. If the sum of all gases analyzed is less than 100%, what must be done?

Answer 9

1. Obstructed sample line.
2. The overall game must be adjusted until the sun reaches 100%.

Question 10

HELIUM ANALYZER

1. What are other names for this analyzer?
2. What testing is this used for?
3. How do you calibrate and what gas percentages?
4. Do not use with flammable gases.

Answer 10

1. Thermal conductivity analyzer
   -Wheatstone Bridge.
2. Helium dilution.
3. Low 0%. Room air
   -High 10% helium.
   - zero, allow helium to clear, then re-zero

Question 11

NITROGEN ANALYZER

1. What is the name of this analyzer?
2. What test is this analyzer used for?
3. Other names used that would refer to this analyzer?

Answer 11

1. Geissler Tube Ionizer
2. FRC via N2 washout
3. Ionization chamber
   -phototube
   -light emitted
   -linearizer amplifier

Question 12

NITROGEN ANALYZER
(GEISSLER TUBE IONIZER)

1. How is it calibrated?
2. How does it work?

Answer 12

1. Low = 0%
   - Use 100% O2 (has 0% N2)

-High= known N2 concentration
(Use room air (room air has 79% N2)

2. Sample is pumped into an ionization chamber,
   -a light is emitted &
   -monitored by a phototube.
   -Intensity of light is directly proportional to the percent of N2
   -measures gas %

Question 13

NITROGEN ANALYZER
(GEISSLER TUBE IONIZER

1. What is a positive feature about this analyzer?
2. Is a scrubber or desiccant needed?

Troubleshooting:

3. What would cause sporadic or erratic zero readings which return to the expected value?
4. How do you calculate % error?

Answer 13

1. Fast. Breath by breath
2. No. Not rebreathing.
3. Aspiration of water through the needle valve.(moisture)
4. Expected Value - Measured X 100
   / Expected Value

Question 14

BLOOD GAS ANALYZERS

1. What values are directly measured on a blood gas analyzer?
2. What is the priority order of gases and what do they represent?

Answer 14

1. PCO2, PO2, PH
2. PCO2= ventilation.
   (partial pressure of carbon dioxide)
   —PO2= oxygenation
   (partial pressure of oxygen)
   —PH acid-base balance

Question 15

BLOOD GAS ANALYZERS

1. What is the name of the PCO2 electrode?
2. What our terms that might be used to refer to this electrode?

Answer 15

1. Severinghaus Electrode
2. Nylon spacer.
   — Teflon membrane
   — smooth membrane

Question 16

BLOOD GAS ANALYZERS
(PO2 Electrode)

1. What is the name of the PO2 electrode?
2. What features describe this electrode that are terms that might be used to refer to this electrode?

Answer 16

1. Clark Electrode
2. Membrane is not smooth
   —Platinum cathode
   — silver-silver chloride anode
   —Polypropylene membrane (gas permeable)
   — requires a polarizing voltage (battery or plugged in)

Question 17

BLOOD GAS ANALYZERS
(PO2 Electrode)

1. What is the maintenance required for this electrode?
2. What are features of this electrode in respect to maintenance?
3. If given answer option of “MYLAR MEMBRANE” = It IS NOT the Answer. Why?

Answer 17

1. Periodic / routine cleaning of the tip with pumice
2. Rough surface attracts protein causing blood clots.
3. Does not allow sufficient diffusion of oxygen.
   —

Question 18

BLOOD GAS ANALYZERS
(PO2 Electrode)
Clark Electrode

Troubleshooting:

1. What causes ERRATIC measurements & how it is fixed?
2. What substances are pumice?
3. What can cause an “unacceptable drift”?
4. What will tears in the membrane cause?

Answer 18

1. Membrane can attract protein and form clots.
   —periodic & routine cleansing of the electrode tip with pumice.
2. Volcanic powder or dust.
3. Depletion of buffers in the electrode.
4. Inaccurate data

Question 19

BLOOD GAS ANALYZERS
(PH Electrode)

1. What is the name of this electrode?
2. What are the two electrodes for PH measurement?

Answer 19

1. Sanz Electrode
2. Reference Electrode
   — Measurement Electrode

Question 20

BLOOD GAS ANALYZERS
(PH Electrode)

1. Describe the Reference Electrode?
2. Describe the Measurement Electrode?
3. How does the ph electrodes work?

Answer 20

1. Reference Electrode
   —contains KCL Buffer Solution with a known pH
   —it is sealed and has a ceramic plug
2. Contains buffer
   —a silver-silver chloride wire
   — a pH sensitive glass capillary tube
3. Introduction of a sample
   —causes an electrical potential to develop.
   —the voltage difference between the two electrodes
   —is proportional to the pH difference.

Question 21

CALIBRATION OF BLOOD GAS ANALYZERS
PH

1. pH Calibration limits?
2. Describe the calibration process?

Answer 21

1. Balance (Low) 6.838
   —Slope (high) 7.384
2. If displayed pH solution value differs
   —the balance is adjusted to the low value
   —the slope is adjusted to the high value.

Question 22

CALIBRATION OF BLOOD GAS ANALYZERS
PH

Troubleshooting:

1. If the pH electrode cannot be calibrated, what would this indicate?
2. A noisy erratic, unstable reading from any electrode, may indicate?
3. What should be done if a clot forms?
4. What should be checked first before changing the membrane?

Answer 22

1. Inability to maintain temperature.
   —must have constant temperature.
2. Re-membraning may be necessary.
3. Run protein remover f/b 2 rinse cycles.
4. Gas cylinder PSI & solution levels.

Question 23

CALIBRATION OF BLOOD GAS ANALYZERS PCO2/PO2

1. PCO2 calibration limits?

2 PO2 calibration limits?

3. What unit of measure are the gases PO2 & PCO2 displayed as?
4. What unit of measure are the calibration tanks in?

Note: Question may be:
When calibrating an electrode

5. Convert % to mm Hg (Formula)?
6. Shortcut for above formula?

Answer 23

1. PCO2
   —Balance (low)= 5%
   —Slope (high) = 10%
2. PO2
   —Balance (low)= 0%
   —Slope (high) = 12% or 20%
3. mm Hg
4. Percent
5. (PB - PH2O) X Fractional Concentration of gas (gas % as decimal)
   (760 - 47) X 0.12=85.56
6. Gas % X 7
   12 X 7=84
   Pick closest answer.

Question 24

OXYGEN ANALYZERS

1. 2 Types of O2 analyzers?
2. How measures?
3. Which analyzer is like a Clark Electrode?

Answer 24

1. Fuel Cell:
   —Galvanic Fuel Cell
   —Zirconium Fuel Cell
   Polarographic
2. Creates a current
   —as a result of oxidation/reduction of oxygen.
3. Polarographic (has electrolytes in electrode).

Question 25

OXYGEN ANALYZERS Galvanic/Zirconium Fuel Cell & Polarographic 1. Inspired oxygen (Fi02) procedure? 2. Expired oxygen (FE02) & what test measures FE02?

Answer 25

1. Low= 21% (room air) —High= 100% (100% oxygen) 2. Exercise Testing (FE02) —Low=12 - 14% —High= 21% (room air)

Question 26

OXYGEN ANALYZERS Galvanic/Zirconium Fuel Cell & Polarographic Facts & Troubleshooting 1. What are response times for both types? 2. Which type uses a battery? 3. If unable to calibrate, what should be done? 4. What affects accuracy of both types? 5.

Answer 26

1. Fuel Cell = can be 60 seconds —Polarographic = 1 - 3 seconds 2. Polarographic 3. Galvanic = Change the Fuel Cell —Polarographic = 1st - change the battery 2nd - electrolyte level 4. Water on sensor, high pressures (inline with vent), altitude.

Question 27

Tonometry 1. What is Tonometry?

Answer 27

1. Best method for precise control of PO2.

Question 28

Valves & Sampling Devices 1. Directional Valves? (unidirectional / Bi-directional) 2. Demand Valve? 3. What indicates a sticky demand valve? 4. How do you check for proper valve function on a one way valve? 5. How does a one way valve work 6. Free breathing valve? 7. End- tidal sample?

Answer 28

1. Allows technologist to “switch” the patient into the breathing circuit. 2. Allows patient to breathe from system by opening the valve “on demand” 3. Will chatter with flow. 4. Confirm that the valves are not sticking. 5. When patient inhales, Port A (inspire) opens & Port B (exhalation) remains closed. 6. Allows patient to be switched from breathing room air to breathing through a spirometer circuit. —typically used for spirometry and FRC. 7. Allows collection of a gas from several exhaled breaths. —% of gas is then averaged over the number of breaths collected.

Question 29

Valves & Sampling Devices Valve Function 1. May be a drawing labeled A & B on test. 2. If not labeled, A= inspired B= expired

Question 30

GAS & WATER ABSORBERS 1. What is a scrubber used for? 2. What 2 chemicals are CO2 scrubbers made out of? 3. Sodium Hydroxide comes in two colors & what color change indicates a change is necessary? 4. Hydroxide comes in two colors & what color change indicates a change is necessary?

Answer 30

1. CO2 Absorber 2. Sodium Hydroxide (NaOH) —(Soda Lime) (Soda Sorb) —Barium Hydroxide (BaOH) —(Baralyme) 3. NaOH is: —Light brown — to White —Cream — to Violet 4. BaOH2 is: —White — to Purple

Question 31

GAS & WATER ABSORBERS 1. When are the Absorber/Scrubber replaced? 2. What are indications that the scrubber material may be exhausted or not in line? 3. When the term “rebreathing” is used in regards to testing. What does it mean?

Answer 31

1. When exhausted (manufacturer date expires) —Color change —Weekly 2. Patient will become tachypneic __ c/o feeling hot 3. A scrubber will be needed. (He Dilution & DLCO-RB

Question 32

H2O absorber (Dessicant) 1. Chemical name? 2. Purpose? 3. Indicates the desiccant is exhausted? 4. Affects analyzer, readings and accuracy? 5. Placement of absorbers? 6. ** re-breathing.**

Answer 32

1. Calcium sulfate (CAS04) —Drierite 2. Removes moisture as patient breathes through the system. 3. Color change (blue to pink) — expired (use before manufacturers expiration date) 4. Moisture. 6. Needs a scrubber. 5. 1st—CO2 absorber 2nd—Desiccant 3rd— analyzer

Question 33

GAS & WATER ABSORBERS PERMAPURE TUBING 1. Tubing that replaces desiccant? 2. Special tubing purpose? 3. How it works? ** Phrase for Testing**

Answer 33

1. Permapure tubing. —(Nafion) 2. Allows accurate correction for humidity levels in a gas sample. 3. MOIST EXHALED GAS —-equilibrates to ambient levels DRY CALIBRATION GASES —equilibrates up to ambient levels ** Special tubing will condition the gas to equilibrate with ambient humidity**

Question 34

FLOW MEASURING SPIROMETERS 1. Pneumotachometer or Pneumotachograph measures? 2. 6 Types?

Answer 34

1. A device that measures flow and converts it to a volume display. 2. Turbine (Wright Respirometer) — pressure differential (Fleisch) — thermal element (hot wire) — Pitot Tube — ultrasonic (transit-time, vortex shedding) — peak flowmeter

Question 35

FLOW MEASURING SPIROMETERS WRIGHT RESPIROMETER 1. How works? 2. Measurements/ Flow? **TURBINE PNEUMOTACH** ** NEVER SELECT TURBINE as the PRIMARY SOURCE OF MEASUREMENT. ** ** Measures flow, it is not accurate enough**

Answer 35

1. Flow causes vanes to spin and then displays a volume on the face plate. — has rotating vane with gears 2. Accurate for flows of 3 to 300 L/min. — flows above 300 L/MIN. May break the vanes.

Question 36

FLOW MEASURING SPIROMETERS Pressure differential (FLEISCH) 1. How it works? 2. Where is this FLEISCH pressure differential commonly found? 3. What affects Accuracy? 4. What causes false high volume readings? 5. What is used to reduce condensation? Troubleshooting 6. Pneumotach reads low after cleaning? 7. Low or decreased readings and volumes? 8. The flow pattern is reversed? TERMS FOR TESTING** Diagram

Answer 36

1. Contains a resistive element that causes pressure to drop as gas flow crosses it. **DIFFERENCE IN PRESSURE IS PROPORTIONAL TO THE FLOW. ** 2. Body Box 3. Accuracy is affected by gas composition. (must calibrate with the same gas used for testing) 4. Increased resistance. — moisture in the tubes 5. Heat. — the added heat can make the patient more uncomfortable. 6. Moisture in the transducer lines. 7. A leak. 8. The tube position is switched. ** Resistive element** ** Electrical source** — a flow tube with a resistive element in the middle. — measures front end pressure — measures back and pressure — difference of the two pressures equals flow —converted to volume

Question 37

FLOW MEASURING SPIROMETERS THERMAL ELEMENT (HOT WIRE) 1. Description? 2. Where is this used? Troubleshooting 3. Accuracy is affected by? 4. A hole in the mesh screen? **TEST TERMS** **Thermister Flow tube with a screen and a heated wire. ** Diagram —A flow tube with a screen and heated wire. —Patient blows through the screen —Across the heated wire and cools it.

Answer 37

1. Contains a heated platinum wire or small metal bead that cools as the gas flows across it —requiring an increased amount of current to maintain the temperature. — THE AMOUNT OF CURRENT NEEDED TO MAINTAIN THE TEMPERATURE IS PROPORTIONAL TO FLOW 2. Sleep Medicine — monitor patient breathing through their nose — nasal cannula type device in the nose. —Thermister (thermal element) 3. Gas composition. 4. Decreased resistance. — will give a false flow volume reading

Question 38

FLOW MEASURING SPIROMETERS PITOT TUBE (same as the FLEISCH pressure differential) 1. How it works?

Answer 38

1. A flow sensor with a series of small tubes —that measure both inspiratory and expiratory flow and is —connected to a pressure transducer.

Question 39

FLOW MEASURING SPIROMETERS ULTRASONIC (TRANSIT-TIME, VORTEX SHEDDING) 1. How it works? ** Maybe used as a distracting answer on the test. Exam question options: Not the best answer— Ultrasonic/Transit Time/Vortex Shedding Next Answer—Pressure differential (FLEISCH) Best answer — PITOT tube **TEST TERMS** Ultrasonic transmitter Strut Receiver Vortex shedding Transit time

Answer 39

1 consist of emitting and receiving crystal and flow tube with struts Gas flows across the struts — broken up into waves and vortices — ultrasonic emitting crystal transmits high frequency sound waves to the receiving crystal — each vortex passing through the ultrasonic Bean produces of pulse THE NUMBER OF PULSES IS PROPORTIONAL TO FLOW