PICU [pediatric Intensive Care] is a hospital unit containing a variety of mechanical devices and special equipment for the care and management of pediatric patients who have had heart surgery or other types of surgeries that require critical care. Patients with medical problems such as cystic fibrosis and asthma may also require the use of a PICU. Highly trained personnel, such as a RCP [respiratory care practitioner] will be using modalities such as volume and pressure ventilators, CPAP and BiPap machine. The therapist is responsible for using SPAG machines, transcutaneous monitoring and drawing capillary gases. While handling this type of equipment the RCP will be assessing the patient and have the knowledge to recognize changes that may occur. A RCP will also be able to teach and help rehabilitate long-term therapy patients. One should always remember to document every therapeutic skill that is done.
The RCP who is seeking a work environment that utilizes his/her full scope of training, greater independence, professional team orientation and a high level of patient/family interaction should consider the demanding and rewarding field of home care. Here the RCP working under medical supervision provides quality health care to patients in the home setting, which minimizes their dependence on institutional care. Clinical services, equipment and support for patients are usually provided by DME (durable medical equipment) suppliers whose services include twenty-four-hour, 7 day-a-week service, third party insurance processing, home instruction and follow-up by an RCP and most forms of respiratory care. They provide both respiratory and ancillary equipment and supplies as needed including ventilators, suction, oxygen and O2 equipment, as well as any adaptive equipment that may be necessary. The RCP is responsible for simple patient assessment, airway management including tracheotomy and stoma care, cuff care, suctioning and changing tubes/ties. Additional responsibilities may include CPT with percussion, vibration and coughing, medication administration including oral and aerosol, patient movement and ambulating, equipment operation and maintenance, equipment troubleshooting, cleaning and disinfections and emergency procedures. The RCP is also responsible for completing a written report and sending copies to the patient's physician, the home care referral source and any other members of the home care team that require the information. This report will become part of the patient's permanent medical record. The RCP who works in the home care setting is also able to provide additional benefits to their patients, including a reduction in costs associated with hospitalizations, increased longevity, increased functional performance and an improved quality of life.
The hyperbaric oxygen therapy (HBO) is the therapeutic use of oxygen at pressures greater than one atmosphere. Most therapy is conducted at pressures between two and three atmosphere. HBO is administered via either a multiplace or a monoplace chamber. A multiplace chamber is a large tank capable of holding up to a dozen or more people. It has air locks that allow entry and egress without altering the pressure. The chamber is filled with air, whilethe patient breathes 100% oxygen. The monoplace chamber consists of a transparent Plexiglas cylinder large enough for a single patient. The duties and responsibilities of a respiratory therapist include: monitor the patient's heart rate, respiratory rate, oxygen saturation percentage, fractional inspired oxygen (FiO2), electrocardiogram (EKG) and blood pressure. The therapist must also set the proper parameters on the control panel. A therapist with knowledge in both high-pressure physics and mechanical ventilation must be present whenever a patient who requires mechanical ventilation is in the chamber.
There are several things that RCP's in an endoscope lab have to do. Infection control, equipment preparation, and processing are very important. These three things have to be done before and after each procedure. Endoscopes, bronchoscopes, pulse oximeter, EKG lead, cardiac monitor oxygen cannulae, and bronchoscope accessories are a few of the different types of equipment that will be used. Medications will be given to ensure the patient's comfort. The paperwork includes consent forms, physicians’ orders, specimen labels, and radiology requisitions. Monitoring of the patient during the procedure is crucial.
The RCP will also assist the physician. A flexible fiber optic bronchoscope has a light at the end, which enables the physician to see into the lungs. It also has an open channel, which is used for aspirations, tissue sampling, or oxygenation. After insertion, the physician is able to control the movement of the bronchoscope. During this time, the RCP is supplying the physician with equipment he needs. When the specimen has been taken the bronchoscope is removed. The RCP will monitor the patient's recovery for 24-48 hours.
The basic tests of PFT are done to measure several lung volumes and capacities, flow rates of gases through the airways, and the ability of the lungs to diffuse gases. A combination of these measurements provides a quantitative picture of lung function. The diagnostic and therapeutic roles of PFT help clinicians formulate some general questions about patients with lung disease. A common regimen of PFT in the laboratory is to evaluate the effectiveness of bronchodilator therapy. Measuring volumes and flow for PFT can be accomplished using a variety of instruments and measurement principles. Diagnostic spirometers usually measure and calculate vital capacity, peak expiratory flow rate, and forced expiratory flow rates. PFT is usually safe, but a possibility of contamination is possible. RCP's role is to eliminate as much contamination as possible. This test has to have patient cooperation due to the breathing exercises that has to be done. The patient is instructed on how to breathe for the different tests. RCP's role is to explain the type of breathing that is required and to make sure that the breathing exercise is done correctly.
The stress studies lab is a cardiopulmonary monitoring lab in which the therapist plays an important role. Monitoring a patient's heart and lung is important in analyzing the efficiency of their functions. The stress test is advantageous in a patient with a cranial problem, COPD, hypertension, or a heart insufficiency. This test, under physician supervision, tracks the ability of a patient to exercise on a treadmill while connected to an EKG apparatus. The treadmill starts out at a slow pace and is incrementally increased to tax the heart and lung of the patient. During the test, the therapist monitors the metabolic rate of the patient. The therapist also monitors the O2 going into the patient and the O2 going out which relates to the O2 consumption. The physician monitors the entire procedure and allows him or her the ability to make an informed decision as to the physical well being of the patient.
Pulmonary rehabilitation is a rewarding part of respiratory therapy. It is the RCP’s opportunity to have a direct impact on the lives of their patients. The patient population is generally geriatric patients with chronic lung diseases such as, COPD (Chronic Obstructive Pulmonary Disease) and Emphysema. There are also post-surgical patients that have recently had lung resections and are learning how to cope with only part of their lungs. Pulmonary rehab consists of trying to control respiratory infections, managing the patient's airways, smoking cessation programs and patient and family education. Education plays a vital role in ensuring the patient's success in pulmonary rehab. Patients learn to develop diaphragmatic breathing skills as well as stress management and relaxation techniques. Patients are also encouraged to participate in a daily physical exercise regimen in order to condition skeletal and respiratory accessory muscles. The RCP is also responsible for the assembly and maintenance of various types of equipment, such as O2 tanks, flow meters, O2 blenders and nebulizers. Respiratory therapists are also expected to monitor the patient's vital signs and track their progress in the program. Therapy modalities include nebulizer treatments, metered dose inhalers, oxygen therapy and daily exercise with weights, treadmills, bicycles and arm ergo meters.
The Respiratory Care Practitioner plays a major role in the Intensive Care Unit (ICU). The RCP’s must be able to use appropriate techniques to evaluate the critically ill patient and monitor the effects of disease and treatment. The RCP must be able to accurately gather, interpret, and act on a wide range of patient data. This data may include patient oxygenation, ventilation, respiratory mechanics, and hemodynamics. The RCP must perform general patient assessment including temperature, pulse rate, blood pressure, respiratory rate, and pulse oximetry. Physical assessment includes inspection, palpation, percussion and auscultation. The RCP must also be able to read and understand chest radiographs as well as be familiar with the use, application, and interpretation of major clinical laboratory studies. The RCP must be responsible for managing patients receiving ventilatory support, including oxygenation, ventilation, ventilatory mechanics, and hemodynamics. Key factors in assessing ventilation include monitoring the metabolic rate (CO2 production), acid base status (ABG’s), central respiratory drive, physiological dead space and lung and thoracic mechanics. The RCP’s responsibilities also may include documenting the physicians’ orders, verifying proper ventilation operation, routine checks of the patient ventilator circuit and trouble shooting the ventilator. Data collection, data analysis, interpretation of data, and decision making are just some of the skills involved in being a RCP in the ICU.
The respiratory therapist has many responsibilities in the neonatal intensive care unit (NICU). These responsibilities include monitoring the patient's heart rate, respiratory rate, and breath sounds. The respiratory therapist also gives aerosol treatments. When working with neonates, the respiratory therapist must have a working knowledge of the Silverman's score. The respiratory therapist is also responsible for weaning patients off the ventilator and charting patient progress. When charting patient progress, the respiratory therapist documents the heart rate, respiratory rate, breath sounds, SpO2, PEC02, ventilator settings, and ventilator changes. For more efficient patient monitoring, the respiratory therapist uses several types of equipment. They use exhaled CO2 monitors, pulse oximetry, arterial blood gas kits, pressure ventilators, volume ventilators, high frequency ventilators, oscillatory ventilators, O2 hoods, nasal cannulae, CPAP devices, and ECMO. With the use of this equipment and a working knowledge of how to meet patients’ needs, the respiratory therapist plays a very important role in the NICU.