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Oxygen mask and oxygen source

Equipment to give a nebulizer

Emergency resuscitation equipment

Preprocedure

Action Rationale

1 Explain the procedure to the patient and obtain consent. To ensure the patient understands the procedure and gives valid consent (NMC 2008b, C).

2 Ask the patient what their best peak flow measurements have been and what their current peak flow readings are. This will enable a comparison to be drawn between their current and previous results (British Thoracic Society/Scottish Intercollegiate Guidelines Network 2009, C).

3 Wash and dry hands or use alcohol handrub. To minimize the spread of crossinfection (Fraise and Bradley 2009, E).

4 Assemble equipment; ask the patient to use their own meter, if it is in good working order.

If using a multiple patient use device ensure that it is valved and has disposable single patient use mouthpieces. As different equipment might have slight variations in results (Bongers and O’Driscoll 2006, E).

To prevent crossinfection (Booker 2009, E).

5 Ask the patient to stand or sit upright in whatever position they usually do their peak expiratory flow measurements in. They should be advised not to flex their neck. So that their maximal lung volume can be reached and so that there is no positional obstruction which could affect the results, and to enable comparisons between results (Booker 2009, E; Quanjer et al. 1997, E).

6 Push needle on the gauge down to zero. To ensure the results are accurate (Booker 2009, E).

Procedure

7 Ask the patient to hold the peak flow meter horizontally, ensuring their fingers do not impede the gauge. So that the movement of the needle is not obstructed and can move easily (Booker 2009, E; Frew and Holgate 2009, E).

8 Ask the patient to take a full inspiration to their total lung capacity through their mouth. To ensure they achieve the greatest measurement (Frew and Holgate 2009, E; Quanjer et al. 1997, E).

9 Ask the patient to immediately place their lips tightly around the mouthpiece. The inspiration should be held for no longer than 2 s at total lung capacity. To form an air seal and to prevent their tongue and teeth from obstructing it (Booker 2009, E; Quanjer et al. 1997, E).

10 Ask the patient to blow out down the meter in a short sharp ‘huff’ as forcefully as they can. See Action Figure 10. This can be very quick and need only take about 1 s, to enable accuracy of results (Booker 2009, E; Quanjer et al. 1997, E).

11 Take a note of the reading. As results may vary, ask them to repeat the process a further 2 times and record the maximum measurement achieved. To ensure that the best possible result is achieved (Frew and Holgate 2009, E; Quanjer et al. 1997, E).

Postprocedure

12 Document the readings on the record chart and take further action if necessary. Records must be kept of all assessments made, treatment or care provided and the outcome of this (NMC 2009, C).

13 Discard the mouthpiece and clean the meter in line with local policies and the manufacturer’s recommendation. Wash hands. To prevent the risk of crossinfection (Fraise and Bradley 2009, C).

Action Figure 10 Manual peak fl ow meter technique.

Problem-solving table 12.5 Prevention and resolution (Procedure guideline 12.5)

Postprocedural considerations

Immediate care

A reduction in peak flow may indicate a lifethreatening situation and so should receive urgent medical attention. The treatment provided will be aimed at increasing air flow and oxygenation. Oxygen therapy is usually applied with the aim of keeping oxygen saturations at 94–98% (British Thoracic Society/Scottish Intercollegiate Guidelines Network, 2009). In patients who are known, or suspected, to have hypercapnia, oxygen should be initially administered at 28% via a Venturi mask out of hospital, and in hospital at 24% via a Venturi mask, unless their condition is of such severity to require a greater flow (O’Driscoll et al. 2008). However, if their oxygen saturation exceeds 92% then the flow of oxygen should be reduced (O’Driscoll et al. 2008). All of these patients will require