Welch Allyn PneumoCheck User manual

Fii.!
Welch Allyn
PneumoCheckTM
and
Printer/Charger
Operating
Instructions

Fvi!!
w!!
Welch Allyn
Thank you for purchasing the Welch Allyn PneumoCheck. The
operating and maintenance instructions found in this manual should
be followed to ensure many years of accurate and reliable service.
Please read these instructions thoroughly before using your Welch
Allyn PneumoCheck Spirometer and Printer/Charger.
**Welch Allyn gratefully acknowleges the assistance of Paul L. Enright, M.D. of the
Mayo Clinic in Rochester, Minnesota for his assistance in preparing and reviewing
sections of this manual.
Welch Allyn
CONTENTS
Introduction
to Spirometry
..............
IndicationsforSpirometry
..............
Parts of the Welch Allyn PneumoCC
Preliminary Operating Instructions,
The FVC Test
....................................
Quick FVC Reference Chart..
........
Description.....................................
Measurement Parameters.............
Obtaining Good FVC Results
........
Doing an FVC Maneuver...............
Doing Multiple Tests on a Patient..
Interpretation of Results................
The MVV Test
...................................
Description.....................................
Measurement Parameters
.............
Obtaining Good MVV Results..
......
Doing an MVV Maneuver..............
Doing Multiple Tests on a Patient..
Interpretation of Results................
Parts of the PneumoCheck Printer/l
Printer/Charger Operating instructi
Setting Up......................................
Setting Report Format Options..
....
Predicted Normals.....................
Short Form/Long Form..............
Flow/Volume or Volume/Time PI
Entering
Patient Data....................
Printing
..........................................
Paper Feed....................................
Paper Jams ...................................
PaperReplacement
.......................
Stopping the
Printer
.......................
Error Conditions.............................
Calibration Check and Flecalibratio
The ATS Recommendation
...........
CalibrationCheck
..........................
Recalibration
..................................
Quick Calibration Check and
Reca

\w!!
Welch Allyn
CONTENTS
Introduction
to Spirometry..
...........................................................
.l
IndicationsforSpirometry
............................................................. .2
Parts of the WelchAllynPneumoCheck Spirometer.. ................. .3
Preliminary Operating Instructions
................................................ 4
The FVCTest................................................................................... .5
Quick FVC
ReferenceChart
......................................................... .5
Description.....................................................................................
6
Measurement
Parameters
............................................................
.6
Obtaining
GoodFVCResults
....................................................... .8
Doing an
FVC Maneuver.............................................................
12
Doing Multiple Tests on a Patient................................................
14
Interpretation
of Results
..............................................................
17
TheMVVTest................................................................................
.20
Description
..................................................................................
.20
Measurement
Parameters
..........................................................
.20
Obtaining
Good
MVVResults.....................................................
.21
Doing an
MVV Maneuver........................................................... .21
Doing Multiple Tests on a Patient............................................... .22
Interpretation
of Results
............................................................. .22
Parts of the PneumoCheck Printer/Charger
................................23
Printer/ChargerOperatingInstructions
......................................
.24
Setting Up
................................................................................... .24
SettingReportFormat Options................................................... .24
PredictedNormals
.................................................................. .24
Short
Form/Long Form
........................................................... .25
Flow/Volume or Volume/Time
Plot
.........................................
.25
EnteringPatientData
.................................................................
.26
Printing
....................................................................................... .27
Paper Feed
.................................................................................
.28
Paper Jams
................................................................................
.28
PaperReplacement
.................................................................... .28
Stopping the
Printer
.................................................................... .29
Error Conditions..........................................................................
.30
Calibration Check and Recalibration
...........................................
31
The ATS Recommendation
........................................................
.31
CalibrationCheck
.......................................................................
.32
Recalibration
............................................................................... .34
Quick Calibration Check and Recalibration Reference Charts. .
..3 6

INTRODUCTION TO SPIROM
Battery
Maintenance..
................................................................... .37
Battery Recharging
.....................................................................
.37
Battery Replacement
..................................................................
.39
Cleaning and Sterilization
.............................................................
41
Pneumotach ...............................................................................
.41
Body of PneumoCheck
...............................................................
.42
Printer/Charger...........................................................................
.42
Charging
Transformers...............................................................
.42
Accessories
.................................................................................... 43
Warranty.........................................................................................
44
Repair..............................................................................................
44
Appendix
A . PneumoCheckMessages..
.................................... .45
PneumoCheck Status
Messages...............................................
.45
PneumoCheckError
Messages..................................................
.48
PneumoCheck Test Values
........................................................
.48
Appendix B - Maneuver Quality Messages
.................................. 49
Appendix C - Predicted Normal Values
....................................... 51
The Ideal Study..........................................................................
.51
Predicteds Available on Your PneumoCheck.............................
.51
RacialDifferences ......................................................................
.52
CalculatingPredictedValuesManually
......................................
.52
Reference Tables:
Knudson, 1983 122121* .........................................................................
.54
Knudson,
1976,13,........................................................................
.56
Morris, Crapo, et al., 1981
144 ........................................................
57
European Community for Coal and Steel
166 ................................. 58
Coefficients for MVV'ss
................................................................
.58
Appendix D - Technical Specifications
........................................ 59
PneumoCheck ............................................................................
.59
Printer/Charger...........................................................................
.60
StandardsCompliance
...............................................................
.60
Appendix E - Glossary
...................................................................
61
Appendix F
- Bibliography
........................................................... .64
The Welch Allyn PneumoCheck is a
tally designed to perform FVC and h
accurately. In order to properly use y
useful test results, you should be fan
spirometry:
A spirometer is a device that measur
breathed into or out of it.
To perform a spirometry test, a
patie
in a prescribed manner over a knowr
ent types of spirometry tests can be
I
of which yields different information t
1

INTRODUCTION TO SPIROMETRY
The Welch Allyn PneumoCheck is a hand-held spirometer specifi-
cally designed to perform FVC and MVV spirometry tests easily and
accurately. In order to properly use your PneumoCheck and to obtain
useful test results, you should be familiar with the basic principles of
spirometry:
A spirometer is a device that measures the amount of air that is
breathed into or out of it.
To perform a spirometry test, a patient breathes into the spirometer
in a prescribed manner over a known period of time. Several differ-
ent types of spirometry tests can be done using a spirometer, each
of which yields different information about the patient’s lung function.
1

PARTS OF THE WELCH ALLYN
PNEUMOCHECK SPIROMETER (#61000)
PNEUMOTACH
ASSEMBLY
MOUTHPIECE
LIQUID
---I
CRYSTAL
DISPLAY
I
BODY OF
PNEUMOCHECK
ON/OFF
SWITCH
PNEUMOTACH
ASSEMBLY
L(ORANGE)
SPEAKER FOR
AUDITORY
SIGNALS
BODY OF
PNEUMOCHECK
CHARGING
JACK
DATA/CHARGING
CONTACT
3

PRELIMINARY OPERATING INSTRUCTIONS THE FVC TEST
1.
If the instrument has not been stored at room temperature, allow
/
45 minutes for the temperature of the instrument to stabilize.
2.
Visually check the screen of the PneumoCheck (see p. 41) and
check the calibration (see p. 31).
3.
Instruct the patient about what is expected and how to perform a
good test (see p. 8 for FVC or p. 21 for MVV).
4.
Ask the adult patient to attach a disposable mouthpiece using a
push-and-twist motion to ensure a snug fit.
For children, insert a disposable pediatric mouthpiece.
5.
Slide the ON/OFF switch to the right to turn instrument on. The
word CLEAR will appear on the liquid crystal display (LCD) and a
beep will sound indicating the instrument’s memory has been
cleared.
6.
When SELECT is displayed, select the type of test by repeatedly
depressing the TEST button:
Press once and release to access FVC.
Press again and release for MVV.
Press again and release for CAL (calibration).
Press and release a fourth time to return to SELECT.
With each selection the appropriate word or abbreviation will appear
on the liquid crystal display (SELECT, FVC, MVV, CAL). Within
three seconds that particular test will begin.
QUICK FVC REFERENCE CHART
How To Use Your PneumoCheck a
3
Enter Age, Height, Race, Sex into
Printer/Charger
3
Instruct and Demonstrate Correci
FVC maneuver
t
1
Visually Check Screen of PneumoCh
i
3
Switch PneumoCheck ON, wait fo
SELECT and press TEST
1
DoFVC1,2,3...
3 Good Tests?
1
Place PneumoCheck into PrinterKha
i&
Wait for green DATA light to stop
1 Interpret Results J
5

THE FVC TEST
QUICK FVC REFERENCE CHART
How To Use Your PneumoCheck and Printer/Charger
Enter Age, Height, Race, Sex into
Printer/Charger
I
Instruct and Demonstrate Correct
I
Visually Check Screen of PneumoCheck
I
t
Switch PneumoCheck ON, wait for
SELECT and press TEST
DoFVC1,2,3...
Place PneumoCheck into Printer/Charger
1
Wait for green DATA light to stop
flashing, then press PRINT
1
+
Interpret Results
5

DESCRIPTION
The most frequently performed spirometry test is the forced expira-
tory vital capacity test, or FVC. It is commonly used for basic pulmo-
nary function testing as well as managing patients with chronic
obstructive pulmonary disease (COPD), asthma, emphysema,
bronchitis, or other lung diseases.
When doing a single maneuver, the patient inhales as much air as
possible, then exhales as rapidly and as completely as possible into
the spirometer. To perform a complete FVC spirometry test, the
patient should complete three or more acceptable FVC maneuvers
with a brief rest between each one.
MEASUREMENT PARAMETERS
Several characteristics of the FVC maneuver are helpful in evaluat-
ing the patient’s lung function.
The two most commonly used parameters are FVC and FEV1 :
FVC
Forced Expiratory Vital Capacity, the total amount of air (in liters)
exhaled during an FVC maneuver.
FEVl
Forced Expiratory Volume in one second, the volume of air (in liters)
exhaled during the first second of the FVC maneuver. FEVl is also
the measure of the average flow rate during the first second of the
FVC maneuver.
Other commonly used FVC parameters include:
FEVl
/FVC%
(also called RATIO) the ratio of the FEV1 to the FVC, expressed as
a percentage.
FEF25%-75%
Forced Expiratory Flow between the 25% and 75% volume points
(also called Mean Mid Expiratory Flow or MMEF). A measurement
of the average rate of flow (in liters/second) during the middle 50%
of the FVC maneuver.
6
PEF
Peak Expiratory Flow, the highest rat
during the FVC maneuver.
Once an acceptable FVC maneuver I
results can be compared to establish1
determined. The norms are based OI
of the patient.
Lung disorders usually fall into one
01
lung diseases or restrictive disorders
Obstructive lung diseases are those
1
rates or airflow limitation, such as ast
Chronic Obstructive Pulmonary
Disc:
Restrictive disorders are those that c(
reduced, such as congestive heart fa
pneumonia, pleural fibrosis, pneumoc
In general, it is possible to categorize
these two groups and gauge its seve
but it is usually not possible to identif
further information. The patient’s res
ment, response to various bronchodil
specific pulmonary tests may be
neec
disorder.
NOTE: During FVC maneuvers in the
instrument assumes that air at body 1
saturated with water (BTPS) will be L
applied.
7

PEF
Peak Expiratory Flow, the highest rate of airflow (in liters/second)
during the FVC maneuver.
Once an acceptable FVC maneuver has been completed, the test
results can be compared to established norms and a course of action
determined. The norms are based on the height, age, race and sex
of the patient.
Lung disorders usually fall into one of two categories: obstructive
lung diseases or restrictive disorders.
Obstructive lung diseases are those that cause a reduction in airflow
rates or airflow limitation, such as asthma, chronic bronchitis,
Chronic Obstructive Pulmonary Disease (COPD) and emphysema.
Restrictive disorders are those that cause the lung volume to be
reduced, such as congestive heart failure with pulmonary edema,
pneumonia, pleural fibrosis, pneumoconiosis and gross obesity.
In general, it is possible to categorize a lung disorder into one of
these two groups and gauge its severity with a basic spirometry test,
but it is usually not possible to identify the specific disorder without
further information. The patient’s respiratory history, work environ-
ment, response to various bronchodilators, and results from more
specific pulmonary tests may be needed to fully diagnose the
disorder.
NOTE: During FVC maneuvers in the normal operating mode, the
instrument assumes that air at body temperature and pressure, fully
saturated with water (BTPS) will be used, and a BTPS factor is
applied.
7

OBTAINING GOOD FVC TEST RESULTS
Accuracy of spirometry testing is very dependent on the effort of the
patient and is only valid if the patient cooperates and performs the
test to the best of his/her ability. Properly instructing and coaching
the patient throughout the maneuver is therefore critical.
Your Welch
Allyn PneumoCheck has a sophisticated monitoring
system which will help you in deciding whether a maneuver was a
valid effort.
However, you must know how to properly teach your patients to
perform good tests or your PneumoCheck will continually find fault
with maneuvers and you and your patient will quickly become
frustrated.
To Obtain a Good FVC Result:
1.
2.
3.
4.
5.
Unacceptable conditions inc
l slow or hesitating start
l air leaking around the m
l coughing during the first
l mouthpiece obstruction
l quitting too soon
6. When the maneuver has been c
message. If a message appear:
maneuver (see p.
49), instruct tt-
problem and repeat the test.
Explain the test and what you expect.
Demonstrate how to place the disposable mouthpiece in the
mouth (teeth on the outside, forming a good seal with the lips).
Demonstrate how a maneuver is done by doing one yourself.
Make sure your effort is a good one by inhaling all the way and
then exhaling as completely and rapidly as possible either into
the instrument or simply into the disposable mouthpiece.
Coach your patient throughout the test: “Now blast out hard and
fast!! All you can!! More! More! Keep going a little more!”
Learn to recognize poor maneuvers by closely observing the
patient:
An acceptable maneuver requires:
l adequate understanding
l maximal inhalation
l a rapid start of the effort
l apparent maximal effort with continuous, steady
exhalation
l at least three seconds of exhalation (the ideal is
six to ten seconds)
89

6.
Unacceptable conditions include:
l slow or hesitating start
l air leaking around the mouthpiece
l coughing during the first second of the maneuver
l mouthpiece obstruction by tongue, lips, or teeth
l quitting too soon
When the maneuver has been completed, observe the quality
message. If a message appears indicating an unacceptable
maneuver (see p.
49), instruct the patient on how to correct the
problem and repeat the test.
9

Example of Acceptable (GOOD FVC) Effort: Examples of Unacceptable Efforts
ACE:23 HEIGHT:7Zin
RACE: 2 SEX: M
ACTUAL NORM %NORM ABN
FVC
Pzs ?
&0x
. 2
$
185
4.19
58$g
10.81 IS:02
7s
108
NORMS :
Knudson 1983
Good FVC maneuver.
< VS30P30 >
FVC Xl
,~r......,.......,......,..
,2,,.......................
*&..l SEC ’
10
E: 37 HEIGHT: bbin
B:Z w:F
RCTURL NORM
%NORM RSN
NORMS: Knudson 1983
( VS30P30 1
Slow FVC start: begin faster.
FVC Wl
,b.,
,a.
‘6.89SEC
,*.
; ,.,. ;,,!..I .I..I. :.,I..:
r ‘..:. :,.:..:.....:
Mb.
’
SOLU~ I~J L?TER&
’ ’
BAD START
I
-:23 HEICHT:YZin B:Z B:m E
ACTUAL NORM %NORM ABN
FVC
NORMS: Knudson 1983
( VS30P30 ) F
FVC intrrrupted: avoid coushins. k
7.44 SEC
COUGH
\
11

Examples of Unacceptable Efforts:
@g:37 HEICHT:66in RRCE.2 B.F
ACTUALNORM %NORM ASN
NORMS: Knudson 1983 ( VS30P30 >
Slow FVC start: brgin fastor.
FVC Wl
6.89 SEC
BAD START
-:23 HEIGHT.72in s:Z SB:M
RCTUflL NORM %NORM RBN
%:02
d: 73 t 0
5.60 1 7
468z
$6
18: 3 B
NORMS: Knudson 1983
( VS30P30 >
FVC interrupted: avoid coughing.
FVC Xl
7.44 SEC
COUGH
11
a: 23 HEIGHT: 72 1 n
m:z m:rl
ACTUAL NORM %NORM RBN
NORMS: Crapo 198 1
< VS30P30 >
Fugdon termination of FVC.
V too short: blow out longer.
FVC
#l
I’(_
,I.
0.86 SEC
I$OLU&E
IAN L?TER~ ’’
BAD STOP
AZ:23 HFIGHT:7Zin
RACE,2 B:tl
RCTUALNORM XNORM RBN
FVC
NORMS: Knudson 1983
( VS30P30 )
Weak FVC sffort: blast harder.
FVC #l
8.47 SEC
,.
WEAK TRY

DOING AN FVC MANEUVER
1. Upon selection of FVC, the PneumoCheck first measures zero
airflow through the pneumotach to assure maximum accuracy.
During this time (no more than seven seconds) the word
STEADY is displayed and it is important to hold the
Pneumo-
Check still so that an accurate reference can be made. If the
PneumoCheck is moved during this time, the STEADY message
will remain until it is held quite still for at least three seconds, or
until an UNSTEADY message appears. Should an UNSTEADY
message appear, depress the TEST button to start FVC again.
2. The PneumoCheck then displays the message DO FVC 1, and
beeps.
3. The patient may sit or stand, but position should be noted,,. A
sitting position is often preferred for stability.
4. Instruct the patient to inhale deeply, put the mouthpiece in his/
her mouth and exhale as completely and with as much force as
possible.
After completely emptying the lungs, the patient removes the
instrument from the mouth. The PneumoCheck will beep after
about four seconds, indicating it has seen the end of the
maneuver.
NOTE: Inhalation should not be done through the pneumotach.
Back end of pneumotach should not be blocked.
In performing an FVC maneuver the patient’s lips and teeth
should be placed around the mouthpiece, with the lips forming a
seal. The mouth should be opened
w
obstruction by the teeth or tongue.
5. The PneumoCheck will then disp
results. It will then provide a seri
message appears automatically,
patient’s effort. The message for
FVC. For a complete list of the c
see p. 49.
6. Press and release the DATA but
additional quality messages and
parameters for the maneuver: F\
FVC%), MMEF (or FEF 25%-759
and discussion of these values, I
(P. 17).
7. Press the TEST button to return
13

seal. The mouth should be opened wide enough to avoid any
obstruction by the teeth or tongue.
5.
6.
7.
The PneumoCheck will then display BUSY while calculating test
results. It will then provide a series of messages. The first
message appears automatically, and gives an indication of the
patient’s effort. The message for an acceptable effort is GOOD
FVC. For a complete list of the other quality control messages
see p. 49.
Press and release the DATA button consecutively to see
additional quality messages and each of the calculated
parameters for the maneuver: FVC, FEW, RATIO (or
FEV1/
FVC%), MMEF (or FEF 25%-75%), and PEF. For a definition
and discussion of these values, refer to Interpretation of Results
(P. 17).
Press the TEST button to return to SELECT.
13

DOING MULTIPLE TESTS ON A PATIENT
ASSESSING ACCEPTABILITY:
According to the American Thoracic Society recommendations for
testing,,, the patient should perform at least three acceptable FVC
maneuvers, the best two of which must match one another within
5%. The best effort is then used to assess patient status.
No more than eight maneuvers should be obtained to avoid fatiguing
the patient.
This is easily accomplished with your Welch Allyn PneumoCheck as
it will automatically:
1. Assess acceptability.
2. Save the best test.
3. Determine repeatability (“matching”).
Following is a description of the specifics:
When power is first turned on, the instrument’s memory is empty as
indicated by the CLEAR message.
The PneumoCheck automatically stores all test data for the best
FVC and the best MVV as well as the most recent FVC and MVV
maneuvers. To review BEST or LAST test:
Press TEST button to access SELECT.
Press DATA button once and release to access BEST FVC.
Press DATA button again and release to access LAST FVC.
Press DATA button and release a third time to return to
SELECT.
After accessing BEST or LAST memory, wait three seconds for the
quality control message. Then, push and release DATA to see
calculated values for that test.
14
The PneumoCheck will determine whl
performed should replace the manem
as BEST test. In making this determir
looks at the quality control messages
“good” maneuver is one that has no
ic
cough in the middle of the maneuver t
SELECTING BEST TEST:
One Acceptable, One Not
If the new maneuver is acceptable an
maneuver was not, then the previous1
discarded and the new maneuver is s
Likewise, if the new maneuver is not I
stored BEST maneuver was acceptat
BEST maneuver is retained.
Both Acceptable, Both Unacceptab
If the stored BEST maneuver and the
acceptable or both unacceptable, the
mines which is BEST based on the fo
Criterion For Best FVC Maneuver:
The larger sum of the FVC and FEVl
Criterion For Best MVV Maneuver:
The higher value as expressed in liter
DETERMINING REPEATABILITY:
In addition to selection of the best tes
the tests were reproducible, that is, tc
do this the currently stored best test
i!
test and a message appears after the
15

ASSESSING ACCEPTABILITY:
The PneumoCheck will determine whether the maneuver just
performed should replace the maneuver that was previously stored
as BEST test. In making this determination, the PneumoCheck first
looks at the quality control messages for the new maneuver. A
“good” maneuver is one that has no identifiable faults, such as a
cough in the middle of the maneuver or a hesitating start (see p. 8).
SELECTING BEST TEST:
One Acceptable, One Not
If the new maneuver is acceptable and the previously stored BEST
maneuver was not, then the previously stored BEST maneuver is
discarded and the new maneuver is stored in its place.
Likewise, if the new maneuver is not acceptable while the previously
stored BEST maneuver was acceptable, then the previously stored
BEST maneuver is retained.
Both Acceptable, Both Unacceptable
If the stored BEST maneuver and the new maneuver are both
acceptable or both unacceptable, the PneumoCheck next deter-
mines which is BEST based on the following criteria:
Criterion For Best FVC Maneuver:
The larger sum of the FVC and FEVl
Criterion For Best MVV Maneuver:
The higher value as expressed in liters/minute.
DETERMINING REPEATABILITY:
In addition to selection of the best test, it is important to know that
the tests were reproducible, that is, to know that they matched. To
do this the currently stored best test is compared to the most recent
test and a message appears after the quality message.
15

Match Criteria INTERPRETATION OF RESULTS
FVC
The previously stored best maneuver and the new maneuver are
compared:
l MATCH will be displayed if both FVC values are within 5% of
each other and both FEVl values are within 5% of each other.
If both FVC values and both FEVl values are not within 5% of
each other:
l NO MATCH will be displayed if the new maneuver is
5% less than the previously stored BEST.
l NEW BEST will be displayed if the new maneuver is 5%
greater than the previously stored BEST.
MVV
l MATCH will be displayed if the MVV values of the two tests
being compared are within 15% of each other.
l NO MATCH will be displayed if the MVV values compared are
not within 15% of each other.
Remember that results displayed at the completion of the
maneuver are for the maneuver just completed. See p.14 for
instructions on accessing BEST and LAST tests.
NOTE: Turn the ON/OFF switch to OFF and back to ON before
beginning a test on a new patient, so that the previous patient data
memory is cleared.
16
The PneumoCheck Printer/Charger VI
which are abnormal, ,,. If the FEVl/f
obstructive disorder is indicated. Use
of the obstruction:
l An FEVl above 80% of predicte
Borderline Obstruction.
l An FEVl between 60% and 809
Mild Obstruction.
l An FEVl between 40% and 609
Moderate Obstruction.
l An FEVl below 40% of predicte
Severe Obstruction.
l If the FEVI is below 80% of pre
below 80% of predicted, the po:
Restriction in addition to the Ob
If the FEVl/FVC ratio is normal, bu
strictive disorder is indicated, and
severity of the restriction:
l An FVC between 60% of predic
normal indicates a Mild Restric
l An FVC between 50% and 60%
Moderate Restriction.
l An FVC below 50% of predictec
Severe Restriction.
Any patient who has a normal FVC, F
considered to be within normal limits
obstructive lung disease can be
rulec
asymptomatic asthmatic who is in rer
17