Organ procurement organization and university-based respiratory care program partnership to develop student internships.

INTRODUCTION: Health care providers working as organ recovery coordinators (ORC) in the United States have diverse backgrounds and many of the skills needed for the position are obtained during on-the-job training. Some students in health care programs express interest in the organ procurement field but have limited experience and knowledge regarding organ procurement practices. In response to this, a partnership was developed between an undergraduate respiratory care (RC) program and its local organ procurement organization (OPO) to develop and initiate an internship designed to educate students regarding organ procurement. APPROACH: The 160-h internship was developed with collaboration between the OPO administration and faculty from the university RC program, which closely followed the OPO's formalized per diem ORC orientation model. Student reflective journals were qualitatively analyzed to determine the shared experiences during the OPO internships. FINDINGS: One RC student participated in the internship in 2017 and three RC students participated in 2019. The student interns actively participated in organ donor management in the critical care and surgical settings with the scheduled ORCs. Student progression of emotional competence and leadership were demonstrated throughout the internship. DISCUSSION: The OPO internship benefited RC students by providing opportunities for professional development that may not be available during their typical clinical rotations and strengthened their critical care skills and emotional competence. CONCLUSION: Employment as an ORC is an emerging role for respiratory therapists. Offering educational opportunities such as internships in emerging roles promotes student development and autonomy while promoting the respiratory therapy profession.

Development of a Pulmonary Workshop for Organ Recovery Coordinators' Continuing Medical Education.

Organ recovery coordinators (ORCs) have varied professional education backgrounds; however, based on their specialized education, their training may not have included in-depth mechanical ventilation and pulmonary management. An 8-hour pulmonary workshop was developed in collaboration between an organ procurement organization and a university-based respiratory care department. The workshop focused on pulmonary management and hands-on laboratory exercises using mechanical ventilators. A program assessment questionnaire was completed by participants following the workshop, which requested their self-reported comfort/familiarity with pulmonary management skills before and after the workshop on a 5-point Likert scale. Following the pulmonary workshop, the mean ORC comfort/familiarity for all pulmonary management skills increased significantly (P < .01). This program suggests ORCs can develop a greater awareness and comfort with pulmonary management by participating in a continuing education pulmonary workshop. Continuing education initiatives focused on pulmonary management of donor patients using hands-on competencies should be part of the ORCs practice improvement efforts.

Identifying Potential Ventilator Auto-Triggering Among Organ Procurement Organization Referrals.

CONTEXT: Ventilator auto-trigger is the delivery of an assisted mechanical ventilated breath over the set ventilator frequency in the absence of a spontaneous inspiratory effort and can be caused by inappropriate ventilator trigger sensitivity. Ventilator auto-trigger can be misinterpreted as a spontaneous breath and has the potential to delay or prevent brain death testing and confuse health-care professionals and/or patient families. OBJECTIVE: To determine the frequency of organ donor referrals from 1 Organ Procurement Organization (OPO) that could benefit from an algorithm designed to assist organ recovery coordinators to identify and correct ventilator auto-triggering. DESIGN: This retrospective analysis evaluated documentation of organ donor referrals from 1 OPO in central Texas during the 2013 calendar year that resulted in the withdrawal of care by the patient's family and the recovery of organs. MAIN OUTCOME MEASURES: The frequency of referrals that presented with absent brain stem reflexes except for additional respirations over the set ventilator rate was determined to assess for the need of the proposed algorithm. RESULTS: Documentation of 672 organ procurement organization referrals was evaluated. Documentation from 42 referrals that resulted in the withdrawal of care and 21 referrals that resulted in the recovery of organs were identified with absent brain stem reflexes except for spontaneous respirations on the mechanical ventilator. As a result, an algorithm designed to identify and correct ventilator auto-trigger could have been used 63 times during the 2013 calendar year.

Right Versus Left Prong Nasal Cannula Flow Delivery and the Effects of Nasal Cycling on Inspired F(IO2) in an Adult Anatomic Model.

BACKGROUND: Nasal cycling may present negative consequences for oxygen-dependent patients using a nasal cannula. This study investigates the effects of nasal cycling on the delivered F(IO2) via nasal cannula in an anatomic model following a baseline study comparing right and left prong nasal cannula oxygen flow delivery. METHODS: Flow from right and left nasal cannula prongs were measured simultaneously using thermal mass flow meters while delivering 0.5-6-L/min oxygen for 5 nasal cannulas from different manufacturers. An adult mannikin head with an anatomically correct upper airway was connected to a QuickLung Breather test lung. Nasal cannula-delivered F(IO2) was recorded using a polarographic oxygen analyzer with naris occlusion simulated by inserting a 5.0 endotracheal tube into the naris and inflating the endotracheal tube cuff. Data were recorded with both nares open, for right naris occluded and left naris patent, and for left naris occluded and right naris patent at 0.5-6 L/min. RESULTS: A paired t test demonstrated statistical differences between right and left nasal cannula prong oxygen flows (P < .01). Multivariate analysis of variance demonstrated no significant differences in nasal cannula prong flow between nasal cannula manufacturers. Repeated measures analysis of variance demonstrated significant differences for measured inspired F(IO2) (P < .01) when alternating nares were occluded and patent. The Bonferroni post hoc test showed significant differences for measured F(IO2) between patent nares and right naris patent-left naris occluded (P < .01) and between patent nares and left naris patent-right naris occluded (P < .01). Measured F(IO2) decreased by as much as 0.1 when one naris was occluded. CONCLUSIONS: Oxygen delivery by nasal cannula may be inefficient in the presence of the nasal cycle. Delivered nasal cannula oxygen concentrations decreased when bilateral nasal patency changed to unilateral nasal patency. Although statistically different, nasal cannula prong oxygen flow may not be clinically important across the full range of flows.

Managing Asthma on the College Campus: Findings of a Texas Pilot Study.

BACKGROUND: Students attending institutions of higher education have the option of utilizing their student health center (SHC) for asthma management. However, a review of the available literature revealed no previous research as to how SHCs on college campuses in Texas manage students with asthma. This led to the following research questions; how are SHCs in Texas managing asthma for college students, and what are the SHC directors' attitudes and perceptions of the impact of asthma on their college campuses? METHODS: This descriptive pilot study randomly selected 20 colleges in Texas; 17 institutions agreed to participate. The inclusion criteria consisted of 4-y colleges accredited by the Southern Association of Colleges and Schools with an undergraduate student population of greater than 1,000 full-time students, excluding online colleges. Once identified, the director of each institution's SHC was contacted by telephone and invited to complete the Managing Asthma on College Campuses Survey instrument via telephone interview (n = 14) or e-mail (n = 3). Descriptive statistics were used to analyze quantitative data and common themes were noted for the qualitative data. RESULTS: Quantitative data obtained through the survey revealed 23.5% of SHCs provide individualized asthma action plans to students and 35% of SHCs stated they have an emergency action plan for asthma exacerbations. Respondents noted 2 major barriers for effective asthma management on campus: lack of understanding of chronic disease management and underuse of the SHC due to a lack of awareness of its existence. Perceived barriers to visiting the SHC included access issues, money, and students self-medicating with short-acting ß2 agonist inhalers and/or over-the-counter medications. CONCLUSIONS: The majority of directors were satisfied with asthma services provided to students; however, they felt more face-to-face asthma education was needed.

Apnea testing: the effects of insufflation catheter size and flow on pressure and volume in a test lung.

BACKGROUND: The apnea test is used to determine the absence of respiratory drive when determining brain death. Current guidelines for performing the apnea test do not specify the size of insufflation catheter (IC) to use with each endotracheal tube (ETT) size, despite case reports describing procedure-related complications with the use of various IC sizes. We studied the effect of the ratio of IC outer diameter to ETT inner diameter on the pressure and volume generated within the lungs during the apnea test. METHODS: We tested ETTs with inner diameters of 6.0-10.0 mm, IC outer diameters of 10-16 French, and oxygen-supply tubing, at oxygen flows of 6-15 L/min, in an intubation manikin connected to a test lung. RESULTS: The multivariate analysis of variance method identified significant differences in the pressures and volumes during the apnea test (P < .001), and the Tukey method identified significant differences in the pressures and volumes associated with IC/ETT ratios ≥ 0.7 and < 0.7 (P < .05). CONCLUSIONS: An IC with an outer diameter < 70% of the ETT inner diameter, at 6 L/min, may prevent inappropriate lung pressure and volume during the apnea test. This recommendation, coupled with current American Academy of Neurology guidelines for the determination of brain death, may reduce the risk of procedure-related complications.

Suction catheter size: an assessment and comparison of 3 different calculation methods.

BACKGROUND: Current American Association for Respiratory Care (AARC) clinical practice guidelines recommend a suction catheter to endotracheal tube ratio (SC/ETT) based on the external diameter of the SC and the internal diameter of the ETT. An SC/ETT ratio of < 50% is consistent with the current recommendation. We theorized that a more satisfactory assessment of SC/ETT ratio could be accomplished using volume or area formulas and expansion of diameter recommendations. Some respiratory care texts recommend an SC/ETT ratio that exceeds the clinical practice guideline standard. METHODS: We calculated the internal volume and cross-sectional area of various ETT sizes, the external volume and cross-sectional area of various SC sizes, and the SC/ETT ratios. We also measured negative pressures created by suction in a lung model, during multiple suction maneuvers. RESULTS: Volume and area calculations provide an alternative method for determining the SC/ETT ratio. A volume or area ratio of 50% corresponds to a diameter ratio of 70%. Negative pressures during suctioning remain low at the new ratios, so a larger SC than current clinical practice guidelines still allows adequate air passage between the SC and ETT. CONCLUSIONS: Our results support an alternative SC/ETT ratio when pairing SCs and ETTs.

Broncholithiasis secondary to pulmonary actinomycosis.

We report a case of broncholithiasis secondary to pulmonary actinomycosis. Broncholithiasis has occasionally been reported in association with actinomycosis, but it is unclear if actinomycosis leads to lymph node calcification with subsequent erosion into the airway, producing a broncholith, or if an existing generic broncholith is secondarily colonized with Actinomyces. The patient had post-obstruction pneumonia, and computed tomography showed calcified nodules obstructing the bronchus intermedius and distal necrotizing pneumonia. The nodules included sulfur granules containing Gram-positive branching filamentous organisms consistent with Actinomyces. The finding of Actinomyces throughout the broncholith is strong evidence that the etiology of the broncholithiasis was a primary pulmonary Actinomyces infection.