SPUTUM INDUCTIONS:

SOURCE OF PATIENTS:

  1. patients are sent up from OPD, they will be seen in our physio room
  2. patients referred from wards: if mobile, should be sent to our physio OPD room (preferably not having eaten breakfast) first thing in the morning . If not mobile, the portable nebulizer can be taken down to wards and induction performed there, or an assistant asked to bring the patient up to physio OPD in a wheelchair.

TIMES:

Sputum inductions are best done early in the morning if the person is from wards. However, OPD patients will be seen as they arrive.

PROTECTIVE GEAR:

The following protective gear is to be worn when nebulizing someone:

  1. duck mask
  2. apron
  3. gloves

Tell the patient to turn away from you if they cough, and ask them to handle their own sputum jar lids if possible. Make sure the fan is off, and the curtains are closed. If we ever get UV lights, make sure they are ON.

PROCEDURE:

Explain the procedure to the patient- or mother and child. Explain that if they need to cough, they must move the mask onto their forehead and cough into the sputum bottle. Explain the difference between saliva and sputum. Give the patient a magazine to read, or let the child sit on their mothers lap. Emphasize that should the patient feel bronchospastic, SOB, nauseous or dizzy, they should call you immediately. Be very wary of epileptics- stay close by!

Remove 5ml hypertonic saline from the bottle with a syringe. Recap and store safely afterwards. Put saline into correct size mask, attach to machine and put on patient. Switch machine on. Check it is nebulizing well. Nebulize for 15-20 min. If still unproductive, take outside and ask to do steps, or if immobile, then do autogenic drainage and PD.

If 2 samples (AFB)/3 samples (AFB & MCS)/1 sample (MCS) are obtained, tell patient to take samples back to ward or OPD and give them to a nurse. If nothing obtained, write an apology note and send back to the doctor that originally saw them- they will need to make another plan.

INCIDENT REPORT:

If something happens to you that puts you at risk of infection, follow the OHS Incident Management guidelines. Report it to your supervisor and then the medical manager.

If something happens to the patient, call supervisor immediately and document vary carefully in patients file.

PRECAUTIONS:

-dyspnoeic (short of breath and distressed)

-asthmatic/wheezy

-epileptic

Call the supervisor before you see these patients.

Compiled by:

ME Bezuidenhout

January 2010

Review Jan 2011