Contents

Respiratory Services Disclaimer Service Overview Canterbury Respiratory Services Staff Staff Contact List Department Timetables - Respiratory Services Meetings and Ward Rounds (Christchurch Hospital) Outpatients Timetable Bronchoscopy Timetable Admissions Protocol Which Respiratory Team? Which Physician? FSA Referrals - General Respiratory FSA Referrals - Sleep Referrals Referrals for Inpatient Care - Includes Day Patients Patient Follow-Up after Inpatient Respiratory Admission Information for Registrars and House Surgeons Orientation Registrars' Orientation Checklist - Respiratory Services House Officers' Orientation Checklist - Respiratory Services Ward work and general information Admissions Arranging follow-up appointments Discharge summaries Patient management Drug charting Smoking cessation Dealing with abnormal results Managing the on-call (Registrars only) Secretaries Inserting chest drains Admitting to acute NIV unit Arranging and reviewing radiology Arranging a bronchoscopy/thoracoscopy Arranging domiciliary oxygen Arranging a sleep test Arranging respiratory physiotherapy Arranging Palliative Care Team referrals Arranging Lung Cancer Meeting case reviews Arranging X-ray Meeting case reviews Deteriorating respiratory patients Outpatient clinics - Registrars only Respiratory physiology laboratory Infection control issues Quality assurance Private patients Education sessions Mortality Meeting Integrated Respiratory Service Mortality Meeting Guidelines Preamble Purpose Objectives Legal status Key roles Case selection Meeting format and timetable Meeting preparation Guidelines for presenters Guidelines to assist case comments and discussion Final word Appendix Respiratory Ward (Ward 25) Criteria for Admission to Room 10 Ward 25 Troubleshooting Out of Hours Out of Hours CPAP Enquiry - Sleep Unit Emergency CPAP Machine and Mask Issue Out of Hours BiPAP Enquiry Emergency BiPAP Machine or Mask Issue Request for Sleep Studies All Other Sleep Unit Requests Out of Hours Domiciliary Oxygen Enquiries Key Points Oxygen concentrator sounding an alarm Cylinder or regulator damaged or faulty Run out of oxygen cylinders Miscellaneous Empty / faulty / damaged oxygen cylinders – neonatal / paediatric patients Spare equipment is held at the following places Negative Airflow Rooms Respiratory Outpatient Unit Nursing Objective Referrals to the Unit Respiratory Outpatient Clinics Clinic Nursing Staff Clinic Accommodation Booking Procedures Clinic Timetable Hours of Operation Respiratory Physiology Laboratory Location Staff Service Hours Diagnostic Service Description Service Quality Requesting Tests Interpretation of Tests Research in Canterbury Respiratory Services - The Canterbury Respiratory Research Group Structure Governance of Research by employees of Canterbury Respiratory Services and CRRG Summary The Research Register Cardio-Respiratory Integrated Specialist Services (CRISS) CRISS Staff Referral to CRISS - Patient Selection Guidelines Services Available Sleep Services Contact details Definitions Background Referral to Sleep Service Diagnostic Tests Management of OSA Power Dependent Patients: Risk Categories Action Plan - in the event of prolonged power failure Additional Information Long Term Follow-Up Outpatient Management of OSA Clinical Pathway Definitions Background Assessment Hospital Outpatient Referral References Respiratory Physiotherapy Services Orientation for Medical Staff Physiotherapists Referral Process Four Categories of Treatment Nutrition Services Clinical Dietitian Referral Process Contacting the Dietitian Key Areas of Nutritional Input Patients not seen on the ward Special Authority Applications for Special Foods Respiratory Social Workers Social Work Contacts Referral Requirements for Social Work Assessment Other Social Work Tasks (see also Section B) Respiratory Clinical Psychologist Referral Respiratory Education Services (Adult) Hospital-Based Education Service and Referral Information Patient Education in the Community Staff Education Community-Based Education Services Procedures and Protocols Acute Non-Invasive Ventilation Unit General Statements Guidelines for Admission to the Non-Invasive Ventilation (NIV) Unit Ward 25 Commencing Non-Invasive Ventilation (NIV) Procedure Weaning Non-Invasive Ventilation (NIV) Purpose/Objective Personnel Authorised to Perform Procedure Associated Documents Definitions General Statement on Weaning NIV Equipment Procedure References Transfer of a Patient from the NIV unit (Room 10) Ward 25 to the Intensive Care Unit (ICU) Purpose/Objective Personnel Authorised to Perform Procedure Associated Documents General Statement Equipment Procedure/Guideline References Troubleshooting NIV Advance Care Planning (ACP) Introduction to Advance Care Planning What to do if a Person asks about Advance Care Planning Resources for Staff Resources for Patients More Information: Who to Contact Aminophylline 250 mg/10 mL Infusion Guidelines Amphotericin - Instructions for Use Antibiotic Desensitisation Asbestos-Related ACC Claims Bronchoscopy Indications / Contraindications Diagnostic Uses Therapeutic Uses Contraindications Risks and Complications Increased Patient Risk Increased Staff Risk Complications Arranging Bronchoscopy Bronchoscopy Booking Procedure Cancelling or Changing Bookings Pre-Bronchoscopy Responsibilities RMO Staff Duties before the Bronchoscopy Nursing Staff Duties before the Bronchoscopy Occupational Health and Safety Bronchoscopy Procedure Preparation for Bronchoscopy Protocols for Individual Consultants Sample Diagnostic Procedures Cytology Brushes Microbiology Specimen Sheath Brushes Standard Bronchial or Mass Biopsy Transbronchial Lung Biopsy (TBB) Wang Needle Biopsy / (Transbronchial) Needle Aspiration (TBNA) EBUS - Endobronchial Ultrasound Specimen Handling Instructions for EBUS/TBNA Cytology Samples Bronchial Washes Broncho-Alveolar Lavage Procedure for the Removal of Foreign Bodies Interventional Bronchoscopy Procedures Stent Insertion Protocol Using the Fibreoptic Bronchoscope (i.e., light source but no video) Performance Characteristics for Various Bronchoscopic Procedures On Completion of Bronchoscopy Post-Bronchoscopy Responsibilities RMO Staff Responsibilities After Bronchoscopy Nursing Staff Duties After the Procedure/Recovery Guidelines Training for Nursing and Medical Staff Training for the Bronchoscopy Nursing Staff Requirements for the Trainee Bronchoscopist / Medical Staff Bronchoscopy Emergency Procedures Bleeding Endobronchial Tamponade Setting up Rigid Bronchoscope Pneumothorax Kit Fire Safety Procedures Cardiac / Respiratory Arrest Contacting Respiratory Team in Emergency Annual Review of Bronchoscopy Emergency Procedures Bronchoscopy Equipment Bronchoscopy Cleaning Procedure Cross Infection Quality Control Taking Sample Cultures Hospi-gard - Instructions for Use Medical Thoracoscopy Chest Drains Chest drain insertion and management General Indications Relative Contraindications Equipment Equipment for Seldinger Drain Insertion "guidewire technique" Equipment for Large Bore Drain "blunt dissection technique" Consent and Complications Premedication Location and Personnel for Chest Drain Insertion Patient Position and Site of Insertion Aseptic Technique Anaesthesia Drain Insertion Securing the Drain Drainage Systems Dressing Post Procedure Care Pleural Effusion Drainage Chest Drain Troubleshooting Surgical Emphysema Long Term Tunnelled Plural Catheter (TPC) Nursing Management of Chest Drains and Related Procedures Assisting with Seldinger Chest Tube Insertion Assisting with a Wide Bore Chest Tube Insertion Care of Chest Drains Changing Chest Drainage Collection System Removing Chest Drains Flushing an Intercostal (IC) Chest Drain Assisting with Pleural Aspiration/Biopsy Administering Intra-pleural Medication for Pleurodesis 3-way Tap Procedure IC Tube Without 3-way Tap Procedure Administering Intra-pleural Streptokinase 3-way Tap Procedure IC Tube Without 3-way Tap Procedure Administering Intra-pleural Tissue Plasminogen Activator (t-PA/Alteplase) and Dornase Alfa (Pulmozyme/DNase) 3-way Tap Procedure IC Tube Without 3-way Tap Procedure Pneumostat Patient Information Leaflet Tunnelled Pleural Catheter (TPC) Referral Assisting with TPC Insertion Accessing a TPC for drainage Domiciliary Oxygen Points to Consider Before Referring for Oxygen Assessment and Provision of Home Oxygen Oxygen Categories Respiratory Category Cardiac Category Neurological Category Palliative Category Paediatric Category Oxygen Risk Category Follow-Up Troubleshooting After Hours for Current Oxygen Patients Guidelines for Patients Requiring Oxygen Therapy During Air Travel for Treatment or Clinical Appointments Patients Flying with Oxygen for Non-Medical Reasons Patients Flying with Oxygen for Medical Treatment Telephone Numbers Portable Concentrator Policy Overview - Loan of Portable Concentrators to CRISS Patients Points to Consider Prior to Loan of Concentrator Process of Loan/Return of Portable Concentrators References Guidelines for Nasal High FLow Oxygen - New Community Policy Overview - Nasal High Flow Oxygen in the Community Procedure Cleaning and disinfection of Fisher and Paykel myAIRVO2™ humidifiers Procedure The myAIRVO2™ - Consumable and Cleaning Information as Recommended by Fisher and Paykel Product Specialist Heliox Therapy - Management of Large Airway Compromise Heliox Therapy Guideline Home IV Service / Therapeutic Drug Monitoring (TDM) Referring Patients for Home IV Ward 25: Chronic Bronchiectasis Planned Treatment Regime Cystic Fibrosis Inpatient: Acute, Short Term Inpatient: Complex, Long Term, and Chronic Managing Home IV Induced Sputum and Hypertonic Saline Guidelines for Sputum Collection Sputum Specimens - Urgent and Routine Procedure for Induced Sputum Specimens Inpatient Transfer for Lung Transplant Intragam (Gammaglobulin) Treatment Lung Transplant Referrals Current Referral Criteria for NZ Heart & Lung Transplant Service Investigations Therapeutic Drug Monitoring Acute Rejection Chronic Rejection/ Bronchiolitis Obliterans Syndrome (BOS) Nebulised Treatments Assembly of Pari Nebuliser to Deliver Antibiotics Nebulised Antibiotics - Patient Information - Colistin Nebulised Antibiotics - Patient Information - Tobramycin (Tobi) for Patients with CF Nebulised Antibiotics - Patient Information - Tobramycin (80mg in 2mls) for Patients with Bronchiectasis Nebulised Hypertonic Saline Hypertonic Saline – Information for Patients Portacath Insertion Procedure for Respiratory Patients Management Guidelines for Specific Respiratory Conditions Asthma Beta Agonist Withdrawal in Asthma "Resistant" Asthma Beta2 Receptor Desensitisation Anti IgE Therapy Magnesium Therapy Leucotriene Receptor Antagonists Chronic Obstructive Pulmonary Disease (COPD) Community Acquired Pneumonia (CAP) Cystic Fibrosis CF Patients Admitted to Hospital After Hours Admission of Cystic Fibrosis (CF) Patients Cystic Fibrosis and Infection Control Treating Pulmonary Infections in Adults with Cystic Fibrosis General Information Oral Antimicrobials for Treatment of Pulmonary Exacerbations Intravenous Antimicrobials for Treatment of Pulmonary Exacerbations Inhaled Antimicrobials for Acute and Chronic Treatment of Pulmonary Exacerbations Other Respiratory Medication for the Treatment of Cystic Fibrosis Colistin for Antibiotic Therapy for Patients with CF Pseudomonas Eradication Guidelines Cystic Fibrosis Related Diabetes (CFRD) and Insulin Deficiency Cystic Fibrosis Annual Review Management of Haemoptysis Management of haemoptysis in patients with Cystic Fibrosis / Bronchiectasis Life Threatening Major Haemoptysis Management of Major haemoptysis >125 mL/24 hours (without features of life threatening haemoptysis) Distal Intestinal Obstruction Syndrome Using Gastrograffin - Patient Information Preparation for Colonoscopy – Patient information Low Fibre (Residue) Diet Clear Fluids / Clear Fluid Diet Helpful Hints Guidelines for Physiotherapy for Cystic Fibrosis Vitamin D Guidelines for CF Deteriorating respiratory patients Haemoptysis (Adult) Initial Assessment for All Patients Life Threatening Major Haemoptysis Lung Cancer Management Guidelines Diagnosis of Lung Cancer Staging - non-small cell lung cancer Staging - small cell lung cancer Patient pathway Respiratory physician Lung cancer nurse specialist Information available for the patient Initial evaluation Further evaluation of the patient considered for surgical management Considerations Assessing pulmonary function Assessing cardiac function Smoking cessation Staging of non-small-cell lung cancer Staging and establishing tissue or cytological diagnosis Imaging Unenhanced CT thorax and upper abdomen Contrast enhanced CT thorax MRI Positron emission tomography (PET) Other imaging Imaging patient pathway - non small cell lung carcinoma Clinical stage I or II disease after clinical evaluation and CT thorax Stage III disease, being considered for chemoradiation Stage IV disease or lower stage disease not considered a candidate for treatment with curative intent Imaging patient pathway - small cell lung cancer Patient being considered for concurrent chemoradiation Patient not suitable for concurrent chemoradiation Diagnostic procedures Sputum cytology Bronchoscopy EBUS-TBNA (Endobronchial Ultrasound - Transbronchial Needle Aspiration) Imaging guided FNA Cervical mediastinoscopy or an anterior mediastinoscopy under GA Surgical biopsy Patient pathway for tissue or cytological diagnosis Stage I and II disease, central lesion Stage III disease, mediastinal lymphadenopathy, potential surgical candidate if mediastinal lymph nodes negative Clinical stage IV disease and accessible solitary extrathoracic lesion, radical treatment possible if metastatic disease not confirmed Clinical stage IV disease and multiple extrathoracic lesions Accessible pleural effusion Solitary adrenal metastasis, potentially curable disease otherwise Treatment of NSCLC Primary treatment Adjuvant treatment Treatment of relapsed disease Treatment of SCLC Specific problems encountered in the assessment and management of LC Endobronchial therapy Epidural metastases causing spinal cord compression Bone metastases in long or weight-bearing bones Metastectomy in patients with solitary metastases Solitary pulmonary nodule Broncho-alveolar carcinoma Satellite nodule, synchronous tumour or pulmonary metastasis Pancoast (superior sulcus) tumour Pleural effusions Chest wall invasion Mediastinal invasion Superior Vena Cava obstruction Follow up after treatment Associated documents Neuromuscular Diseases and Ventilatory Failure/Home Ventilation Nicotine Dependent Patients Obstructive Sleep Apnoea Pleural Disorders Pleural Effusion Procedure and Protocol Pleural Effusions Chest Drains/Tube Thoracostomy Pleural Infections Malignant Pleural Effusions Persisting bronchopleural fistula Spontaneous Pneumothorax Haemothorax Pulmonary Hypertension Symptom Control for Respiratory Patients Tuberculosis Venous Thromboembolism, DVT and PE Reviews, Feedback, and Document Control Managing Unscheduled Updates to the documentation Managing Scheduled Reviews of the documentation Archive Process Review Schedule and Information Release Notes 2017 December 2017 November 2017 July 2017 March 2017 2016 December 2016 August 2016 June 2016 May 2016 February 2016 January 2016 2015 December 2015 November 2015 October 2015 September 2015 August 2015 July 2015 June 2015 May 2015 April 2015 March 2015 February 2015 January 2015 2014 December 2014 November 2014 October 2014 September 2014 August 2014 July 2014 June 2014 May 2014 April 2014 March 2014 January 2014 2013 October 2013 June 2013 May 2013 2012 September 2012 August 2012 June 2012 2011 November 2011 September 2011 February 2011 2010 November 2010 October 2010 July 2010 June 2010