Check ambient conditions (use a reliable barometer and thermometer) Ensure the correct system settings for dead space, pressure range, volume, and BTPS correction Accurate calibration for volume and pressure Check volume accuracy ±75 mL 0–90% response time ≤150 ms Linearity: ≤0.5% of full scale Accuracy: ±1% of full scale Adjust for lag and response time QC using regular biological controls Quality assurance using syringe or DLCO gas simulator
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Interference from 5% CO2 or 5% water vapour ≤10 ppm error in CO Drift for CO ≤10 ppm over 30 s Drift for tracer gas ≤0.5% of full scale over 30 s BHT 10±2 s
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Maximum time for unforced exhalation to RV is ≤12 s Vinsp target of ≥90% of largest VC in same lung function testing session Vinsp ≥85% of VC is acceptable if VA is within 200 mL or 5% of highest VA from acceptable DLCO trial Vinsp must be <4 s, longer Vinsp must be noted on report Exhalation post-BHT past sample collection on classic systems <4 s Exhalation to RV post BHT on RGA systems can be up to 12 s Between test wait time: 4 min, 10 min for patient with severe airflow obstruction (on RGA, check tracer gas concentration at end-exhalation ≤2% of the inspired concentration) Must remain seated during wait time Recommended to check end-exhalation CO levels prior to inhalation of test gas; this can be used to adjust to the test for CO back-pressure and calculate COHb; allows compensation for water vapour and CO2 effects Repeatability requirement: there must be at least two acceptable manoeuvres that are within 2 mL·min−1·mmHg−1 (0.67 mmol·min−1·kPa−1) of each other
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Record when last cigarette was smoked Always use DLCO corrected for Hb and COHb where applicable Clearly state if no recent Hb is available Report the grading of the DLCO manoeuvres Record altitude
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