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Thursday, August 20, 2009

Perhaps pulmonary toilet is a dirty word

This is a blog about wisdom, and I recently had a comment left on my blog that provided me with some great wisdom about the pulmonary toilet. I don't usually do this, but I have decided this comment was wisdom enough to make the front page.

So, without further adieu, from my "FAQ about the Pulmonary Toilet," here is a comment worthy of it's own post:

"Hi there- I Googled "pulmonary toilet" because I've had it up to here (picture my hand being held above my head in a chopping laterally motion...) with that term. When are we going to start calling this something a little bit more nice?

When I was an RT student 8 yrs ago, 1 of my instructors was on a kick to change the industry standard and have us students use the term "pulmonary hygiene." I must say that I really prefer that better. Am I alone here, people?

Despite my annoyance with the term "pulmonary toilet" I must give you a big thanks for giving a thorough definition of what it is. I work at a hospital with very few RT protocols (sad, I know) so very often docs will write "pulmonary toilet Q4" without stating what they want.

If they ever answer their pager to clarify the order I then have to pretty much go down the list of items which you described in your blog.

Despite your descriptions I found one error which Glenna sort of corrected. The device that you describe as PEP actually sounds more like the flutter valve, also a very good airway clearance device. PEP is positive expiratory pressure device which has the ability to make the expiratory pressure easier or harder to blow against.

Of note, where I currently work we use an airway clearance modality called EZ-PAP which is often over-ordered at this hospital but in some cases it has literally saved needing to re-intubate someone. I am a huge believer in this modality.

For those folks who can't use an incentive spirometer, EZ-PAP is quite wonderful.I will come back to this blog. Thanks a lot for caring about sharing your RT info!

Believe it or not, pulmonary toilet where I work is under ordered. How's that for an admission. We don't use PEP, EZ-PAP, or flutter valves where I work because the admins here are adamant that insurances will not refund for it -- and they are expensive they say.

So, despite we RTs begging for these for years due to studies verifying there efficacy over typical CPT, we may never get those devices here.

Yet pulmonary toilet is a dirty term. Well, it's a fun term, but Pulmonary Hygiene would be more appropriate, and perhaps more "politically correct" -- not that this blog is necessarily politically correct.

However, we RTs tend to have dry sense's of humor, and therefore it the probably reason for such an inappropriate term as "pulmonary toilet."


_JuZz.RT_ said...


im new to this blogSpot, also an RT..(from the philippines btw.Ü)

just finished reading this update bout "Pulmonary Toilet"., never thought that there was such a term..
nweiz, hope ya guys keep posting cuz this blog really helps as you read through it..^^


Anonymous said...

I gotta tell ya, I'm not a fan of the EZ-PAP. Almost everybody here gets it ordered, and it seems like a lot of people have a hard time doing it right...I'm just not a huge fan I guess, but if the patient actually can use it, it does seem to work pretty well.

Vote For David said...

Toilet in this case sounds like an anglicized form of the french toilette, which can mean cleaning. Pulmonary Toilet then translates roughly to "cleaning out the ol' windpipes"