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Hospital implementation of ETCO2 monitoring system

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EtCO2-- Created using PowToon -- Free sign up at http://www.powtoon.com/join -- Create animated videos and animated presentations for free. PowToon is a free tool that allows you to develop cool animated clips and animated presentations for your website, office meeting, sales pitch, nonprofit fundraiser, product launch, video resume, or anything else you could use an animated explainer video.

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Monitoring Devices save lives!

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Video production compliments of Oridion Capnography Inc.

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http://www.cordellmed.com/BCI_Capnocheck_II.htm If you already have a nice Vital Signs Monitor and need End-Title CO2, this is a great choice. Capnocheck® II Stand Alone Capnograph is a full-featured, highly portable unit available in your choice of configurations, delivering capnography only or capnography combined with oximetry.

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American Nurses' Association, (2008). Revised nursing informatics: Practice scope and standards or practice. ANA Press

Carlisle, H. (2014). The case for capnography in patients receiving opioids. American Nurse Today, 9(9), 22–27.

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Opioid induced post operative respiratory depression is a significant problem in hospitals. I have seen first hand the negative consequences of overdosing patients with narcotics or the cumulative effect of the narcotics/benzodiazepines/muscle relaxants. Managing patients pain is not always easy especially with narcotic tolerant patients or narcotic naive patients. Patients in pain want the pain to go away immediately and often the medications take time to work. We are trained as nurses to ask the patient to rate their pain and we treat with pain medications according to this number. Unfortunately this number does not take into account the patients respiratory status. It doesn't tell the nurse that the patient is having apneic episodes when no one is in the room. It doesn't tell the nurse that the patient is sleeping and snoring without stimulation but when awakened rates pain at a 10/10. Having ETCO2 monitoring gives the nurse concrete data to tell the patient it is not safe to administer any more narcotic medications at this moment but I will call the doctor and see what else we can do. It also provides the data to support why the nurse is not treating the pain score of 10/10. ETCO2 monitoring also provides valuable patient specific information on how a particular medication affects the patient. For example, if you administer Diluadid 1mg IV to a patient and then leave the room and your monitor alarms frequently with high ETCO2 or low respiratory rate then you know that the dose is too much for that patient. A smaller dose more frequently might be safer.

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It requires hospitals to change their current IV pumps or purchase ETCO2 monitors. The monitoring modules are only compatible with their system. ETCO2 monitoring is obtained through the use of a special nasal cannula. Not all patients are compliant with leaving a nasal cannula in place especially if they do not require oxygen. As with any alarm system there is a potential for false alarms and this could contribute to the current alarm fatigue that exists already.

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Helps identify and manage ventilation events and complications. It can also help diagnose specific conditions. It trends the respiratory rate, ETCO2 and apnea episodes. It can be used in intubated and nonintubated patients as well as oral or nasal breathers. It has programable alarm parameters that provide patient specific ranges.

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Postoperative respiratory failure was the third most common preventable safety incident in hospitals between 2006-2009. It affected more than 600,000 patients costing the healthcare system more than $1.2 billion dollars (Carlisle, 2014). With health care's shifting paradigm safety has become a system focus. As technology advances we have the ability to monitor patients more closely and provide additional safety mechanisms to minimize and prevent complications. Health care informatics integrates nursing and information science to allow nurses to manage and communicate data necessary in supporting their role as clinicians (ANA, 2014, P.1) In effort to decrease the number of preventable injuries from opioid induced respiratory depression many hospitals have added pulse oximetry monitoring to their post operative floors. Unfortunately pulse oximetry is not the best indicator of respiratory depression and often does not alarm until the patient is nearly apneic. Pulse oximetry monitors oxygenation not ventilation status. It is not an accurate indication of respiratory status because often the patients are wearing supplemental oxygen and the number is falsely elevated. The most accurate indication of respiratory status is ETCO2 monitoring. Sadly most hospitals are still only using ETCO2 monitors in specialty areas and not on general post operative floors. The Alaris pump is one system that has built in safety with ETCO2 monitoring available. It has additional modules that can be connected for other monitoring as well.
http://www.carefusion.com/documents/brochures/infusion/IF_Alaris-EtCO2-module_BR_EN.pdf

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September 1, 2014

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Author/Name: Heather Carlisle, PhD, DNP, FNP-BC, RN-BC
Title or Affiliations: Heather Carlisle is a nurse practitioner at the University of Arizona Medical Center in Tucson and a clinical assistant professor in the College of Nursing at the University of Arizona. She is board certified in pain management by the American Society for Pain Management Nursing.
Credible: Dr. Carlisle is a credible source she is board certified in pain management.