TCM problems

  1. Anybody have any tips for getting reliable readings consistently from a transcutaneous CO2 monitor???

    Last night, taking care of a 2 week-old former 26+6 weeker, I was ready to kill the TCM.

    The last gas on dayshift had a CO2/TCCO2 correlation of +2 (53/51). At 4 pm, I re-callibrated the sensor and changed the site. Membrane looked fine, so left it alone as I have gotten really wacky readings after re-membraning (now I re-cal at least 3 times in a row after re-membraning...)

    Next ABG to be at 5pm. TCCO2 climbed from 50s to 60s and gas was delayed until 5:30 pm due to brief brady/desat (gave her time to recover). TCCO2 at time of gas reading 64 CO2 on gas = 50. OKAY, crappy correlation.

    7pm, I change site (no re-cal -we usually only do it q shift). TCM reading 57-69 over next 3 hours. Next gas 10 pm: TCCO2 64 again), ABG: 63.

    Changed site again after the 10pm gas and TCCO2s in sixties. Report at 11 pm: TCCO2 starts dropping to the mid 40s. I'll find out this afternoon what the 12mn gas was...

    What am I doing wrong???
    Last edit by nell on Sep 11, '02
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  2. 14 Comments

  3. by   dawngloves
    Our RTs manage that and we rarely use them. Have you asked them for advice?
  4. by   nell
    Thanks Dawn, that's my next stop...

    Ended up putting the baby on the oscillator last night - and still fought with the TCM.
  5. by   karenelizabeth
    we regually use TCP02 mostly on the tinys

    Find that as the infant gets older and the scin thickens and with biger infants born closed to term, they become increasingly unreliable.

    Humidity unsticks the Tina's too which gives odd readings

    Also get a problem if the infant is odematus. It's a case of finding somewhere that's not as bad.

    When I get those strange readings, I do excatly what you did change spots, re cal, but also re membraine. and chesk gas.
  6. by   guest01
    I have RT remembrane and recalibrate, but it takes hours; also they are good with tips on how to get them to work better, like site and site prep and making sure it sticks well.
    I find the monitors to be undependable and a pain in the ***. Hopefully they'll invent something better.
  7. by   nell
    Thanks, karenelizabeth and Barb from RI. I haven't had much luck finding an RT forum that is active - what I've found hasn't had any posts in weeks.

    Anybody have any favorite sites for placing TCMs?

    Thanks
  8. by   karenelizabeth
    To start with some where fleshie (hard to find in a 24 weeker LOL) abdomen thighs etc have used back if babe nursed prone.

    careful how you position them once the tina are on though cos I say a babe with bad round white area after lying on one, really worried that it would turn necrotic soooooo happy when it was ok.

    also watch temp used we turn down for real premmie (have turned up for older infant but then you have to be really careful it does not burn).

    Our timer is normally set for 4 hrs but again if turned temp up or for real premmie I have turned down to 2-3hrs.

    When the work they are magic (had one 48 hr period with only 4 lots of bloods taken for gases and they all were spot on)

    When there not there worse than usless

    All our monitors are HP and re cal takes 20 mins max. so if in doubt I re membeane and re cal. If that not working still and bloods OK ask dr (frequently tell dr and sugest there they can stick it if not happy) if can leave off and rely on sats monitor. I see no point in adding to skin tramma and burns risk (increasing risk if infection, fluid loss etc) , and the increased handling of sick unstable and disorganized infant, which makes them more unstable and disorganigzed, leading to greater o2 requirements, calerie consumption etc.
  9. by   nell
    Thanks karenelizabeth,

    I got a different assignment last night - the nurse who had the babe on HFOV was having a hard time with the TCM too - and she is VERY experienced and a real NICU pro...

    Originally posted by karenelizabeth
    When the work they are magic (had one 48 hr period with only 4 lots of bloods taken for gases and they all were spot on)
    You're kidding! You are doing something more right than us!!! We mostly use HP also.

    When there not there worse than usless
    This is where we are with this little one. Fortunately, we aren't doing 24 weekers and this one is now 29 weeks and 1150grams. Messing with the TCM really screws with the "minimal handling" that we try to do with these kids.
  10. by   karenelizabeth
    So so so understand.
    The sicker they are the more you need to handle them
    The less they need that

    It's ssoooooo frustrating
  11. by   NicuGal
    We haven't used those in years...the kids were getting burns from them and they were really unreliable. We now use the VIA...it take the blood from the line, analyzes it and give it back so we aren't wasting blood
  12. by   KRVRN
    Ooh NicuGal, those sounds so very neat. What does VIA stand for?
  13. by   NicuGal
    Something IntraArterial Sampling. RT sets it up...it hooks to the UAC and it takes the blood and runs the sample. It can also run glucose We use it on the itsy bitsy ones and the kids that desat as soon as you open the door. Saves a lot of blood

    I'll see if I can find the book at work and see what it's real name is :lol Our only complaint is that they tubing is short .
  14. by   karenelizabeth
    sounds great but not all out vented babe's have art lines

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