Capnography (ETCO2 Monitoring) Do you monitor extubated patients in the PACU w/ it?

GHGoonette, BSN, RN · May 14, 2011

No, ours don't use them. Were there any incidents that may have prompted this request?

meandragonbrett · May 17, 2011

No, we do not.

RN1980 · May 19, 2011

no we dont, only in or, icu and rare instances in our er will we use the device.

RNiel · May 21, 2011

GH - No, there wasn't an incident. The one CRNA that requested it on behalf of the others stated that it was soon to be a standard of care, but I've not heard anyone else mention it or seen any articles on it.

Thanks for the input everyone.

GHGoonette, BSN, RN · May 22, 2011

I can't see why it should be a standard for all patients; I think in 21 years I've only had an anaesthesiologist request capnography once on a patient in PACU, and that time we just took a spare monitor from the equipment room. Seems silly to expect hospitals to lay out thousands of $$$ for something that just gathers dust 99.99999% of the time....

suanna · May 22, 2011

I've never seen an ETCo2 monitor for extubated patients- We frequently use CO2 monitoring on our vented patients to facillitate weaning, but on an extubated patient??? How does it "hook up"?

djmed · Jun 8, 2011

There are ETCO2 monitors for extubated patients and we need to start to utilize these on ALL our patients who are on PCA's. The data out there that shows monitoring only SpO2 is so ineffective. ETCO2 increases far before the SpO2 falls in those patients who are in trouble. We have been using it at our institution for ALL our intubated patients. It's how we wean without using ABG's. And with the AHA now recommending it be a measurement during an arrest, we will all have to finally catch up on this old technology

PACURN1818 · Jun 18, 2011

We use the ETCO2 monitors, but not for all patients. Patients who are suspected of retaining CO2, or who had a rough extubation, or have a history of sleep apnea usually end up with them ordered. They stay in PACU 2 hrs most of the time, and go with the ETCO2 monitor to the floor. If they are going home through same day the monitor comes off when they leave PACU. This is a chargable service item for us.

The real issue comes when most of the patients are stuck in PACU minimum 2 hrs even if they would be ok to go otherwise. The flow can back up real quick.

I do question how accurate the number reading is, and sometimes it will say the patient isnt breathing even when can tell they are.

Kitesurfing bum · Aug 22, 2011

http://www.npr.org/2011/08/22/139670971/when-not-to-quit-man-revived-after-96-minutes

This is worth reading...The new spokesman for capnography!!!

MunoRN, RN · Aug 23, 2011

We recently went through a large scale review of our monitoring practices for OSA patients and patients receiving narcotics/sedatives. Our conclusion was that O2 monitoring is almost worthless compared to EtCO2 monitoring. All O2 monitoring tells you is that you've got a problem that should have been addressed hours ago. We are in the process of moving to EtCO2 monitoring only for all patients who meet the inclusion criteria, which is about half of all our post-op patients. It's not cheap by any means, but it's better than nothing, which is essentially what you are doing with O2 sat monitoring.

pacurn60 · Aug 24, 2011

We do CO2 monitoring on some of our extubated patients. Again our PCA's pumps monitor CO2. We ordered CO2 monitors for 4 of our bays but it is sometimes hard to know what patients will need CO2 monitoring. We put it on any patients suspected of CO2 retaining/ sleep apnea patients and any patient the nurse feels it is waranted. As the other writer wrote CO2 monitoring will be the next standard JCAHO , Medicare will be requiring. CO2

monitoring is the best monitor of a patients ventilation status. There is a great article in the JoPAN(Journal of peri anesthesia nursing) this month about Capnography and CO2 monitoring.