PCA pumps and capnography

It became a new standard of practice at a hospital I recently left. It was a very new thing there, though.

We used it in CVICU with patients on PCA pumps.

We do it with our post-op OB/GYN patients... to me it's a good way to get people off their dilaudid PCA pump and onto PO meds ASAP because it's so annoying and intrusive (and I've never once seen it alarm when there's an actual problem...)

Research has shown that capnography is the earliest indicator of of respiratory depression.Even with a low resp rate O2 sat can be maintained so respiratory deterioration is difficult to detect.It becomes even more difficult for pts on supplemental O2. Many professional associations and regulatory agencies have called for action to prevent opioid induced resp depression and thus the use of capnography.

We've done that at my hospital for a few years now (at least 4). While, like most things, they can refuse it, usually telling them the safety risks gets them to keep it on.

I have had it work for a patient, who was awake and talking to me one minute, then after a single dose from the PCA, began to lose consciousness (vision dimmed, hearing dimmed, vision lost, blacked out). He must have been teetering on the edge of overdose and that one dose sent him over. Luckily I was right there in the room with him when it happened, but even if I hadn't been, the capnography would have gotten our attention quickly..