Use of EtCO2 monitors in inpatient hosptial palliative setting

ErinS, BSN, RN · Jun 3, 2011

I guess I am not sure why this would be used. Usually my pt's are not a pca until they are actively dying, at which point we expect a change in respiratory status. Do you have additional info?

CompleteUnknown · Jun 3, 2011

Are you talking about patients who are actively dying or palliative patients who are troubled by increasing pain but not actively dying? If it's the latter, I seem to remember reading somewhere about a study that was done on this. I think the patients that were studied were in hospital to have their pain relief increased/titrated to manage severe and increasing pain and no issues were identified by measuring end tidal CO2, in other words increasing the narcotic dose did not result in any changes in respiratory status in the patients studied.

Just had a bit of a look and found an abstract. The study was " Respiratory function during parenteral opioid titration for cancer pain" and the conclusion states "Parenteral opioid titration for relief of cancer pain was not associated with respiratory depression as demonstrated by significant changes in ET-CO2 or oxygen saturation in non-oxygen dependent cancer patients."

Wondering if you have more information on this too?

Edited to add: Should have also said it was only a small study (30 patients I think) and they were not dependent on oxygen.

KellyB143 · Jun 3, 2011

Thank you for responding.

Basically, I am attempting to research the topic in an effort to change policy at my facility. Our palliative unit is fairly new (about 2 years). Right now our policy states that patients who are "end of life" will not use the EtCO2 monitor. However, our palliative team is saying that those "actively dying" will not use the EtCO2.

Currently, ALL of our patients on unit are DNR (though this is changing in the near future). Some of our patients are in-patient hospice (for pain crisis or other symptom management issues). About 60% of our patients die on unit and the other 40% go home or to LTC with hospice.

Essentially, I have major ethical issues with 1. the pause function the monitor triggers on the PCA (thus withholding pain medication until RR reaches >6) 2. promising patients/families a diginified, QUIET atmosphere and then slapping on a monitor that loudly alarms pretty constantly on some people.

I have several years hospice experience and have been at this facility for 7 months. The team seems to have a much narrower definition of "actively dying" than I. Specifically, they seem to think that people who are actively dying are completely unresponsive. I have not found that to always be the case. I have cared for people who talk right up to the moment they die.

I have been unable to find any articles that speak to palliative care and the use of this type of monitoring.

Our comfort order set states that patient's families can refuse to have vital signs monitored and at the very least I think this type of monitoring should be included in that.

Thoughts? I really appreciate any help with this!!!

CompleteUnknown · Jun 4, 2011

Thank you for responding.
Basically, I am attempting to research the topic in an effort to change policy at my facility. Our palliative unit is fairly new (about 2 years). Right now our policy states that patients who are "end of life" will not use the EtCO2 monitor. However, our palliative team is saying that those "actively dying" will not use the EtCO2.
Currently, ALL of our patients on unit are DNR (though this is changing in the near future). Some of our patients are in-patient hospice (for pain crisis or other symptom management issues). About 60% of our patients die on unit and the other 40% go home or to LTC with hospice.
Essentially, I have major ethical issues with 1. the pause function the monitor triggers on the PCA (thus withholding pain medication until RR reaches >6) 2. promising patients/families a diginified, QUIET atmosphere and then slapping on a monitor that loudly alarms pretty constantly on some people.
I have several years hospice experience and have been at this facility for 7 months. The team seems to have a much narrower definition of "actively dying" than I. Specifically, they seem to think that people who are actively dying are completely unresponsive. I have not found that to always be the case. I have cared for people who talk right up to the moment they die.
I have been unable to find any articles that speak to palliative care and the use of this type of monitoring.
Our comfort order set states that patient's families can refuse to have vital signs monitored and at the very least I think this type of monitoring should be included in that.
Thoughts? I really appreciate any help with this!!!

That sounds horrible Kelly.

We use syringe drivers and if someone is actively dying we don't routinely check vital signs other than documenting respiratory rate with each driver check. I'm in LTC so we don't have end tidal CO2 monitors anyway but I've never heard it suggested that they should be used. What happens if the patient or POA refuse the monitor?

Hopefully some who work in palliative care in hospitals will respond. Can you update this if you find out more?

tewdles, RN · Jun 5, 2011

what a bunch of hooey. We palliate symptoms not numbers.