End Tidal CO2 Monitoring and Capnography
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Procedure Guidelines
9.13 END TIDAL CO2 MONITORING CAPNOGRAPHY
INDICATIONS:
| Intubated Applications (Mainstream) | Non-Intubated Applications (Sidestream) |
|---|---|
| Verification of ETT or King Tube placement | Bronchospasm: asthma, COPD and anaphylaxis |
| ETT or King Tube surveillance during transport |
Hypoventilation: drug overdose, stroke, |
| CPR: compression efficacy, early sign of ROSC, survival predictor* |
Hyperventilation: DKA, metabolic acidosis, sepsis, CNS Hyperventilation |
| Optimize ventilation of patients |
Objective data to terminate resuscitation
PROCEDURE:
- Select EtCO2 setting on monitor if not set to default
- Assure nasal cannula or sensor to E.T. tube or King Tube is correctly placed
- Check for wave forms
- Record wave form
- Capnography device should remain in place for continuous monitoring, with frequent checks to ascertain that the tube does not migrate.
- At hospital, record waveform again
DOCUMENTATION:
- Upon confirmation of successful endotracheal intubation or King Tube placement (positive wave form), print a strip and document the initial reading on the abbreviated report.
- Document any airway or pharmacologic interventions based on capnography readings.
- Upon arrival to the emergency department and after transferring the patient to the hospital’s bed/gurney; obtain a second strip demonstrating a continued positive wave form.
- Attach both strips to the completed run report. A code summary should accompany all cardiac arrest reports.
CAPNOGRAPHY WAVEFORM ANALYSIS:
NORMAL – 35-45 mm Hg MANAGEMENT: Monitor
DISLODGED ETT: Loss of waveform, Loss of EtCO2 MANAGEMENT: Replace ETT
ESOPHAGEAL INTUBATION: Absence of waveform MANAGEMENT: Re-intubate
HYPOVENTILATION: ↓ RR, EtCO2 > 45 mm Hg MANAGEMENT: Assist ventilations/intubate
HYPERVENTILATION: ↑RR, EtCO2 < 35 mm Hg MANAGEMENT: ↓ventilations
BRONCHOSPASM: “Sharkfin” MANAGEMENT: Bronchodilators
