CAPNOGRAPHY
AND ITS RELEVANCE TO NURSES
Andreia Trigo
BSc Nursing, MSc Management and Administration, MSc Advanced Practice
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DISCLAIMER
• Honorarium and travel from Medtronic for this presentation
• Co-director of SedateUK
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OUTLINE
• Introduction
• Learning objectives
• What is Capnography?
• Applications
• Importance – real-world use
• Reading and interpreting capnographs
• Relevance for nurses
• Resources for learning and development
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WHY AM I HERE?
1st – Anaesthetic nurse
2nd – PG Anaesthesia and Pain Management
3rd – Administering sedation for interventional pain procedures
4th – SedateUK
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LEARNING OUTCOMES
▪ Capnography outside the operating room
▪ Establish a relationship between normal capnogram and phases of breathing
▪ Recognise normal and abnormal waveforms that can be associated with sedation
▪ Recognise importance of expired CO2 value, changes in waveform shape and changes in
RR for clinical decision making in sedation
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C APNOGRAPHY OUTSIDE THE
OPERATING ROOM
ü Endoscopy, Radiology, Cath labs, Dentistry,
Small procedures rooms, Recovery, Critical
care units, A&E, others
Sedation is a drug-induced depression of
consciousness, that ranges in a continuum from alert
to general anaesthesia.
ü Advanced Life Support
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SedateUK
C APNOGRAPHY OUTSIDE THE
OPERATING ROOM
ü ALS 2015 Guidelines
“Waveform capnography must be used to confirm and continually monitor tracheal tube placement, and may be
used to monitor the quality of CPR and to provide an early indication of return of spontaneous circulation (ROSC).”
The role of waveform capnography during CPR includes:
• Ensuring tracheal tube placement in the trachea.
• Monitoring ventilation rate during CPR and avoiding hyperventilation.
• Monitoring the quality of chest compressions during CPR.
• Identifying ROSC during CPR.
• Prognostication during CPR.
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C APNOGRAPHY OUTSIDE THE
OPERATING ROOM
ü House of Delegates of ASA 2011
“During moderate or deep sedation, the adequacy of ventilation shall be evaluated by continual observation of
qualitative clinical signs and monitoring for the presence of exhaled carbon dioxide unless precluded or
invalidated by the nature of the patient, procedure, or equipment.”
ü AAGBI 2011 & 2015
“Continuous capnography should be used for all patients undergoing moderate or deep sedation, and should be
available wherever any patients undergoing anaesthesia or moderate or deep sedation are recovered.”
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SEDATION IN A CULTURE OF
SAFETY
ü Patient suitability for sedation
ü Sedation as a continuum
ü Environment preparedness
ü Patient variability in response
ü Titration to effect
ü Alertness in Sedated Patients (ASP) score©
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SedateUK
SedateUK
SEDATION AND MONITORING
Reduced
respiratory
drive
Decreased RR
or TV
Reduced
alveolar
ventilation
Increased
PaCO2
ü Clinical vigilance of patient’s response
ü Capnography, EtCO2, RR
ü SpO2
ü NIBP
ü ECG
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SEDATION AND MONITORING
30 sec
60 sec
1.2 min
C APNOGRAPHY AND PHASES OF
BREATHING
A normal capnogram always has the following features:
PhaseIII
PhaseII
PhaseI
- CO2 starts at zero and returns to zero
PhaseIV
- A maximum CO2 is reached with each breath (ETCO2)
- The amplitude depends on: ETCO2 concentration
- The width depends on: expiratory time
- There is a similar shape for subjects with normal lung
function
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C APNOGRAPHY WAVEFORMS IN
SEDATION
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Capnogram
Normal
Abnormal
Absent
Chest wall
movement?
No
Yes
Positive response
to opening the
airway?
1. Periodic
breathing
2. Bradypnoeic
hypoventilation
3. Hyponoeic
hypoventilation
Yes
4. Apnoea
No
!
5. Upper Airway
Obstruction
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C APNOGRAPHY: FACTORS FOR
CLINIC AL DECISION MAKING
Pre sedation
During sedation
• EtCO2
• Waveform shape
• RR
Change greater than1.3 kPa from presedation
OR
Outside [4.0 – 5.7 kPa]
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C APNOGRAPHY TRAINING
• http://www.covidien.com/pace/clinical-education/channels/capnography
Covidien is now Medtronic Minimally Invasive Therapies
LEARN MORE
!
CHANNELS
PROCEDURE
SPECIALTY
CLINICAL ISSUE
CARE SETTING
FACILITIES
Capnography
Clinical education and non-clinical education modules related
to the use of etCO2 monitoring with non-intubated and
• http://www.capnography.com
intubated patients in various clinical settings. These programs
are designed to help provide safe and effective ventilatory
monitoring of the patient.
Featured
Capnography Waveform Tutorial
and Exercise Website
Principles of Capnography:
Interpreting Waveforms
Continous Capnography and the
Difficult Airway
INDIVIDUAL OPPORTUNITIES
Microcap® Portable Capnography
Capnostream® Bedside
Integrated Pulmonary IndexTM
Microcap® Plus Portable
Monitor: A Guide to Buttonology
Capnography Monitor with Nellcor
(IPI) Training
Capnography Monitor: A Guide to
It gives me great pleasure to put forth the 8th edition of the Capnography
SpO2 Technology: Guide to
Buttonology
website. Unprecedented encouragement from medical professionals,
Buttonology
engineers, technological innovators, and students across the world gives me a
sense of satisfaction AndreiaTrigo|enquiries@sedate-uk.com
that long hours spent in the initial designing and
Web-Based
Web-Based
Web-Based
Web-Based
Non-Accredited
Non-Accredited
Non-Accredited
Non-Accredited
deployment of earlier editions of this website were not futile. It is heartening
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to state that over 500,000 personnel visit this site annually. During the last few
years, this website was able to fulfill its goal as an avenue to provide dynamic,
animated, interactive and up-to-date information on capnography that is
SEDATION AND C APNOGRAPHY
TRAINING
• Safe Sedation Course
• www.sedate-uk.com | enquiries@sedate-uk.com
• One day course
• Knowledge and skills
• Certificate
• Accreditted by RCP and RSM
• Protocol / Assessment and monitoring form / Sedation policy template
ü 25th June 2016
• Safe Sedation community
ü 16th July 2016
ü 20th August 2016
ü 10th September 2016
ü 12 November 2016
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FINAL THOUGHTS
ü Capnography is part of the Advanced Life Support guidelines.
ü Capnography is mandatory every time Sedation is administered.
ü The capnogram remains stable during patient motion and is reliable in low-perfusion states.
ü Capnography detects airway/respiratory compromise quicker than pulse oxymetry.
ü 3 Factors for clinical decision making: changes in ETCO2, waveform shape and RR
“Capnography is the only single monitoring modality that
provides airway, breathing and circulation assessment”
Krauss, 2005
Thank you!
Andreia Trigo
enquiries@sedate-uk.com
AndreiaTrigo|enquiries@sedate-uk.com
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