PACU EtCO2 monitoring

[BobLoblaw78]

My hospital is going with EtCO2 monitoring in PACU for all patients. Cost was apparently negligible, but it still seems like overkill to me. I think there is a push in the nursing literature but couldn't tell you for sure. Has anyone else experienced this change? I imagine this will create many unnecessary calls to anesthesia for CO2 levels that are not within "normal ranges". And that is assuming these monitors work as well as they should. I can see how it would benefit certain patients, especially on the floor but I don't foresee this helping out the seasoned PACU RN's. I actually can't remember a case where I wished I would have had this to help identify respiratory failure earlier.

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[cchoukal]

Our PACU nurses sometimes use this for patients with known sleep apnea. I have never been called about it. They are trained to look at it as a qualitative monitor, not quantitative.

 

[UscGhost]

If the nurses are appropriately trained then it's useful.

I cant count the number of times that I have seen a patient obstructing and the RNs just happily stare at the monitor because the saturation hasn't dropped from 100% yet

 

[drmwvr]

If the nurses are appropriately trained then it's useful.

I cant count the number of times that I have seen a patient obstructing and the RNs just happily stare at the monitor because the saturation hasn't dropped from 100% yet

yes...then take the NC off an go to a mask when the sat does start to go....

 

[coffeebythelake]

very unlikely to make a difference in patient care,
is it common practice at your hospital to have deeply sedated and obstructing patients brought out to pacu?

 

[BobLoblaw78]

very unlikely to make a difference in patient care,
is it common practice at your hospital to have deeply sedated and obstructing patients brought out to pacu?

Not common practice. And if we have a patient that is concerning now, then we use it. Thankfully we don't really have the nurse like above that is oblivious to an obstructed patient. If anything, they will assist breathing at the slightest hint of obstruction i.e. any tonsillectomy that makes any noise is getting jaw thrust.

 

[cchoukal]

Not common practice. And if we have a patient that is concerning now, then we use it. Thankfully we don't really have the nurse like above that is oblivious to an obstructed patient. If anything, they will assist breathing at the slightest hint of obstruction i.e. any tonsillectomy that makes any noise is getting jaw thrust.

this is my observation as well.

 

[zizzer]

I think it's a good thing as long as they learn that it's a qualitative, not quantitative monitor like somebody else said. Nurses often make me nervous not listening to me telling them how much opioids they received and when they received them, taking the oxygen off immediately, then sitting somewhere far away without an audible SpO2. That said, I also can't think of a time when somebody has stopped breathing and they haven't noticed. They tend to always have the desaturation alarm on, but I like the idea of having some redundancy in place for if a patient does stop breathing. Also nice to catch it earlier before desaturation.

 

[BobLoblaw78]

I actually prefer the noisy breathing as long as they are ventilating adequately. I try to train them the noisy breathing is a good monitor and to get worried when they don't hear it.

 

[jwk]

I think it's a good thing as long as they learn that it's a qualitative, not quantitative monitor like somebody else said. Nurses often make me nervous not listening to me telling them how much opioids they received and when they received them, taking the oxygen off immediately, then sitting somewhere far away without an audible SpO2. That said, I also can't think of a time when somebody has stopped breathing and they haven't noticed. They tend to always have the desaturation alarm on, but I like the idea of having some redundancy in place for if a patient does stop breathing. Also nice to catch it earlier before desaturation.

👍 Nasal EtCO2 monitoring is qualitative at best.

We transport all patients on O2 (apparently there are places that don't) and the first PACU order is O2 per NC. Always surprised at how quickly some nurses want to pull off the NC after arrival.

 

[nimbus]

I actually prefer the noisy breathing as long as they are ventilating adequately. I try to train them the noisy breathing is a good monitor and to get worried when they don't hear it.

“Noisy breathing is better than no breathing.”

 

[nimbus]

I don’t see a problem with ETCO2 monitoring in PACU.

Also for those who say ETCO2 monitoring is not quantitative, I don’t recommend checking a blood gas when ETCO2 is 80.

 

[teacher2md]

The PRODIGY trial showed that post-operative respiratory depression is common and clinically meaningful.

The future is going to be continuous ETCO2 monitoring for all post-op patients receiving opioids. It sounds like your hospital is one of the early adopters.

 

[coffeebythelake]

The PRODIGY trial showed that post-operative respiratory depression is common and clinically meaningful.

The future is going to be continuous ETCO2 monitoring for all post-op patients receiving opioids. It sounds like your hospital is one of the early adopters.

What is the PRODIGY trail comparing these general floor patients to? The standard which is no continuous monitoring at all ("vital signs check every 4 to 8 hours"), and where the nursing to patient ratio is like 1:8? i hope that isnt the monitoring standard in your PACU