End Tidal CO2 Waveform Capnography

UNCONTROLLED WHEN PRINTED

Indications

To be attached to the BVM circuit when ventilating or oxygenating a patient e.g.:

Cardiac arrest or Peri-arrest - aids recognition of pulselessness, apnoea, quality of CPR or ROSC
Unconscious (Medical or Trauma)
Rapid sequence induction
Mandatory with all advanced airway adjuncts - aids confirmation of endotracheal tube placement

Nasal adapter to be used:

Post-sedation where level of response drops (e.g. RASS minus 2 or lower)
Unconscious patients where BVM is not necessary or impractical
High risk or peri-arrest patients where tolerated (e.g. symptomatic STEMI, cardiogenic shock etc.)

Contraindications

Patient Factors & Considerations

End tidal CO₂measures the level of expired carbon dioxide at the peak of the expiratory phase as a guide to ventilatory effectiveness
Unreliable in patients under 10kg
Not to be used for general monitoring of respiratory rates in uncomplicated cases
Normal reference range is 35 - 45 mmHg, but varies in unsealed circuits with a mixture of gases (e.g. OPA/BVM or Nasal)
Oxygen mask can be placed over the nasal adapter
Waveform shape is particularly helpful in conjunction with the reading in mmHg
Nasal monitoring may require support with tape if necessary. An oral breath option may be seen occasionally
The adapter should be placed behind the bacterial filter as pictured
Extremely low values may be due to death / cardiac arrest, misplaced or displaced endotracheal tube or metabolic derangement
Apply sound judgement to troubleshoot unanticipated low values
ROSC patients may have high values initially - this should not be actively corrected too early (e.g. hyperventilation) as per cardiac arrest CPG

Procedure

Select the appropriate adapter (nasal or ventilation circuit)
The 2 wired sensors will click into place by aligning the two blue arrows with the design of the adapter (Pic 1)
Misaligned sensors will not provide satisfactory readings
Ventilation circuits - the adapter must be positioned behind the bacterial filter (Pic 2)
Nasal monitoring - should be applied as shown. Tape support optional (Pic 3)

CPG111 end tidal arrows