- The health benefit to the patient
- The financial impact to your bottom line
- Costs associated with monitors, sampling lines, and warranties
- Availability of purchasing programs
- Maintenance and calibration fees
- Reimbursement options
The Business Case for Capnography
- The American Heart Association (AHA) calls for capnography monitoring to monitor quality of chest compressions, to confirm endotracheal tube placement, and to use as an early indicator of the return of spontaneous circulation (ROSC). 1,2
- The American Society of Anesthesiologists (ASA) recommends supplementing visual monitoring with the use of pulse oximetry and capnography for patients under moderate to deep sedation. 3
- The Anesthesia Patient Safety Foundation (APSF) recommends continuous monitoring of oxygenation and ventilation to help reduce the likelihood of unrecognized, clinically significant opioid-induced respiratory depression. 4
- Prolonged apnea: $394
- Mild desaturation: $463
- Severe desaturation: $529
- Reduce the cost per gastrointestinal endoscopy procedure by $858
- Generate an average annual cost avoidance of $304,2349
What Equipment Will I Need?
- Will I need to purchase a new monitor(s), or will I use sampling lines with my institution’s current multiparameter monitors?
- Does the sampling line I use have most components integrated, or will I need to purchase accessories such as small-scale fluid fittings to make leak-free connections and water traps?
Multiparameter Monitors (MPM) Versus Bedside and Portable Monitors
Are Purchasing Programs Available?
What Is the Warranty Coverage?
- Sampling lines
- Damage caused by misuse or neglect
- Accident or causes external to product (i.e., drops or faulty electrical power)
- Product on which serial number or lot code has been removed or made illegible
- Product or part thereof that has been disassembled, serviced, reassembled, or modified by anyone other than the seller
- Reuse of a product sold for single use
- Performance of preventive maintenance
Is Maintenance and Calibration Required? What Is the Cost?
Is Capnography Monitoring Reimbursed?
- PSI #90: Composite Measure Patient Safety (PSI) for Selected Indicators — This measure includes postoperative respiratory failure and pulmonary embolism. Capnography is recognized as the fastest method for detecting changes associated with ensuing respiratory failure. There are several composite measures included in PSI #90 as a weighted measure.
- PSI #04: Death Rate Among Surgical Inpatients with Serious Treatable Complications — Capnography may improve postoperative outcomes in situations that could have otherwise been fatal.
- Ambulatory Surgical Center (ASC)-4: Hospital Transfer Admission — Capnography may be used to recognize changes in respiratory status and as an early indication of airway compromise.
Capnography Monitoring Cost in a Hospital
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1. Field JM, Hazinski MF, Sayre MR, et al. Part 1: Executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 suppl 3):S640–S656.
2. Link MS, Berkow LC, Kudenchuk PJ, et al. Part 7: Adult advanced cardiovascular life support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 suppl 2):S444–S464.
3. Committee of Origin: Standards and Practice Parameters. Standards for Basic Anesthetic Monitoring. American Society of Anesthesiologists Website. https://www.asahq.org/~/media/Sites/ASAHQ/Files/Public/Resources/standards-guidelines/standards-for-basic-anesthetic-monitoring.pdf. Last affirmed on Oct. 28, 2015. Accessed Oct. 31, 2017.
4. Stoelting RK, Overdyke FJ. Essential Monitoring Strategies to Detect Clinically Significant Drug Induced Respiratory Depression in the Postoperative Period Conclusions and Recommendations. Anesthesia Patient Safety Foundation Website. https://www.apsf.org/newsletters/pdf/fall_2011.pdf. Updated Sept. 26, 2015. Accessed Dec. 7, 2017.
5. Andersen LW, Berg KM, Chase M, et al. Acute respiratory compromise on inpatient wards in the United States: incidence, outcomes, and factors associated with in-hospital mortality. Resuscitation. 2016;105:123–129.
6. Agarwal SJ, Erslon MG, Bloom JD. Projected incidence and cost of respiratory failure, insufficiency and arrest in Medicare population, 2019. Abstract presented at: Academy Health Congress; June 2011; Seattle.
7. Yan JW, McLeod SL, Iansavitchene A. Ketamine-propofol versus propofol alone for procedural sedation in the emergency department: a systematic review and meta-analysis. Acad Emerg Med. 2015:22(9):1003–1013.
8. Jopling M, Heard L, Kofol T, Warner E. Evaluating the cost-effectiveness of capnography monitoring in procedural sedation: a gastroenterology (GI) suite cost-avoidance model. Gastrointestinal Endoscopy. 2015;81(5S):AB193. Health Grades Patient Safety in American Hospitals Study. March 2011. Available at http://patientsafetymovement.org/wp-content/uploads/2016/02/Resources_Reports_Patient_Safety_in_American_Hospitals_Study.pdf.
9. Saunders R, Erslon M, Vargo J. Modeling the costs and benefits of capnography monitoring during procedural sedation for gastrointestinal endoscopy. Endosc Int Open. 2016;4(3):E340–E351.
10. Saunders R, Davis JA, Kranke P, Weissbrod R, Whitaker DK, Lightdale JR. Clinical and economic burden of procedural sedation-related adverse events and their outcomes: analysis from five countries. Ther Clin Risk Manag. 2018;28;14:393–401.
11. Saunders R, Struys MMRF, Pollock RF, Mestek M, Lightdale JR. Patient safety during procedural sedation using capnography monitoring: a systematic review and meta-analysis. BMJ Open. 2017;30;7(6):e013402.
About the AuthorMore Content by Michael Noble