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Seven Problems with Capnography Monitoring ― and How to Solve Them

Capnography (etCO2)  monitoring is designed to help you identify ventilation changes to improve patient safety. But we recognize you are already using a lot of monitoring devices. You may be concerned that adding capnography monitoring will bring a new set of problems to your already challenging clinical workflow. 
With the right tools and strategies, capnography monitoring can work for you ― and your patients. In this blog, we’ll discuss how to manage common challenges such as nuisance alarms. We’ll also address patient safety and comfort, evaluate connectivity and integration options, and share how to articulate the economic case for adopting capnography monitoring technology.

1. Alarm fatigue

The proliferation of monitors designed to provide more physiologic information and improve patient safety has also increased the number of alarms clinicians encounter. Yet it is estimated that 85 to 99 percent of alarms do not require an intervention.
To reduce alarm fatigue, you can take these key steps:
  • Manage default alarms. Common alarm causes listed by the Joint Commission include alarm thresholds set “too tight” and default alarms not adjusted to individual patient needs.1,2
  • Educate patients. Another common cause of alarms is a lack of understanding on the patient’s part. Too often, patients aren’t properly instructed about why they are being monitored, so they remove the monitor sensor.
  • Educate staff. For clinicians, clearly understanding the operation, alarm features, and limitations of the monitors they’re using is key. They’ll be able to assess and identify causes of alarms and take steps to reduce alarm fatigue. We offer comprehensive, free training to ensure your success.
Related: For more information on reducing alarm fatigue and improving patient safety, download the white paper.

2. My patients don’t know what capnography monitoring is 

When patients don’t know why they are wearing the capnography sampling line, they may remove it. They don’t understand that removing the line disrupts their ventilation monitoring  and jeopardizes their safety. Make sure your patients know why you’re using capnography monitoring and clearly explain the benefits to their health. View the patient education website

3. My patients think the sampling lines are uncomfortable to wear and smell

Many nasal cannulas and etCO2 sampling lines are made from a unique plastic that may emanate an uncomfortable smell. Manufacturers continue to find innovative ways to help reduce the smell and improve the comfort of the sampling line. To ensure compliance, however, it’s important to educate your patients about why they are wearing a sampling line. 

4. My patients experience skin breakdown 

In many cases, your patients may need capnography and sampling lines only for the short term. During long-term capnography monitoring, the sampling lines may irritate the skin.  Follow your hospital’s protocol for monitoring skin integrity and apply these strategies to help reduce skin breakdown:
  • Conduct frequent skin assessments based on patient condition
  • Move the sampling line
  • Reduce pressure points


5. My patients keep removing the sampling line, causing inaccurate etCO2 readings

Try placing medical tape over the sampling line where it overlays the patient’s cheeks. Be sure you do not place the medical tape over the CO2 sampling or O2 delivery ports as this area creates an oxygen cloud for delivery while also collecting etCO2 samples. 

6. I’m not sure if I can use a sampling line on my patient during an MRI scan

You can! If you want to use the monitor during MRI scanning, place the monitor itself outside the MRI suite. There must be a hole in the suite wall of 10 centimeters in diameter. Contact your local representative for information about sampling lines that can be used in this setup. 

7. My hospital already monitors SpO2 with pulse oximetry and it’s hard to convince them to monitor etCO2 too

Pulse oximetry only reflects oxygenation and should be used together with capnography, which measures ventilation. SpO2 changes lag when a patient is hypoventilating or apneic.
Capnography monitoring is designed to help you immediately identify a change in ventilation. On average, capnography monitoring will detect a change 3.7 minutes before pulse oximetry.3 
In a procedural sedation study, pulse oximetry identified only 33 percent of patients with respiratory distress, while capnography captured 100 percent.4 
The Joint Commission Sentinel Event Alert #49 states5:
  • Do not rely on pulse oximetry alone (measures oxygenation).
  • Pulse oximetry may show the patient is sufficiently oxygenated during a respiratory compromise event. 
  • Capnography is an early detector of respiratory compromise.
Given its value in measuring ventilation, capnography monitoring offers many clinical benefits to you ― and your patients. By using these strategies and solutions to work through the challenges you may face, you can make the most of your monitoring experience.

Related: We offer easy-to-use continuous monitoring solutions to help you keep your patients safe. Learn how you can gain more value from your medical devices using Vital SyncTM.

© 2018 Medtronic. All rights reserved. Medtronic, Medtronic logo and Further, Together are trademarks of Medtronic. All other brands are trademarks of a Medtronic company. 12/2018-18-PM-0230

1. The Joint Commission. Medical device alarm safety in hospitals. Sentinel Event Alert. April 8, 2013; issue 50.
2. Graham KC, Cvach M. Monitor alarm fatigue: standardizing use of physiological monitors and decreasing nuisance alarms. Am J Crit Care. 2010;19(1):28-35.
3. Langhan ML, Chen L, Marshall C, Santucci KA. Detection of hypoventilation by capnography and its association with hypoxia in children undergoing sedation with ketamine. Pediatr Emerg Care. 2011;27(5):394-397.
4. Maddox RR, Oglesby H, Williams CK, Fields M, Danello S. Continuous Respiratory Monitoring and a “Smart” Infusion System Improve Safety of Patient-Controlled Analgesia in the Postoperative Period. In: Henriksen K, Battles JB, Keyes MA, Grady ML, eds. Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 4: Technology and Medication Safety). Rockville, MD: Agency for Healthcare Research and Quality (US); Aug 2008.
5. The Joint Commission. Safe use of opioids in hospitals. Sentinel Event Alert. August 8, 2012; issue 49.

TOPIC: Microstream™ Capnography MonitoringMedical-Surgical

About the Author

Michael Noble is a Senior Market Strategist for the Medical-Surgical and Procedural Sedation areas of care in the hospital at Medtronic. He develops strategies to help clinicians ensure patient safety with continuous monitoring solutions like Microstream™ capnography, Nellcor™ pulse oximetry, and Vital Sync™ clinical decision support.

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