Case Number 4627
Request Date 12/02/2016
Completion Date 10/03/2016 

 

Details of the Request

How do you monitor patient Co2 within all your Trust: For example Resuscitation, Theatres (including cath. labs, endoscopy suites etc.), Emergency Departments and Adult, Paediatric and Neonatal care areas.

Wherever possible, I would like disclosure of the Brand of the monitor (or other technology) the quantity and their age.

 

Details of the Response

For Intensive Care Unit:

The Trust has Marquet CO2 monitoring through the ventilators. This has a dedicated cable and module, these are several years old but have single use airway adapters. The product code for the adapters is 6684612.

We also monitor through the bedside monitors with single use adapters. These are ordered through Fukuda and made by Oridion, product code is XS04624. All our ventilated patients have CO2 monitoring.

 

For Resuscitation:

If a patient arrests in theatres, for example, they will be connected to an anaesthetic machine which monitors the patient’s CO2.

If a patient arrests in A&E or Cardiology out-patients, they can be monitored using a LifePak 15 defibrillator (5 in A&E, 1 in Cardiology).

If a patient arrests on the ward, at present, we use an EasyCap CO2 detector for monitoring CO2, this is a visual device that connects to the endotracheal tube and these are kept on every single cardiac arrest trolley within the Trust. If the patient requires a transfer to an area with a higher level of care then a transfer monitor (Fukuda) is collected from ITU. This will be changing in light of the recommendations from the Resuscitation Council (UK), all future defibrillators purchased by the Trust will have CO2 monitoring.

We are purchasing five defibrillators each year on a rolling replacement programme.

 

For Theatres:

In regards to monitoring patients CO2 within theatres, all patients’ expired CO2 is continuously monitored during induction in the anaesthetic rooms and throughout their procedure until the point of discharge from theatre to recovery. If the patient does require further monitoring of CO2 in recovery then we have a monitor available to connect the patient to; Dynascope/ Fukuda ds-7100 > 5years in age.

CO2 is currently monitored through the following machines in theatres:

Astiva 5 Machines with Cardiocap / 5 monitors approx. 15 > years old

Aysis Machines approx. 2 years old (These are new anaesthetic machines)

 

If we have patients that require a general anaesthetic out of department in the following areas; MRI, CATH LAB, MATERNITY, CT, A&E, INTERVENTIONAL SUITE, then they will have their CO2 monitored through the anaesthetic machines listed above.

 

If we have a patient that requires intubation on the wards and need transferring internally then we will monitor their CO2 through the Dynascope/ Fukuda DS-7100. This will also apply to any patients that require critical external transfers where we will use a Propac monitor which is >20 years in age.

 

If we are required to assist with Paediatric and Neonatal intubation in A&E then the CO2 will be monitored through the following machines;

Dynascope/ Fukuda DS-7200 >5 Years in age.

 

For Paediatrics:

In the paediatric department / wards – Ash ward (inpatients) and Oak ward (day surgery / ambulatory care) we currently do not monitor end tidal CO2 routinely. We monitor CO2 on blood gases as clinically indicated with a blood gas analysis machine on Cherry/Maple Ward opposite (our nearest Blood gas analyser)

The only eventuality that we require CO2 monitoring is when we have to intubate a patient prior to retrieval to a tertiary centre for Intensive Care. In this case, the theatre team / anaesthetist bring their portable monitor with ETCO2 monitoring capability.

In Paediatric A&E they have two static monitors with ETCO2 monitoring capability, one in the main A&E resus bay and one in an emergency cubicle in the Paediatric A&E department. The monitors are Fukuda Denshi and are approximately 5 years old. CO2 on blood gases is monitored again according to clinical indication on the A&E analyser.

 

For NeoNatal:

We monitor patient CO2 during resuscitation and when sick babies are inpatients on the unit.

During delivery, resuscitation and reintubation of sick babies we use disposable Pedicaps to check endotrachael tube placement by observing colour changes to indicate presence of CO2.

We monitor babies whilst on the unit using Transcutaneous CO2 monitoring using x 2 Sentec (6months old) and x 2 Tina (3 years old) monitors.

We also trialled ETCO2 monitoring in ventilated babies but discontinued use after inaccurate results. We plan to restart this with new technology in the future.