St. Mark's Hospital - May 11, 2017

Hypercapnia during sedation is a patient safety issue.

On March 28, 2017, St. Mark’s Hospital implemented end-tidal CO2 monitoring (ETCO2 capnography) via nasal cannula for all Patient Controlled Analgesia (PCA) using Alaris ETCO2 technology. The purpose of introducing this new technology is to improve the safety of our patients while on PCA.

Our nursing and respiratory therapy staff have been undergoing training in the use of this new technology. Members of our medical staff will receive two presentations by email, orienting them to the clinical rationale for the use of ETCO2 monitoring for the prevention of respiratory compromise associated with PCA pump use.

High and low ETCO2 alarms will be initially set at the parameters recommended by Alaris, e.g. 60 mmHg (HIGH) and 10 mmHg (LOW). Staff are being trained that the normal ETCO2 range is 35-45 mmHg, and that ETCO2 readings <30 mmHg or >50mmHg may be experiencing respiratory compromise. As we gain more experience with this monitoring system, we may adjust the Alaris ETCO2 alarm parameters to achieve an optimal balance between early detection while avoiding alarm fatigue.

Alaris PCA pump “brains” should be updated to Version 20. If you encounter a pump that is running a lower version, please contact Megan Evans, PharmD, Assistant Director, Pharmacy at (801) 268-7015.

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