Cardinal Healthcare
EtCO2 Module Pocket Guide Ver 8
Pocket Guide
2 Pages
Preview
Page 1
Alaris® EtCO2 Module Pocket Guide Setting Alarm Limits: 1. Press CHANNEL SELECT key. 2. Press LIMITS. 3. Select limit parameter to be changed. 4. Enter a numeric value using keypad or up/down arrow keys. 5. Press CONFIRM. 6. Press MAIN SCREEN.
1. Press CHANNEL SELECT key. 2. Select TREND. 3. Press PAGE UP and PAGE DOWN to navigate through trend data pages. To move cursor bar press up or down arrow keys. 4. Press ZOOM to change time period. 5. To exit press EtCO2 Main. 6. Press MAIN SCREEN.
PCA/EtCO2 Trend Data:
Possible causes: • Patient has true measurement of low EtCO2 • Disposable not correctly attached to patient or securely connected to module Possible responses: Check disposable connections and assess patient and follow hospital protocol actions.
Note: This function requires use of Alaris PCA module. 1. Press CHANNEL SELECT key. 2. Press OPTIONS. 3. Select PCA/EtCO2 Trend Data. Navigate as described above in section titled Trend Data. 4. To exit press EtCO2 Main. 5. Press MAIN SCREEN. Operator Precautions: For proper operation of the Alaris® System (formerly Medley® System) the user must be familiar with the features, disposables, administration sets, set-up and programming. This guide includes selected information and suggestions and is not intended to be comprehensive instructions for the set-up and operation of the Alaris® System. For complete instructions along with Warnings and Cautions, refer to Alaris® System Directions for Use (v8).
3POC0331
Alaris® EtCO2 Module Pocket Guide Setting Alarm Limits: 1. Press CHANNEL SELECT key. 2. Press LIMITS. 3. Select limit parameter to be changed. 4. Enter a numeric value using keypad or up/down arrow keys. 5. Press CONFIRM. 6. Press MAIN SCREEN.
Possible causes: • Patient has true measurement of high EtCO2 • Fever or hypermetabolic state • Disposable is not properly attached to patient Possible responses: Check disposable and compare value to baseline and follow hospital protocol actions.
Pre-Silencing Alarm:
High FiCO2 Alarm
1. Press SILENCE to pre-silence monitoring alarms for 2 minutes. Note: Infusion alarms will not be silenced.
Possible causes: • Patient is inspiring exhaled CO2 or disposable not properly attached to patient • O2 mask may not be properly attached (if patient is wearing an O2 mask) • O2 flow to mask may have stopped • Drapes or covers may be over patient’s face Possible responses: Check disposable, O2 flow, mask and/or drape position and follow hospital protocol actions.
Troubleshooting The module is trying to clear the clogged disposable. If cleared, the module will automatically resume monitoring. If unable to clear, the module will go into a DISCONNECT OCCLUDED DISPOSABLE alarm.
Disconnect Occluded Disposable Alarm The disposable is occluded or needs to be reset. First try disconnecting disposable and then reattach. If the device again reads DISCONNECT OCCLUDED DISPOSABLE, obtain and attach a new disposable.
Autozero In Progress Alarm
1. Press CHANNEL SELECT key. 2. Select TREND. 3. Press PAGE UP and PAGE DOWN to navigate through trend data pages. To move cursor bar press up or down arrow keys. 4. Press ZOOM to change time period. 5. To exit press EtCO2 Main. 6. Press MAIN SCREEN.
PCA/EtCO2 Trend Data: Note: This function requires use of Alaris PCA module. 1. Press CHANNEL SELECT key. 2. Press OPTIONS. 3. Select PCA/EtCO2 Trend Data. Navigate as described above in section titled Trend Data. 4. To exit press EtCO2 Main. 5. Press MAIN SCREEN. Operator Precautions: For proper operation of the Alaris® System (formerly Medley® System) the user must be familiar with the features, disposables, administration sets, set-up and programming. This guide includes selected information and suggestions and is not intended to be comprehensive instructions for the set-up and operation of the Alaris® System. For complete instructions along with Warnings and Cautions, refer to Alaris® System Directions for Use (v8).
3POC0331
Possible causes: • Patient is not breathing • Disposable is not properly attached to patient and/or device • Disposable is not detecting exhaled breath (shallow breath) Possible responses: Check disposable and assess patient. Consider using different disposable type and follow hospital protocol actions.
Change Waveform Height:
Low EtCO2 Alarm
1. Press CHANNEL SELECT key. 2. Press OPTIONS. 3. Select WAVEFORM HEIGHT. 4. Select 60mmHg or 99mmHg. 5. Press MAIN SCREEN.
Possible causes: • Patient has true measurement of low EtCO2 • Disposable not correctly attached to patient or securely connected to module Possible responses: Check disposable connections and assess patient and follow hospital protocol actions.
High EtCO2 Alarm
1. Press CHANNEL SELECT key. 2. Press OPTIONS. 3. Select WAVEFORM TIME SCALE. 4. Select 5 or 10 seconds (for lower respiratory rates select 10 seconds). 5. Press MAIN SCREEN.
Possible causes: • Patient has true measurement of high EtCO2 • Fever or hypermetabolic state • Disposable is not properly attached to patient Possible responses: Check disposable and compare value to baseline and follow hospital protocol actions.
Pre-Silencing Alarm:
High FiCO2 Alarm
1. Press SILENCE to pre-silence monitoring alarms for 2 minutes. Note: Infusion alarms will not be silenced.
Possible causes: • Patient is inspiring exhaled CO2 or disposable not properly attached to patient • O2 mask may not be properly attached (if patient is wearing an O2 mask) • O2 flow to mask may have stopped • Drapes or covers may be over patient’s face Possible responses: Check disposable, O2 flow, mask and/or drape position and follow hospital protocol actions.
Troubleshooting Clearing Disposable Alarm
®
No Breath Detected Alarm
The module is performing an autozero calibration. During this time no data is obtained. Monitoring will automatically resume when completed. No intervention is necessary.
Change Waveform Time Scale:
Trend Data:
High EtCO2 Alarm
1. Press CHANNEL SELECT key. 2. Press OPTIONS. 3. Select WAVEFORM TIME SCALE. 4. Select 5 or 10 seconds (for lower respiratory rates select 10 seconds). 5. Press MAIN SCREEN.
Clearing Disposable Alarm
®
© 2005 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
Low EtCO2 Alarm
1. Press CHANNEL SELECT key. 2. Press OPTIONS. 3. Select WAVEFORM HEIGHT. 4. Select 60mmHg or 99mmHg. 5. Press MAIN SCREEN.
Change Waveform Time Scale:
Trend Data:
© 2005 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
Change Waveform Height:
The module is trying to clear the clogged disposable. If cleared, the module will automatically resume monitoring. If unable to clear, the module will go into a DISCONNECT OCCLUDED DISPOSABLE alarm.
Disconnect Occluded Disposable Alarm The disposable is occluded or needs to be reset. First try disconnecting disposable and then reattach. If the device again reads DISCONNECT OCCLUDED DISPOSABLE, obtain and attach a new disposable.
Autozero In Progress Alarm The module is performing an autozero calibration. During this time no data is obtained. Monitoring will automatically resume when completed. No intervention is necessary.
No Breath Detected Alarm Possible causes: • Patient is not breathing • Disposable is not properly attached to patient and/or device • Disposable is not detecting exhaled breath (shallow breath) Possible responses: Check disposable and assess patient. Consider using different disposable type and follow hospital protocol actions.
EtCO2 Waveform Examples The following are examples of common EtCO2 waveforms. The waveform trends are examples only and do not represent all potential abnormal waveforms. Analysis of these waveform trends may provide an early indication of the noted possible causes. The associated possible responses are suggestions only and are not meant to replace current clinical practice or hospital protocols. Always consult hospital protocols. Abnormal waveforms are not always associated with alarms.
Normal Waveform (Normal Ventilation; 35-45 mmHg) Clinical findings: • Normal breathing, Normal EtCO2 A - B: Baseline period of no CO2, End of inhalation B - C: Exhalation begins, Begin rapid rise in CO2 (mmHg) C - D: Sustained exhalation, Alveolar plateau D: End of expiration, end tidal CO2 (EtCO2) value D - E: Inhalation, Rapid decrease in CO2
Hypoventilation (Abnormal Waveform) Clinical findings: • Slow breathing, High EtCO2 Possible Causes: • Over medication or increased sedation • Snoring or possible obstruction Possible Responses: • Always follow hospital protocols • Access ABCs • Assess sedation level • Stimulate patient • Notify RT or MD
Hyperventilation (Abnormal Waveform) Clinical findings: • Rapid breathing, Low EtCO2 Possible Causes: • Increase in pain level or splinting area of pain • Increase in anxiety or fear • Respiratory distress or shortness of breath Possible Responses: • Always follow hospital protocols • Treat cause of increased respiratory rate • Assess ABCs (Airway, Breathing, Circulation) • Decrease pain stimulus or encourage calm • Notify RT or MD
Hypoventilation with Shallow Breathing (Abnormal Waveform) Clinical findings: • Slow breathing, Low EtCO2 followed by deep breath (see pointing arrow) Possible Causes: • Over medication or increased sedation • Low tidal volume Possible Responses: • Always follow hospital protocols • Assess ABCs • Maintain patient airway • Encourage patient to take deep breaths • Notify RT or MD
(mmHg)
(mmHg)
(mmHg)
(mmHg)
Partial Airway Obstruction (Abnormal Waveform) Clinical findings: • Irregular breathing, possible audible sound or snoring, EtCO2 may be above or below baseline Possible Causes: • Poor head or neck alignment • Over medication or sedate Possible Responses: • Always follow hospital protocols • Assess ABCs • Encourage patient to take deep breaths • Perform a head tilt or chin lift; Check position of cannula • Notify RT or MD (mmHg)
No Breath (Abnormal Waveform) Clinical findings: • Sudden loss of EtCO2 reading, Very shallow or no respiratory rate pattern observed Possible Causes: • No Breath or Apnea • Very shallow breathing • Over medication or sedate • Displaced cannula Possible Responses: • Always follow hospital protocols • Assess ABCs • Stimulate patient • Open airway • Notify RT or MD (mmHg)
References: 1. Capnography in the Management of the Critically Ill Patient, EducationPAK for Critical Care and Procedural Sedation - A Guide to Capnography, CD-ROM - Needham, MA Oridion Medical, 2003. 2. AACN Procedure Manual for Critial Care 4th Ed. (2001). Ed. Lynn-McHale, D.J. & Carlson K.K., American Association of Critical-Care Nurses. 3. Thalan’s Critical Care Nursing Diagnosis and Management 4th Ed. (2001) Ed. Urden, L.D., Stacy, K.M. & Lough, M.E., C.V. Mosby
EtCO2 Waveform Examples The following are examples of common EtCO2 waveforms. The waveform trends are examples only and do not represent all potential abnormal waveforms. Analysis of these waveform trends may provide an early indication of the noted possible causes. The associated possible responses are suggestions only and are not meant to replace current clinical practice or hospital protocols. Always consult hospital protocols. Abnormal waveforms are not always associated with alarms.
Normal Waveform (Normal Ventilation; 35-45 mmHg) Clinical findings: • Normal breathing, Normal EtCO2 A - B: Baseline period of no CO2, End of inhalation B - C: Exhalation begins, Begin rapid rise in CO2 (mmHg) C - D: Sustained exhalation, Alveolar plateau D: End of expiration, end tidal CO2 (EtCO2) value D - E: Inhalation, Rapid decrease in CO2
Hypoventilation (Abnormal Waveform) Clinical findings: • Slow breathing, High EtCO2 Possible Causes: • Over medication or increased sedation • Snoring or possible obstruction Possible Responses: • Always follow hospital protocols • Access ABCs • Assess sedation level • Stimulate patient • Notify RT or MD
Hyperventilation (Abnormal Waveform) Clinical findings: • Rapid breathing, Low EtCO2 Possible Causes: • Increase in pain level or splinting area of pain • Increase in anxiety or fear • Respiratory distress or shortness of breath Possible Responses: • Always follow hospital protocols • Treat cause of increased respiratory rate • Assess ABCs (Airway, Breathing, Circulation) • Decrease pain stimulus or encourage calm • Notify RT or MD
Hypoventilation with Shallow Breathing (Abnormal Waveform) Clinical findings: • Slow breathing, Low EtCO2 followed by deep breath (see pointing arrow) Possible Causes: • Over medication or increased sedation • Low tidal volume Possible Responses: • Always follow hospital protocols • Assess ABCs • Maintain patient airway • Encourage patient to take deep breaths • Notify RT or MD
(mmHg)
(mmHg)
(mmHg)
(mmHg)
References: 1. Capnography in the Management of the Critically Ill Patient, EducationPAK for Critical Care and Procedural Sedation - A Guide to Capnography, CD-ROM - Needham, MA Oridion Medical, 2003. 2. AACN Procedure Manual for Critial Care 4th Ed. (2001). Ed. Lynn-McHale, D.J. & Carlson K.K., American Association of Critical-Care Nurses. 3. Thalan’s Critical Care Nursing Diagnosis and Management 4th Ed. (2001) Ed. Urden, L.D., Stacy, K.M. & Lough, M.E., C.V. Mosby
Partial Airway Obstruction (Abnormal Waveform) Clinical findings: • Irregular breathing, possible audible sound or snoring, EtCO2 may be above or below baseline Possible Causes: • Poor head or neck alignment • Over medication or sedate Possible Responses: • Always follow hospital protocols • Assess ABCs • Encourage patient to take deep breaths • Perform a head tilt or chin lift; Check position of cannula • Notify RT or MD (mmHg)
No Breath (Abnormal Waveform) Clinical findings: • Sudden loss of EtCO2 reading, Very shallow or no respiratory rate pattern observed Possible Causes: • No Breath or Apnea • Very shallow breathing • Over medication or sedate • Displaced cannula Possible Responses: • Always follow hospital protocols • Assess ABCs • Stimulate patient • Open airway • Notify RT or MD (mmHg)