Key Concepts to Understand During
EtCO2 Monitoring and
PCA Therapy
Sedation Level is the best clinical indicator of reapiratory
depression and should be assessed during PCA therapy.1
SpO2 monitoring is a late detector
of respiratory depression and readings can be falsely elevated if supplemental
oxygen is administered during
SpO2 monitoring.2
EtCO2 monitoring is
a measurement of breath to breath exhaled CO2.
EtCO2 gas
is a reflection of alveolar ventilation.3
- Increased EtCO2 level is typical in the case of underventilation opioid induced respiratory
depression.
This presents as a slow but deep ventilation breathing pattern where
increased EtCO2 gas is exhaled with each breath.
- Decreased EtCO2 levels are
also evident where the ventilation breathing pattern is slow and shallow.
This presents as low EtCO2 gas levels
and is associated with opioid induced respiratory depression.4
Patient Teaching is an absolute necessary procedure
to increase patient compliance with monitoring procedures, understanding
of safety, and decreasing
anxiety associated with increased necessary monitoring.5
1Macintyre, P.E. & Ready, L.B. (2002)
Acute pain management a practical guide Second Edition.
2Practice guidelines for perioperative management of patients
with obstructive sleep apnea. (2006) American Society of Anesthesiologist
Task Force Anesthesiology
104: 1081-93.
3Hutchison, R. (2006) Capnography monitoring during opioid
PCA administration. Journal of Opioid Management 2 (4).
4Ramsey, M. “Respiratory monitoring for acute pain management” Advancing
Safety in Acute Pain Management and Sedation, Main Line Health Hospital.
Sponsored by Cardinal Health June 16, 2006.
5AACN Procedure Manual for Critical Care 4th Ed. (2001). Lynn-McHale,
D.J. & Carlson, K.K. American Association of Critical-Care Nurses. |
