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ETCO2: What Every Technician Should Know

Views: 17940 - Comments: 29

Chantal Faraudo, CVT, CVPP, provides a practical overview to using end-tidal CO2 monitoring in practice. She covers different types of equipment, what ETCO2 is telling us, how to troubleshoot problems with our patients, and why this is such an important monitoring tool.

This talk is specifically RACE-approved for 1 Technician CE credit.
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Chantal Faraudo's picture
Chantal Faraudo

CVT CVPP

Enrolled: 07/2014

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Caroline Tanner's picture

The part explaining the proper way to inflate the trach tube is a little confusing. Are you supposed to inflate and test the leak sound after the tube is in the patient? I thought you weren't supposed to hear a leak at all . Is there a video to watch this done?

Chantal Faraudo's picture

Caroline,
Thanks for asking for clarification and you ask a very good and IMPORTANT question! Here is a step by step process for checking the cuff of your intubated patient:

1. Before intubating, inflate the cuff on the endotracheal tube to make sure it doesn't have any leaks and holds air. Always measure the length of the tube to the patient before intubating. The tube should extend to the thoracic inlet to the incisors. If the tube is too long it should be cut to prevent excessive dead space and inserting the tube too far.

2. Lubricate just the cuff of your ET tube with water soluble lube (preferably individual sterile packets). Be careful not to get too much lube over the murphy's eye or end of the tube, particularly the small tubes used for cats. Then deflate the cuff with the lube on it. The lube's job is to help create a seal once it is inflated in the trachea.

3. Intubate the patient. You only want to inflate the cuff enough to have a light seal to prevent tracheal damage. Especially in cats!!! This is important in dogs as well since they can develop strictures from tracheal damage as well. With only the 02 on, slowly inflate the cuff while listening at the patients mouth, while another person provides a breath until the manometer gets to 20 cm of H20. You want to hear a leak at 20 cm of H2O pressure in your patient. This will prevent over inflation of the cuff and prevent tracheal necrosis and tears. Then turn on your anesthetic gas. Note how much air you placed in the cuff.

4. Auscultate the thorax for equal bilateral sounds and observe the chest rising on both sides of the chest.

5. Within 5-15 minutes as the patient's plane of anesthesia gets deeper, recheck your cuff with the procedure above as relaxation of the muscles around the airway can occur and you may need to add additional air to the cuff so you hear a leak of air at 20cm of H20. It is best to deflate the cuff completely and add air until you hear a leak at 20cm of H20, rather than just adding extra air. Note how much air you placed in the cuff.

6. You never want to inflate your cuff to "how the bulb feels", for instance "it feels firm" or "full". This is a dangerous practice that can allow for overinflation of the cuff and result in serious harm to the patient.

7. Often times if an appropriate sized ET tube is used, very little air is needed to seal the airway.

Hope this provides clarification for you.

Tinille McKenzie-Wyatt's picture

Have you ever used Silkospray by Rusch? What do you think of it if you have? Would you also use lube on the tube to help create the seal as noted in point #2?

Chantal Faraudo's picture

Hi Tinille,
Thanks for watching our video on ETCO2! I have not used Silkospray by Rusch. Are you referring to using it on the patient or on a piece of equipment? We use a sterile water soluable gel on our endotracheal tubes when we intubate to help create a seal with the cuff. We do not use any kind of aerosol and water soluable gel is inexpensive and seems to work quite well. Not to say this spray isn't a great tool also, just don't have any experience using it. Here is a study you may be interested in reading about Silkospray vs. WSLJ (water soluable jelly) Pretty interesting. It is mostly in reference to the use of the endoscope but interesting nevertheless. Hope this is helpful to you! http://www.hoajonline.com/jacs/2049-9752/2/7

Chambrea Wells's picture

The presenter was explaining how to use a red rubber tube to get a more accurate reading with the side stream ETCO2 attachment; however, you cannot see what see is pointing at as she is explaining this little helpful trick.

Tinille McKenzie-Wyatt's picture

Thank you- great lecture- for future ones her laser did not show up here and we couldn't see the different waveforms she was addressing as well as some other parts...good info though!

Cynthia Ries's picture

Usually there are notes on the discussion that you can print out, but I'm not seeing any here. Was this just a miss or are there really no notes on this lecture?

Kaitlyn Sanborn's picture
Hi Cynthia, We're still working on getting those notes uploaded, there's a new process for uploading with the switch to the new site. I just sent you an email on this topic and I'll send you another message once we have those documents back up and running.
Lori Sipes's picture

I would love it if there were notes available to print. I couldn't see the points of the capnograph you were pointing to on the video, I'd like to label my diagram.

Kaitlyn Sanborn's picture
Hi Lori, We are working on getting those notes uploaded to the site, there's a new process for uploading them compared to how we did it on the old site. I sent you an email in the meantime, and I'll drop you a line again once we have those documents back up.
Courtney Rasbach's picture

I would love to say it would be nice to be able to download notes (ppt, or word outline notes) of these videos with pics!

Kaitlyn Sanborn's picture

Hi Courtney, I just emailed those notes over to you. We have a new process to upload lecture notes to the website, and we'll get these ones up as soon as we can.

Holly Ross's picture

Loved this lecture! But the link to the speakers notes isn't working properly, at least for me. Can someone email them to me as well? Every time I click on the print speakers notes link it just takes me right back to the video.

Beth Ann Fretz's picture

Hi Holly,

I just sent you a PDF of the speaker's notes. Please let me know if you have any further questions!

Jamie Sapien's picture

It's really not helpful when I cannot see where her laser is pointing to. It makes it harder to follow along when I just need clarifications.

David Bernazani's picture

This is an excellent and informative video lecture that I have recommended to the rest of my coworkers to watch.
I wish I had seen it a long time ago!
PS just FYI, in the video, we cannot hear most of the audience's questions, so repeating them (by the speaker) would be helpful, as well as remembering that we cannot see the laser pointer in the diagrams on the video. But thanks for some great information!
-Dave B, rvt

Valwynn Williams's picture

Hi Chantal!
Really enjoyed your video! So helpful to me :-) Question for you. You mention FiO2 very briefly, (which in itself, is a complete subject :-)), but I imagine it's pretty important in the calculations of your patients various anesthetic parameters. Can you point me to any further information, on @Dove (or otherwise) video or print, that would address this aspect of patient care vis a vis Capnography.

Thanks for your time and I look forward to more of your work!

Valwynn Williams, RVT

Sarah Harris's picture

Hi Valwynn,

Thanks for the great question. You aren't kidding when you say FiO2 could be a topic in itself! In particular, FiO2 needs to be considered when we think about all the different ways we administer oxygen therapy to the hospitalized patient. If you have access to Critical Care Medicine by Silverstein and Hopper, it has a section on oxygen therapy that I find really informative regarding FiO2 and the percentages with different administration methods. The other book that I really like on this topic is Anesthesia and Analgesia for Veterinary Technicians by Thomas and Lerch. It goes into more specific detail about the anesthetized patient and ETCO2 monitoring. We don't have other information on atdove regarding FiO2 but we will definitely add it to the list of topics to consider for the future!

Kristen Black's picture

Is there any way you could maybe upload a diagram or picture on how to use the red rubber with the sidesteam capnometer? We ALWAYS have issues with our readings being inaccurate and I'm really interested in introducing this new method with the rest of the team.

Kristen Black's picture

Is there any way you could maybe upload a diagram or picture on how to use the red rubber with the sidesteam capnometer? We ALWAYS have issues with our readings being inaccurate and I'm really interested in introducing this new method with the rest of the team.

Tasha LaForme's picture

For a new tech to the field, I enjoyed listening to the ventilation test and trying to figure it out on my own but the problem I am having is that I can't see what you are pointing at during the presentation, so I don't know which capnograph you are talking about. Is there an answer sheet or maybe another video can be posted? It was super helpful when the pictures were highlighted in a yellow box but that only happens with the first 3. Thank you :)

Rachel Medo's picture

Hi Tasha,

Thanks for your patience while I tried to solidify an answer for you!

Unfortunately the way that this particular video was recorded, we don't have an answer key for the in person quiz. We are working on a solution to make sure that this doesn't happen in future lectures!

Stephanie  Cowan 's picture

This was a pretty frustrating video for me. I was hoping to come away with a more solid understanding of wave forms and to beef up my knowledge of ETCO2 and I'm afraid I'm just more confused. The pointer did not show up at all so it was difficult to appreciate what was being pointed to. Allowing audience comments and questions throughout interrupted train of thought and got us off topic a bit. Basic definitions were repeated multiple times at the expense of more in depth information. I would love to see more detail with the actual machine present for show and tell (maybe broken down into shorter videos). And I would love a longer lecture focusing on more advanced concepts of ETCO2 and Respiratory physiology, presented by Megan Brashear.

Rachel Medo's picture

Hi Stephanie, thanks for providing your feedback.

I’m sorry that this video didn’t clarify ETC02 for you. At these CE lectures, we encourage attendees to ask questions so that they, too, can get the most information, and hopefully apply it to their daily practices. We will definitely look into creating shorter videos that address the ETC02 machine in more detail. In the meantime, are there particular questions you have that we can try to answer? Please feel free to reach out to me directly at rjohnson@dovelewis.org.

Thank you.

Laura Homan's picture

Were the notes ever able to print? When I preview them to print it is blank? May I contac someone or have them emailed to my account listed in my profile? Thanks!

Rachel Medo's picture

Hi Laura,

I'm sorry you are having trouble accessing the notes. I will email them to you directly!

Shaunna Emmons's picture

I have recently transferred to my clinic's anesthesia department and we use this video for training. I was wondering if there could be better clarification on the use of the red rubber? Since the pointer doesn't show on the screen, its hard to understand what she is explaining.

Thanks!

Rachel Medo's picture

Hi Shaunna,

Thanks for your comment.

I've reached out to a few of our technicians here at DoveLewis to see if we can get a short video or article written about red rubber catheters specifically. I know there have been a few questions about their use and it would be great to have dedicated content related just to that topic. Once we get materials uploaded on the site I'll make sure to email you directly so you can share it with your team!

If you have any additional questions, feel free to email me directly at rmedo@dovelewis.org.

- Rachel