NORTH COAST EMERGENCY MEDICAL SERVICES Policy # 5327

POLICIES AND PROCEDURES

Subject: Medical Direction

End Tidal CO2 Detection Device, Adult and Pediatric

Associated Policies: 02/05/98

  1. Indications:
  1. All patients who have been orally or nasally intubated.
  1. Therapeutic Effect:
  1. Measures presence of CO2 in the airway.
  1. Contraindications:
  1. Absolute:
  1. None.
  1. Relative:
  1. End tidal CO2 detectors may report unreliable results (no CO2 detected) in patients without a pulse due to low perfusion state, inadequate CPR, or on a nonviable patient.
  1. Equipment
  1. End tidal CO2 detector.
  1. Procedure:
  1. Inspect CO2 detector for:
  1. purple color.
  2. dryness.
  1. Suction any fluid that is present in the endotracheal tube.
  2. Remove end caps from both ends of the CO2 detector (if present).
  3. Attach CO2 detector to bag-valve device.
  4. Connect the bag-valve device with the CO2 detector attached to the endotracheal tube, keeping CO2 detector clean and dry.
  5. Begin ventilations, use proper ventilation rate for infant, child or adult, observing for bilateral rise and fall of the chest.
  6. Assess tube placement by auscultating/observing for:
  1. absence of bubbling, gurgling noise in epigastric area-2 breaths.
  2. lung sounds bilaterally-2 breaths, each side.
  1. Observe CO2 detector for color change during exhalation-after a total of 6 breaths.
  2. Initiate corrective measures as needed:
  1. Patient with a pulse.
    1. Yellow-yes, leave in place.
    2. Tan, Reevaluate:
    1. check possible causes of low perfusion such as inadequate ventilation, hypovolemia, etc.
  1. ventilate 6 more times and reassess tube placement and CO2 detector for color change.

c. Purple-problem:

    1. tube is incorrectly placed, extubate,

(2) ventilate with BVM, re-intubate.

2. Patient without a pulse:

a. Yellow-yes, leave in place.

b. Tan, Reevaluate:

(1) may be due to retained CO2 from BVM ventilation, alcohol, carbonated drinks, or inadequate CPR.

(2) ventilate 6 more times and reassess tube placement and CO2 detector for color change.

c. Purple-problem:

(1) visualize vocal cords.

    1. if tube is placed below the vocal cords, leave in place, and check adequacy of CPR.

 

 

 

 

 

  1. Special information:
  1. CO2 detectors are only an adjunct to careful patient assessment.
  2. CO2 detectors should not be used as the sole means of assessing correct ET tube placement.
  3. CO2 detector must be kept clean and dry.
  4. If CO2 detector color is not purple on removal from packet, CO2 detector should be discarded.
  5. Fluid in CO2 detector inactivates detector-if wet, CO2 detector will appear mottled. CO2 detector is then no longer usable and should be discarded.
  6. Adult detector has 38 ccs dead space. This dead space may cause rebreathing of CO2 by patients under 15 kg due to smaller tidal volume of these patients.
  7. If pediatric detector is unavailable, Adult detector can be used for initial assessment only then it must be removed. Do not leave device in place through duration of transport.
  8. CO2 detector becomes inactivated when used over a long period of time. 2 hours for adults and 1 hour for pediatrics.