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NON INVASIVE MONITORS

NON INVASIVE MONITORS. Pulse oximetry. An inexpensive and noninvasive method to measure arterial blood hemoglobin saturations Measures SpO2 Oxygenation in capillary blood. Pulse oximetry. Indications Monitor adequacy of arterial Oxyhemoglobin Quantify response to therapeutic procedures

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NON INVASIVE MONITORS

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  1. NON INVASIVE MONITORS

  2. Pulse oximetry • An inexpensive and noninvasive method to measure arterial blood hemoglobin saturations • Measures SpO2 • Oxygenation in capillary blood

  3. Pulse oximetry • Indications • Monitor adequacy of arterial Oxyhemoglobin • Quantify response to therapeutic procedures • Comply with mandated regulations • Contraindications • The need for ongoing actual measurement of Ph, PCO2, PaO2 • Abnormal hemoglobin

  4. Pulse oximetry • Precautions/complications • False readings • Tissue injury • Assessment of need • Direct measurement not readily available • Continuous and prolonged measurements • When acid-base status not needed • Assessment of outcome • SpO2 should reflect condition • Documentation of results and intervention

  5. Pulse oximetry • Frequency • Determined by clinical status of patient

  6. Pulse oximetry • Instrumentation • Uses photoplesmography • Light detects volume changes in pulsatile blood flow • Uses red and infrared light • Transmitter – two sided • LED’s transmit light through tissue • Intensity of light measured through photodetector on other side

  7. Pulse oximetry • Output signal is filtered and amplified • Processed and displayed

  8. Pulse ox • Components of absorption • Baseline • Pulsatile

  9. Pulse ox • Accuracy • Falls within ± 3-5% of ABG’s • As SpO2 falls, the accuracy will also fall • Not accurate with saturations below 70%

  10. Pulse ox • Procedure • Follow manufactures protocol • Never mix components • Sensor must be right size, fit • Confirm good signal, allow time • Set low SpO2 88-92% • Validate baseline with ABG • Clean and disinfect between patients • Inspect probe site frequently • Never act on SpO2 readings alone • Careful with readings

  11. Pulse ox • Documentation • Date and time • Patients position, location of probe, activity • FiO2 or O2 flow at time of reading • Model of pulse ox • Comparison of SpO2 to ABG • Stability of readings • Patients clinical appearance • Document HR on pulse ox to manual palpitation of HR

  12. Pulse ox • Factors effecting efficiency • COHb • MetHb • Fetal Hb • Anemia • Vascular dyes • Billirubin • Dark skin pigmentation • Poor perfusion • Motion artifact • Nail polish • Ambient light

  13. Pulse ox • ALWAYS TREAT THE PATIENT. NOT THE NUMBER

  14. End Tidal CO2 • Capnometry • The measurement of CO2 in respiratory gases • Capnometer • Instrument that measures end tidal CO2 • Capnography • The graphic display of CO2 concentrations versus time • Shows changes with every breath

  15. ETCO2 • Indications • Evaluate CO2 in mechanically ventilated patients • Monitoring severity of pulmonary disease and response to treatment • Determine tracheal vs. esophageal intubation • Monitor integrity of vent circuit, artificial airway, and ventilator • Reflect CO2 elimination • Monitor inhaled CO2 during therapeutic CO2 administration

  16. ETCO2 • Contraindications • None, remember that your treating the patient, not the number • Precautions • Misunderstanding the numbers • Weighing down the vent circuit • Assessment of need • Standard of care in OR • Assessment of outcome • Results should reflect patients appearance • Monitoring • Vent params • Hemodynamics

  17. ETCO2 • Instrumentation • Infrared absorption • Most common • Raman scattering • Mass spectroscopy • Photoacustic technology

  18. ETCO2 • Sampling ports are either sidestream or mainstream

  19. ETCO2 • Mainstream • In line analyzer chamber placed between the patients airway and the vent circuit • Advantages • Sensor at airway • Fast response • No sample flow • Disadvantages • Secretions and humidity block sensor window • Frequent calibration • Bulky and heavy • Non disposable • Intubated patients only

  20. ETCO2 • Sidestream • Sampling tube placed between patient and circuit, air pumped into measuring chamber

  21. ETCO2 • Advantages • No bulky sensor • Measures N2O • Disposable sample line • Use with non intubated patients • Disadvantages • Secretions block sample tube • Trap needed to remove excess water • Frequent calibration • Slow response • Sample flow may decrease tidal volume

  22. ETCO2 • Waveform interpretation • I • CO2 zero. Origination of exhalation, deadspace • II • Steep upward slope, mixed deadspace gas and alveolar gas • III • Plateau, alveoli empty, end of plateau is PetCO2 • IV • Rapid decrease in CO2, patient inhalation

  23. ETCO2 • In healthy individuals, the PetCO2 averages 1-5mmHg lower than ABG’s (5-6%)

  24. ETCO2 abnormal waveforms • Hypoventilation • Hyperventilation • Leak

  25. ETCO2 abnormal waveforms • Disconnect

  26. Transcutaneous monitors • Provides continuous noninvasive estimated PO2 and PCO2 • Heats blood to arterialize it • Dependant on age and perfusion status • CO2 more reliable • Used mostly in the NICU

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