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NON INVASIVE MONITORS

Learn about the benefits, procedure, accuracy, and interpretation of pulse oximetry and end-tidal CO2 monitoring. Understand indications, contraindications, precautions, and factors affecting efficiency. Discover different types of ETCO2 instrumentation, advantages and disadvantages of each, and waveform interpretations.

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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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