PC.RT.

002
Capnography Monitoring

Capnography Monitoring
VCU Health System Policy

Document Number: PC.RT.002 Effective Date:

Vice President, Chief
Document Owner: Revision #: 2.0
Nursing Officer (CNO)

General Information
Responsible Department:
Nursing Services
Respiratory Therapy
Anesthesia

Responsible Individuals / Who Performs:

Physicians, nurses and respiratory therapists who care for patients that are 1) at high risk for
hypoventilation, or 2) have recently undergone (<24 hours) general anesthesia, procedural
sedation, cardiopulmonary resuscitation, or intubation, or 3) who are being transported with an
advanced airway in place.

Purpose
To define patients (except neonates) who are at risk for impaired ventilation and could benefit from
continuous capnography monitoring.

Definitions

Term: Definition:

Waveform The continuous evaluation of the amount of carbon dioxide (PetCO2) in

Capnography respiratory gases. Capnography is a non-invasive monitoring technique which
may offer rapid insights into ventilation, circulation and metabolism, with the
potential to provide early indications of impaired ventilation.

Policy

A. Equipment capable of providing waveform capnography is available on defibrillators, travel

monitors, anesthesia monitoring equipment, bedside cardiac monitors and procedural
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Capnography Monitoring
sedation areas.

B. All non-emergent adult surgical patients (except obstetric) are evaluated for risk of Obstructive
Sleep Disordered Breathing using the STOP BANG tool prior to an operative procedure

C. All adult patients (except obstetric) are evaluated on admission by a registered nurse
for risk of Obstructive Sleep Disordered Breathing using the STOP BANG tool.

D. Waveform capnography monitoring is used for all adult, obstetric and pediatric patients
(except neonates) in the following situations:

• When undergoing procedural sedation

• During cardiopulmonary resuscitation
• Confirmation of advanced airway placement
• During mechanical ventilation
• During transport of manually and mechanically ventilated patients
• Receiving a continuous basal rate through Patient Controlled Analgesia (PCA) infusion.
(Palliative care patients are excluded.)
• Receiving unplanned administration of the reversal agent Naloxone or Flumazenil.
(Continue monitoring for at least 2 hours after the last administration of the reversal
agent.)

E. Waveform capnography monitoring is available for all adult patients recovering from a
procedure requiring general anesthesia. (Continue monitoring until provider determines and
documents that patient has met post-anesthesia care discharge criteria.)

F. Waveform capnography monitoring is used for all adult and pediatric patients (except
neonates) meeting one of the following criteria which put them at high risk for
hypoventilation:

• Demonstrate clinical signs of hypoventilation, including but not limited to periods of

apnea or sonorous breathing.
• Adult STOP BANG score > 5 and not using a prescribed continuous positive airway
pressure device.
• Known diagnosis of Sleep Disordered Breathing and not using a prescribed
continuous positive airway pressure device.

G. In addition to the conditions listed above, Pediatric (< 18 y/o) patients with the following
conditions are considered high risk for hypoventilation and capnography monitoring is
recommended:

• Trisomy 21
• Pierre Robin Syndrome
• Micrognathia
• Hurler Syndrome and other inborn errors of metabolism

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• Surgery on oropharynx, pharynx, vocal cords, neck (e.g. retropharyngeal abscess)
• Neuromuscular disease (e.g. Spinal Muscle Atrophy, Duchenne's Muscular Dystrophy,
Myotonic Dystrophy, and other disorders that impact respiratory muscles)
• Severe Obesity; history of snoring when sleeping
• Spastic Quadriplegia, Cerebral Palsy
• Other genetic abnormalities which carry significant risk of impaired breathing
• Any other condition with impaired breathing that might lead to hypoventilation

H. If a provider feels that capnography is NOT indicated in a patient who meets criteria listed in
this document, an explanation of the clinical rationale is recorded in the medical record.

Procedure

1. Document the PetCO2 value alongside vital signs whenever capnography is used.

2. Review waveform immediately after placement of an advanced airway or during monitoring and
transport of the patient who is manually or mechanically ventilated.

Related Documents
Related Content:

https://procedures.lww.com/lnp/view.do?pId=40971&hits=end,tidal&a=false&ad=false

https://procedures.lww.com/lnp/view.do?pId=1113061&hits=end,tidal&a=false&ad=false

Evidence Citations
1. American Society of Anesthesiologists, Standard 3.2.4, December 13, 2020
2. Advanced Cardiac Life Support (ACLS) Guidelines, 2015
3. Pediatric Advanced Life Support Guideline, 2015
4. AARC Clinical Practice Guidelines, 2011
5. AACN Procedure Manual for Critical Care, Seventh Edition, 2017

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