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Inside scoop from our experts: Capnography policies

HCPro's Weekly Update on the ANCC Magnet Recognition Program®*, January 18, 2010

This week, a member of our Journeytalk Listserv asked the following question. Linda Klavon, MS, RN, CS, ACNP-BC, CEN, clinical nurse specialist for professional practice at Battle Creek Health System in Battle Creek, MI provided insight from the perspective of her facility.

Q: Is anyone using capnography with patients on pain pumps or opiates? If so what does your policy include?

A: My organization does not have patients on capnography for pain pumps/opiates, but I have consulted at other organizations about the same. The recommendation is generally that any patient who has a known strong sedative reaction to opiates, a suspected or known sleep apnea, and persons with known CO2 retention or COPD-use of BiPap. Some organizations establish the use of capnography for all persons post op/procedure on general units receiving opiates, some organizations make it based on the higher dosages. My personal clinical preferences are:

1. During any conscious sedation procedure until fully recovered,
2. For any patient with a history or showing signs of strong sedative effect after analgesia or sedative administration (difficult to arouse, snoring respirations, etc),
3. For any patient currently on an opiate analgesic who has developed tolerance and is having increased dosing to achieve pain control,
4. Any pediatric patient younger than age 6-8 (variable evidence), pregnant or elder patient, and
5. Any known CO2 retainer.

I like to use capnography on the general floor to trend patients admitted for exacerbation of COPD because they often can be started on BiPap sooner based on climbing CO2 levels before seeing O2 drops in saturation, change in gases or signs of fatigue. They generally recover faster.

Editor's note: On JourneyTalk you can network with your peers, discuss the new manual, share your helpful tips, and get advice on how to meet the program's expectations. Become a member ofJourneyTalk when you subscribe to HCPro's Resource Center® for the ANCC Magnet Recognition Program.

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