Transcutaneous paCO2 Monitoring: Difference between revisions

From Guide to YKHC Medical Practices

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Transcutaneous CO<sub>2</sub> (TC-CO<sub>2</sub>) monitors function by measuring the CO<sub>2</sub> which diffuses out the skin.  Modern TC-CO<sub>2</sub> monitors are a highly accurate, non-invasive method for estimating paCO<sub>2</sub>.<ref>Nassar BS, Schmidt GA. [https://doi.org/10.1513/AnnalsATS.201701-034FR '''Estimating Arterial Partial Pressure of Carbon Dioxide in Ventilated Patients: How Valid Are Surrogate Measures?'''] Ann Am Thorac Soc. 2017 Jun;14(6):1005-1014. doi: 10.1513/AnnalsATS.201701-034FR. PMID: 28570147.</ref><br>
Transcutaneous CO<sub>2</sub> (TC-CO<sub>2</sub>) monitors function by measuring the CO<sub>2</sub> which diffuses out the skin.  Modern TC-CO<sub>2</sub> monitors are a highly accurate, non-invasive method for estimating paCO<sub>2</sub>.<ref name="Nassar2017">Nassar BS, Schmidt GA. [https://doi.org/10.1513/AnnalsATS.201701-034FR '''Estimating Arterial Partial Pressure of Carbon Dioxide in Ventilated Patients: How Valid Are Surrogate Measures?'''] Ann Am Thorac Soc. 2017 Jun;14(6):1005-1014. doi: 10.1513/AnnalsATS.201701-034FR. PMID: 28570147.</ref><br>
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== Primary Purpose ==
== Primary Purpose ==
YKDRH obtained TC-CO<sub>2</sub> monitors for the purpose of following paCO<sub>2</sub> <u>trends</u> in patients receiving high-flow nasal cannula or non-invasive ventilation (i.e. CPAP/BiPAP).  This was necessary because end-tidal CO<sub>2</sub> monitoring is not compatible with these interventions.
YKDRH obtained TC-CO<sub>2</sub> monitors for the purpose of monitoring paCO<sub>2</sub> <u>trends</u> in patients receiving high-flow nasal cannula or non-invasive ventilation (i.e. CPAP/BiPAP).  This was necessary because end-tidal CO<sub>2</sub> monitoring is not compatible with these interventions.




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# Applicable for all age groups (including extremely premature neonates).
# Applicable for all age groups (including extremely premature neonates).
# Initial reading requires approximately five minutes to establish.
# Initial reading requires approximately five minutes to establish.
# The TC-CO<sub>2</sub> reading at any given time reflects the paCO<sub>2</sub> from several minutes prior.
# TC-CO<sub>2</sub> is '''substantially more accurate''' than peripheral venous CO<sub>2</sub> for estimating paCO<sub>2</sub>.<ref name="Nassar2017"/>
# TC-CO<sub>2</sub> measures paCO<sub>2</sub> trends; it DOES NOT measure instantaneous levels.  Therefore, TC-CO<sub>2</sub> '''IS NOT''' an acceptable substitute for ET-CO<sub>2</sub> in these situations:
# Because CO<sub>2</sub> takes several minutes to diffuse out of the skin, the displayed TC-CO<sub>2</sub> reading at any given time reflects the paCO<sub>2</sub> from 2-4 minutes prior.
# The tracing is a flat line (rather than the waveform created by exhaled air).
# TC-CO<sub>2</sub> is used to follow paCO<sub>2</sub> trends; it DOES NOT measure instantaneous levels.  Therefore, TC-CO<sub>2</sub> '''IS NOT''' an acceptable substitute for ET-CO<sub>2</sub> in situations such as:
## Confirmation of ET-tube placement.
## Confirmation of ET-tube placement.
## CPR (neither for CPR adequacy nor ROSC identification).
## CPR (neither for CPR adequacy nor ROSC identification).
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The Sentec devices provides monitoring of:
The Sentec devices provides monitoring of:
# Instantaneous oximetry
# Instantaneous oximetry
# Instantaneous heart rate
# Instantaneous heart rate (with an adjustable duration trend line)
# Trending of paCO<sub>2</sub>
# Trending of paCO<sub>2</sub> (with an adjustable duration trend line)


== Resources ==
== Resources ==

Revision as of 18:29, 13 March 2023

Transcutaneous CO2 (TC-CO2) monitors function by measuring the CO2 which diffuses out the skin. Modern TC-CO2 monitors are a highly accurate, non-invasive method for estimating paCO2.[1]

Primary Purpose

YKDRH obtained TC-CO2 monitors for the purpose of monitoring paCO2 trends in patients receiving high-flow nasal cannula or non-invasive ventilation (i.e. CPAP/BiPAP). This was necessary because end-tidal CO2 monitoring is not compatible with these interventions.


Important Points

  1. Applicable for all age groups (including extremely premature neonates).
  2. Initial reading requires approximately five minutes to establish.
  3. TC-CO2 is substantially more accurate than peripheral venous CO2 for estimating paCO2.[1]
  4. Because CO2 takes several minutes to diffuse out of the skin, the displayed TC-CO2 reading at any given time reflects the paCO2 from 2-4 minutes prior.
  5. The tracing is a flat line (rather than the waveform created by exhaled air).
  6. TC-CO2 is used to follow paCO2 trends; it DOES NOT measure instantaneous levels. Therefore, TC-CO2 IS NOT an acceptable substitute for ET-CO2 in situations such as:
    1. Confirmation of ET-tube placement.
    2. CPR (neither for CPR adequacy nor ROSC identification).
    3. Respiratory monitoring during sedation.
    4. Any situation where monitoring for apnea or any rapid changes in paCO2.

Device

YKDRH has acquired the Sentec Digital Monitoring System.
The Sentec devices provides monitoring of:

  1. Instantaneous oximetry
  2. Instantaneous heart rate (with an adjustable duration trend line)
  3. Trending of paCO2 (with an adjustable duration trend line)

Resources

Sentec Instruction Manual

Instructional Videos:

Neonatal Sensor Application for the Sentec Digital Transcutaneous Monitoring System
Sensor Application Adult Cheek for the Sentec Digital Transcutaneous Monitoring System



REFERENCES

‎

  1. ↑ 1.0 1.1 Nassar BS, Schmidt GA. Estimating Arterial Partial Pressure of Carbon Dioxide in Ventilated Patients: How Valid Are Surrogate Measures? Ann Am Thorac Soc. 2017 Jun;14(6):1005-1014. doi: 10.1513/AnnalsATS.201701-034FR. PMID: 28570147.
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