Standard Operating Procedure SOP ID C04 Version 1.0 Title Approved by Capnography: MobiMed Clinical Effectiveness Group Date Issued 1 st February 2013 Review Date 31 st January 2015 Directorate Clinical Publication Category Clinical Mandatory - No deviation from document permissible 1. Scope 1.1 This Standard Operating Procedure (SOP) outlines the correct procedure for using the Mobimed capnography unit to monitor end tidal CO 2 (ETCO 2 ) and to confirm endotracheal tube placement. 1.2 This SOP must be read in conjunction with Clinical Guideline (CG11) - End Tidal CO2 Monitoring and Clinical Guideline (CG03) - Airway Management. 2. Responsibility 2.1 It is the responsibility of all ambulance clinicians to adhere to this SOP. 3. Introduction 3.1 Capnography is the monitoring of the concentration or partial pressure of carbon dioxide (CO 2 ) in the respiratory gases produced at the end of each breath or ventilation. This directly reflects the elimination of CO 2 by the lungs and indirectly reflects the production of CO 2 by tissues and the circulatory transport of CO 2 to the lungs. Capnography provides information about CO 2 production, pulmonary (lung) perfusion, alveolar ventilation, respiratory efficiency, and the elimination of CO 2.
3.2 Carbon dioxide (CO 2 ) is measured with the aid of an ISA gas analyser, using the sidestream technique. This means that the Mobimed unit continually sucks a small amount of air from the sampling line, which is analysed to indicate the amount of CO 2 present. As the air is entrained into the device, there is a short delay between changes in the levels of CO 2 at the patient end of the sampling line, and the change in the concentration measured by the unit; this is perfectly normal. The sidesteam modality is better able to monitor ETCO 2 in the spontaneously breathing patient and is more suited to capnography. 4. Indications 4.1 Apply device as indicated by Clinical Guideline (CG11) - End Tidal CO2 Monitoring. It is mandatory that one of the three forms of ETCO 2 monitoring available within the Trust (Easy Cap, EMMA or Mobimed) are utilised whenever a BVM is used by an ambulance clinician to ventilate via a face mask, supra-glottic airway, ET tube or surgical airway. Where a device is not available at the commencement of the airway intervention or ventilation, the rationale for this must be recorded in the procedural exclusion section of the PCR and an incident report submitted. 4.2 Whilst ETCO 2 monitoring must commence at the earliest opportunity, the choice of initial device is at the discretion of the senior clinician on-scene. The Easy Cap and EMMA devices are the most rapid to deploy, whilst the Mobimed provides the benefits of full waveform capnography. 5. Contraindications 5.1 None. 6. Directions for Use 6.1 The Mobimed should be set up in the following manner: 1. Turn the Mobimed laptop and measuring unit on. 2. Connect the cable from the ISA capnography module to the measurement unit, by plugging it into the ETCO 2 socket, which has a grey label (Figure 1). 3. Push the rigid green end of the Nomoline sampling hose into the ISA module's gas inlet (Figure 2). A green LED light indicates that the ISA sensor is ready for use. 4. Connect the leur lock gas outlet of the sampling hose to the Nomoline airway adaptor and connect the adaptor between the endotracheal tube/i-gel/face mask and the bag-valve-mask (Figure 3), or to the port on the specific medium flow oxygen masks (Figure 4).
6.2 Figure 1 - Measuring Unit 1. SpO2 2. ECG 3. EtCO2 6.3 Figure 2 - ISA Module 6.4 Figure 3 - BVM/Endo-Tracheal Tube Connection Figure 4 - Sentri ETCO 2 Mask 6.5 After you have connected the ISA sensor to the measuring unit and to the patient's respiration system, a CO 2 waveform will be displayed on the monitor's screen, together with the value for ETCO 2 in kpa (Kilo Pascals) and the respiration rate (Figure 5).
6.6 Figure Five - Mobimed Display 6.7 To adjust the unit settings, press either the settings symbol or the CO 2 box as illustrated in Figure 6. 6.8 Figure Six - Opening Settings Screen 6.9 Once the settings box is open, adjustments to the minimum and maximum values can be made. Additionally adjustments to the waveform scale can be made and the alarm functionality can be disarmed (Figure 7).
6.10 Figure 7 - Capnography Settings 6.11 Further information and the complete Mobimed user guide can be accessed on the Medical Devices webpage. 7. Cleaning and Decontamination 7.1 After each use ensure the following procedure must be applied to clean the device: Dispose of the sampling line, BVM and/or oxygen mask as contaminated waste. Wipe entire exterior surface of the Mobimed capnography unit with a detergent wipe. Only wipe the exterior casing; do not attempt to wipe within the sampling port. 8. Documentation 8.1 In line with Trust Policy, a Patient Clinical Record must be completed and annotated appropriately to identify the utilisation of the device and confirmation of waveform present. Any deviation from this SOP must be recorded, with any potential or actual adverse event reported through the incident reporting system.