End-tidal CO2 (EtCO2) monitoring after tracheostomy tube replacement or suspected tube dislodgement in general neurosurgical unit, Prince of Wales Hospital (PWH)

Abstract Description

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Authors (including presenting author) :

Lee WY (1), Chau YH (1), Wong WML (1), Lee SW (1), Chan, KF (1), Yeung MWW (1), Chiu ST (1)

Affiliation :

(1)Department of Surgery, Prince of Wales Hospital

Introduction :

Temporary tracheostomy is commonly encountered in neurosurgical unit and tracheostomy tube (T-tube) replacement is a usual procedure in neurosurgical general ward. However, “displacement of tracheostomy tubes” is one of the factors that could lead to airway complications. Despite oxygen saturation (SpO2) and respiratory status were monitored after tube replacement, end-tidal CO2 (EtCO2), which changes typically before SpO2, should be the gold standard to confirm an artificial airway position. Tracheostomy as an definite airway, it is of high risk nature. Considering most neurosurgical patients were confused, agitated or unconscious, it is crucial to use capnography to identify airway tube malposition as early as possible.

Objectives :

To promote nurses’ awareness in assessing, monitoring and facilitating documentation for neurosurgical patients with tracheostomy tube replacement or suspected tube dislodgement.

Methodology :

1. Education including a live demonstration and return demonstration for monitoring of EtCO2 was implemented to all neurosurgical nurses in October 2018. 2. Teaching video regarding monitoring of EtCO2 was uploaded to electronic mobile platform for easy retrieval.3. One-page quick reference was posted in ward setting. 4. Standardized label for changing of temporary T-tube was enforced since October 2018. 5. Educational PowerPoint regarding EtCO2 monitoring was enclosed into the nursing orientation program since October 2018.

Result & Outcome :

Program evaluation was conducted in December, 2018. Over 60% of nurses with neurosurgical experiences ranging from 1 to over 10 years responded. The overall results were satisfactory especially in staff group over 3 years’ neurosurgical experience. This program raised staff awareness for assessing, monitoring and documenting the respiratory status of neurosurgical patients with a tracheostomy tube. Yet capnography is not commonly used in general ward, it is safe, easy to perform and is the gold standard to confirm an artificial airway position.