New Capnography Recommendations

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Capnography in the imaging environment focuses on early detection of respiratory depression, hypoventilation and apnea.

Issued by the Association for Radiologic and Imaging Nursing (ARIN), a new, updated position statements1 that  recommend that capnography now be used for patients that are receiving moderate sedation and analgesia during procedures in the imaging environment.

Capnography, which measures a patient’s exhaled carbon dioxide level, is used to monitor patients who are undergoing general anesthesia.In radiology and imaging settings, patients are at increased risk for respiratory compromise during moderate sedation and would largely benefit from this capnography. To prevent such risks, the radiology nurse’s role is to promote high quality care and their skills and expertise are crucial in the assessment, care planning and direct care of patients in this dynamic multifaceted environment.

The radiology environment is complex and multifaceted, being offered in a variety of inpatient and outpatient settings including: cardiac catheterization lab, IR, MRI, procedural CT, ultrasound and in nuclear medicine.

“The care provided to patients [in radiology and image settings]is dependent on evidence-based practice. Guidelines provide healthcare professionals and institutions, literature and research data that guides the improvements within clinical environments,” explained Evelyn P. Wempe, MBA, MSN, ARNP, ACNP-BC, AOCNP, CRN, ARIN president. “ARIN’s position statement is an indication of the importance of adopting this practice throughout radiology environments as a standard. The knowledge of standards of care assists the radiology and imaging nurse in identifying and setting goals that ensures safe, quality care.”

Establishing New Guidelines

Position statements, such as the ones imposed by these guidelines, and standards of care are methods whereby a profession or specialty clearly defines the focus of its activities and responsibilities for which its practitioners are accountable. For radiology and imaging nurses, ARIN is the recognized professional specialty organization.

“Use of capnography in radiology was a much debated issue. To answer relevant questions, ARIN formed a Task Force to research this issue and create a position statement. The position statement informs nurses and other clinicians working in radiology about the use of capnography in the care of the patient,” noted Wempe.

Providing the course of standards for nursing care in any imaging environment in the past, ARIN has demonstrated its commitment to providing nurses with evidence-based position statements to help guide their practice and to ensure the safe care of their patients in the radiologic environment.  Incorporating these statements into practice, radiology and imaging nurses have utilized these evidence-based methods to continue providing the utmost quality nursing care to all patients.

Aside from merely serving to inform and guide nurses, the ARIN position statement also endorses the routine use of capnography in patients during moderate sedation in the radiology and imaging environment.  In this phase, the utilization of capnography monitoring has added value to ensure that patients are safely recovering following a procedure or imaging study.

Detection Services

As stated in ARIN’s position statement, the use of capnography in the imaging environment focuses on early detection of respiratory depression, hypoventilation and apnea. Therefore proving its benefits, the use of capnography can help healthcare professionals to detect early intervention for restoration of adequate oxygenation, subtlest changes in a patient’s breathing and respiratory compromise, known to occur when a patient struggles to breathe, earlier than ever before. Falling oxygen saturation is far too late of an indicator that a patient is not breathing sufficiently.

The detection of respiratory compromise is especially critical because, according to RT Magazine, a leading source of information for respiratory care practitioners, patients who experience respiratory compromise while hospitalized are 29 times more likely to die compared to the rest of the patient population2. Through the objective data obtained through capnography, the device has the potential to reduce the incidence and severity of postoperative respiratory compromise, and improve patient outcomes and reduce the cost of care.

Radiology Nurse Responsibility

The clinical assessment and management of patients by radiology and imaging nurses is critical to the success of patient outcomes and begins in the pre-procedure phase where the nurse is part of the team that assesses the patient’s airway and respiratory condition prior to undergoing moderate sedation.

Radiology and imaging nurses have a variety of responsibilities including the task of providing safe patient care in accordance with the widely accepted standards of the nursing practice. They must also be constantly aware during the intra-procedure phase that patient positioning can dramatically affect ventilation. In response, the use of capnography during this phase is valuable, especially since certain procedures or imaging performed in the radiology department requires patients to be in prone position, that is where the patient lies flat with the chest down and back up.

The radiology nurse is additionally responsible for administering the moderate sedation medications as ordered by the physician. The patient’s response to these moderate sedation medications can further affect ventilation.

Being able to evaluate ventilation through the use of capnography monitoring will provide early detection of any respiratory compromise for earlier intervention, and is a skill required of a radiology nurse. As he or she cares for a patient in the intra-procedure setting, assessment of hemodynamic status with particular attention to the respiratory status is critical.

Monitoring of respiratory ventilation by the nurse then continues into the post-procedure phase of patient care. Radiology nurses caring for patients in this phase will focus on assessing for respiratory compromise.

For both patients and healthcare systems, the use of capnography is a critical tool to strengthen a culture of safety and best practice, seeing as these should remain priorities for all healthcare professionals including radiology nurses. That being said, radiologic and imaging nurses need the appropriate skill sets and require the technology to effectively monitor those patient health parameters.

References

  1. Association for Radiologic & Imaging Nursing. Association for Radiologic & Imaging Nursing Position Statements. http://www.arinursing.org/practice-guidelines/ 
  2. RT Magazine. Market Analysis: Pulse Oximetry. http://www.rtmagazine.com/2015/01/market-pulse-oximetry/
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Lindsey Nolen
Lindsey Nolen

Staff writer at ADVANCE

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