Overcoming Challenges and Driving Consistent Implementation in an Academic Medical Center’s Level IV NICU.

Ann  Donnelly MS, RRT-NPS, Jennifer Erkinger MS, RRT-NPS, AE-C, C-NPT
Milton S. Hershey Medical Center, Penn State Health

Introduction

Neonatal care providers have long understood the intrinsic advantages to monitoring carbon dioxide (CO2) transcutaneously; among other benefits, avoiding unnecessary blood draws can have significant implications for preterm infants with regard to pain and stimulation, infection potential, and even blood loss. Unfortunately, early transcutaneous monitoring (TCM) introduced in the early 1990s presented challenges including frequent calibration, difficult maintenance, and a high operating temperature that adversely affected skin integrity in these fragile patients.

However, the experience with modern transcutaneous CO2 equipment (Sentec Digital Monitor, Sentec, Therwil, Switzerland) at Hershey Medical Center’s Level IV NICU demonstrates that the technology has evolved to accommodate the needs of neonatal care providers and patients; and that with the right education and  implementation, transcutaneous monitoring can be an effective tool for ventilator management and reducing blood draws in the NICU.

Complexities with Blood Gases and Capnography

Historically, CO2 levels have been available through blood draws – either arterial blood gases (ABGs) or capillary heel sticks (CBGs). While this methodology is considered…

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