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Medtronic / Covidien Products / Capnography Monitoring / Safer procedural sedation capnography

Procedural sedation

Safer sedation given with greater confidence

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What are the risks of procedural sedation?

During procedural sedation, there’s often a concern that a sedated patient’s spontaneous ventilation may become inadequate. And clinical evidence suggests that a patient’s sedation level does not remain stable during a procedure, and may change dangerously from moderate to deep1 – which can have an impact on their ability to breathe.

When you consider that only half of moderately sedated patients achieve their target level of sedation2, and that similar patients can react differently to a similar sedative dose, the risks become more apparent.

Respiratory events are more prevalent than you may think:

  • Only 50% of moderately sedated patients achieved their target level.2

  • 20% of patients experienced respiratory related events requiring interventions.3

What is the advice for capnography during procedural sedation?

In the past, there has been some confusion about the advice of clinical societies with regard to capnography. However, there is a growing wave of societies recommending continuous capnography along with pulse oximetry, as an alert to changes in oxygenation and ventilation – two key factors in detecting respiratory related adverse events in their early stages.4

In fact, more than 65 scientific and clinical societies now consider capnography as the standard of care – and recommend its use during procedural sedation.4

Capnography can help you to reduce these respiratory related events:

  • The incidence of respiratory adverse events can decrease by up to 55% with capnography.5

  • Capnography is considered as the standard of care, by over 65 clinical societies.4

Capnography in guidelines

To help you understand the advice, Medtronic has produced an eBook on Clinical Society Guidelines for Capnography Monitoring, enabling you to:

  • Read about some of the clinical societies publishing guidelines and standards for capnography monitoring
  • View guideline and recommendation summaries
  • Gain insight on specific recommendations 

Download the ebook

Would you like to optimize your patients' monitoring during procedural sedation? 4,5

Contact us to learn more about the solutions Medtronic has available: we can help you understand the positive impact that effective capnography monitoring could have on your organisation, and the patients you care for.

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Is there an unjustified barrier to the use of capnography?

Despite respiratory events being the most common adverse event associated with procedural sedation1, there are still objections to the use of capnography on the grounds of cost.5

But in fact, when compared to the possible economic burden linked to respiratory adverse events, capnography is overall cost-saving – with one study quantifying a saving of €55 per 100 patients.5

What 3 solutions are available?

1. Microstream™ capnography

Discover our complete capnography portfolio enabling clinicians to accurately6-10 monitor patients during procedural sedation.

Capnography can help you to reduce these respiratory related events

The Microstream™ capnography portfolio includes bedside monitors that are easy to use7, designed for both intubated and non-intubated patients, and come with a complete portfolio of single-use sampling lines.

2. Educational package

A comprehensive offering of remote and live educational opportunities including interactive decks, e-learning modules, clinical documents, webinars, podcast series, masterclasses and on-site support helping you and your team to:

  • Learn about capnography from the basics to waveforms interpretation
  • Apply procedural sedation using different approaches
  • Recognise complications during procedural sedation
  • Judge on the value of various monitoring technologies
  • Recognise the additional value of capnography during sedation

3. Audit tool 

Log and audit your sedation cases. Medtronic can help you collect data of sedation cases (no identifiable patient data will be collected) and learn about areas of practice that can be improved and areas where your department is performing well!

Would you like to optimize your patients' monitoring during procedural sedation?

Contact us to learn more about the solutions Medtronic has available: we can help you understand the positive impact that effective capnography monitoring could have on your organisation, and the patients you care for.

Contact us

Resources

Implementing capnography to help improve patient safety during procedural sedation: quality improvement in a high-volume gastroenterology department - Dr. Bisschops et al. (UZ Leuven)
 
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Service Evaluation of the Impact of Capnography on the Safety of Procedural Sedation - Corbett et al. (Cambridge)
 
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Dr Martin Lees from Sedate UK demonstrating the responsiveness of Capnography to changes in ventilation
 
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Safer sedation practice for healthcare procedures by the Academy of Medical Royal Colleges

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Sedate UK Webinars & Podcasts

(scroll to the end of the page)

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Medtronic solutions for patient monitoring in sedation
 
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References

1. Frank RL. Procedural sedation in adults outside the operating room. https://www.uptodate.com/contents/procedural-sedation-in-adults-outside-the-operating-room, accessed on 2021-05-20

2. Schick A, Driver B, Moore JC, Fagerstrom E, Miner JR. Randomized Clinical Trial Comparing Procedural Amnesia and Respiratory Depression Between Moderate and Deep Sedation With Propofol in the Emergency Department. Acad Emerg Med. 2019 Apr;26(4):364-374. doi: 10.1111/acem.13548. Epub 2018 Sep 24. PMID: 30098230.

3. Saunders R, Davis JA, Kranke P, Weissbrod R, Whitaker DK, Lightdale JR. Clinical and economic burden of procedural sedation-related adverse events and their outcomes: analysis from five countries. Ther Clin Risk Manag. 2018 Feb 28;14:393-401. doi: 10.2147/TCRM.S154720. PMID: 29535525; PMCID: PMC5836671.

4. Clinical Society Guidelines for Capnography Monitoring. 18-emea-cs-guidelines-for-capnography-2922293.pdf. 2019

5. Bisschops R, Saunders R, Dooms C, Hoffman I, van der Merwe S, Weissbrod R, Torres RT, Van Assche G, Demedts I. Implementing capnography to help improve patient safety during procedural sedation: quality improvement in a high-volume gastroenterology department. Eur J Gastroenterol Hepatol. 2021 Apr 19. Doi: 10.1097/MEG.0000000000002144. Epub ahead of print. PMID: 33905213.

6. Maddox RR, Williams CK, Oglesby H, Butler B, Colclasure B. Clinical experience with patient-controlled analgesia using continuous respiratory monitoring and a smart infusion system. Am J Health Syst Pharm. 2006 Jan 15;63(2):157-64. doi: 10.2146/ajhp050194. PMID: 16390930.

7. Khanna AK, Bergese S, Jungquist CR, et al. Prediction of opioid-induced respiratory depression on inpatient wards using continuous capnography and oximetry: an international prospective, observational trial. Anesth Analg. October 2020;

8. Mehta PP, Kochhar G, Albeldawi M, Kirsh B, Rizk M, Putka B, John B, Wang Y, Breslaw N, Lopez R, Vargo JJ. Capnographic Monitoring in Routine EGD and Colonoscopy With Moderate Sedation: A Prospective, Randomized, Controlled Trial. Am J Gastroenterol. 2016 Mar;111(3):395-404. doi: 10.1038/ajg.2015.437. Epub 2016 Feb 23. PMID: 26902229.

9. Ishiwata T, Tsushima K, Terada J, Fujie M, Abe M, Ikari J, Kawata N, Tada Y, Tatsumi K. Efficacy of End-Tidal Capnography Monitoring during Flexible Bronchoscopy in Nonintubated Patients under Sedation: A Randomized Controlled Study. Respiration. 2018;96(4):355-362. doi: 10.1159/000489888. Epub 2018 Jun 28. PMID: 29953986.

10. Klare P, Reiter J, Meining A, Wagenpfeil S, Kronshage T, Geist C, Heringlake S, Schlag C, Bajbouj M, Schneider G, Schmid RM, Wehrmann T, von Delius S, Riphaus A. Capnographic monitoring of midazolam and propofol sedation during ERCP: a randomized controlled study (EndoBreath Study). Endoscopy. 2016 Jan;48(1):42-50. doi: 10.1055/s-0034-1393117. Epub 2015 Sep 28. PMID: 26415090.

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