Nurses Implementing Capnography in the Post Anesthesia Care Unit for Patients Receiving Analgesics

By Ela Borczynski, RN


Respiratory depression is an adverse event that can occur in patients in the PACU after surgery. Postoperative respiratory monitoring, including end tidal carbon dioxide level (ETCO2) monitoring, is a valuable monitoring tool because respiratory failure is the second most common morbid event after a cardiac event. PCA use is associated with fatal respiratory events. Patients who are sleeping, or appear to be sleeping, but are actually unarousable, may have a normal steady SpO2 while their ETCO2 climbs dangerously. Capnography is able to measure a patient’s ETCO2 as well as respiratory rate and pauses in breathing.

PICO Question

Nurses Implementing Capnography in the Post Anesthesia Care Unit for Patients Receiving Analgesics


Multiple teaching methodologies were employed to reach and engage PACU nurses. Equipment was maintained at the point of care. Biomedical engineers assisted with obtaining capnography equipment, maintenance, and technical help. All nursing staff was educated and notified about this project through staff meetings, email, and in-services during work hours. Surveys were completed by staff prior to and after initiating the project in order to understand their knowledge of capnography.


Educational surveys were given to 100% of the staff (60 nurses) and 31% were completed. 59% had adequate knowledge about capnography and felt comfortable using the product within the unit. At six months 77% staff gained more knowledge and felt more compliant with using capnography.


Patients with PCAs benefited from non-invasive capnography monitoring during recovery from anesthesia. PACU nurses were empowered to initiate evidence-based technology. The new practice was due to comprehensive nurse education, familiarity with a similar capnography monitoring process, and the value nurses placed on having capnography as another assessment tool to safeguard patients. Sustainability will be impacted if the PACU standards of care include capnography for patients.


Use of a standardized tool to assess the sedation needs of these patients promotes communication between members of the multidisciplinary team. Continued education and reinforcement of such tools are necessary for sustainability.  This project was an initial beginning to the development of a sedation protocol to be used for this patient population.  Education of the staff to increase their knowledge of the SBS assessment and document was an important building block for the implementation of a sedation protocol.  Continued small tests of change are needed to sustain the progression of sedation management in pediatric patients follow cardiac surgery.