The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

CASE STUDY:  A TRIAL COMPARING THE EFFECTIVENESS OF THE MERCURY MINI STATCO2® AND THE NELLCOR PEDI-CAP® IN THE PRESENCE OF ENDOTRACHEALLY ADMINISTERED MEDICATIONS

Shawn Hughes B.S., RRT, Betty L. Blake B.S., RRT, NPS, Lee Woods, MD, PhD.  The Johns Hopkins Hospital , Baltimore , Maryland .

Introduction:  The new American Heart Association guidelines for intra-hospital resuscitation recommend the use of an exhaled carbon dioxide (CO2) as the primary means of confirming correct endotracheal tube (ETT) placement.  We compared two exhaled CO2 detectors, Nellcor Pedi-Cap® and Mercury Mini-STAT®, for accuracy of CO2 detection in a neonatal resuscitation situation in which medications are administered via the ETT.

Case Summary:  We tested several drugs that might be given via the ETT during resuscitation for their effect on the two exhaled CO2 detectors.  Normal saline solution (NSS) was used as the control.  Each brand of exhaled CO2 detector was tested in two ways.  First, several drops of each drug were put directly onto the detection filter of the two CO2 detectors and color change recorded (see chart below).  Next, each drug was delivered in an appropriate neonatal dose into a neonatal size test lung via an ETT.  A resuscitation bag and CO2 detector were attached to the test lung and several breaths delivered.  Color change in the CO2 detector was again recorded (see chart below).

Nellcor Pedi-Cap® Positive color change from purple to yellow
Drug/Dose Positive Negative
Normal Saline   With vapor and drops
Infasurf® 1 cc turned yellow With vapor
Epinephrine 1:10,000 0.1 mcg With drops and vapor  
Atropine 0.1 mcg With drops With vapor
Narcan®   0.2 cc to turn <2%

Mercury Mini-STATCO2® Positive color change from blue to yellow
Drug/Dose Positive Negative
Normal Saline 1 cc   With vapor and drops
Infasurf® 0.8 cc turned yellow With vapor
Epinephrine 1:10,000 0.1 mcg With drops With vapor
Atropine 0.1 mcg With drops With vapor
Narcan® 0.1 cc turned yellow 0.1 cc to turn 1-2%

Discussion:  Our study shows that a false positive CO2 detection result can occur when resuscitation medications are used.  All of the medications tested caused a false positive result when the medication contacted the detection filter directly.  This could occur if medication is splashed on the detector or coughed up the ETT by the infant.  When medications were administered through the ETT into a test lung, epinephrine vapor also caused a false positive result with the Nellcor Pedi-Cap® within one to two breaths from the resuscitation bag.  The Mercury Mini-STAT® CO2 did not give a false positive result with epinephrine vapor.  NSS control did not cause a color change on either exhaled CO2 detector with drops or vapor.

Conclusion:  Resuscitation medications can cause a false positive result with exhaled CO2 detectors.  This could result in an incorrect assumption that the infant is successfully intubated.  Exhaled CO2 detectors are a good resource for confirming a successful intubation along with auscultation, but caution should be exercised when used during resuscitation.

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