Canberra Hospital and Health Services Clinical



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  1. Attach CO2 detector (see SOP CO2 detector)

  2. Auscultate, assess chest wall movement and clinical response

  3. Secure ETT (see SOP’s: Securing oral ETT tubes and Securing nasal endotracheal tubes)

  4. Confirm position with chest x-ray – assist radiographer (see x-ray SOP for correct positioning of the baby during the procedure)

  5. Shortening of the ETT may be required to optimise ventilation by reducing dead space – this is a 2 person procedure and the medical officer must be aware this procedure is in progress.

  6. When shortening:

  • The correct position of the ETT must be ascertained

  • The infant must be settled and must not have any respiratory compromise

  • Cut the ETT at a very slight angle which makes it easier to introduce the connector afterwards

  1. Attach to ventilator with preset parameters once there is stability of the ETT

  2. Document the position of the tube in the nursing notes

  3. Vent the stomach by passing an orogastric tube as (see SOP orogastric tube insertion)

  4. Reposition the infant comfortably

  5. Update the parents and support them as necessary


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Section 2 - Colorimetric CO2 Detector for Intubated Infant




Purpose


The colorimetric CO detector is a single use colour metric pH-sensitive indicator used to verify correct endotracheal tube (ETT) placement. It provides a simple visual method to assess exhaled CO₂ during airway management.

Procedures


  1. The detector is inserted between the outer end of the ETT and the manual ventilation device

  2. The Pedi-Cap colour changes from purple, to tan, to yellow which verifies that CO is being exhaled, and returns to purple during inspiration of gas that is free of CO₂

  3. The device responds to exhaled CO₂ with a colour change from purple to yellow after six (6) full breaths.

  4. If still purple ETT may be in the oesophagus or

  • Insufficient breaths are being delivered

  • Insufficient tidal volumes are being delivered

  • The infant is in full circulatory arrest (CO₂ detector should show tan or yellow if effective Cardiopulmonary Resuscitation (CPR) is being delivered)

  • The presence of a large air leak.


ALERT: The colorimetric CO₂ detector may provide constant visual feedback for up to 2 hours e.g. for transport
Colour Differentiation



Oesophageal


Tracheal



Oesophageal or Tracheal with absent pulmonary blood flow
There are two different types of CO2 detectors available for use see illustrations below.

Pedicap detector


Mini stat CO2 detector


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