Presentation on theme: "Transcutaneous Monitoring and Pulse Oximetry"— Presentation transcript:
1Transcutaneous Monitoring and Pulse Oximetry RC 290
2TCM: PO2 and PCO2 via Skin Electrodes Continuous and non-invasiveDigital readout plus hard copyTCM values show values of O2 and CO2 at tissue levelThese values are a affected both by lung function and perfusionTCM used more in infants than adults because infants have thinner skin and less sub-Q fat
4TCM ElectrodesPO2 is a Clark electrodePCO2 is a Severinghaus electrodeElectrodes should not be placed over boneElectrodes may be heated to “arterialize” the siteHeated electrodes need to be moved every 4-8 hoursWater or a sealant solution should be placed on the skin to prevent an air bubble from forming between the skin and electrodeElectrodes usually “sloped”, ie 2 point calibration
5TCM Monitor UnitControls for electrode temperature and high and low limits for alarmsDigital display of TCM valuesPower or energy indicator (shows how much is being used to heat electrodeThis is the perfusion monitor!
6Power/Energy Level Changes After the unit is started and stabilizes, the relative heating power indicator is zeroedIf it starts to have a positive deflection, this means it is taking more power to keep the electrode heated to the set temperatureThis means perfusion has increased!
7Power/Energy Level Changes (cont.) If relative power starts to have a negative deflection, this means it is taking less energy to keep the electrode at the set temperatureThis indicates decreased perfusion!TCM values and arterial values have poor correlation with decreased perfusion!
8If relative heat energy does not have a negative deflection, correlation between TCM and arterial values is goodDecreased TCM PO2 without negative deflection of relative heat energy usually indicates a pulmonary problem
9A negative deflection in relative heating power with a drop in TCM PO2 usually indicates a perfusion problemNot a lung problem!
10TCM Uses Making ventilator changes Effects of activities on infant Feeding, handling, etcEffects of respiratory therapiesO2 changes, PD & P, suctioning , etcIdentifying the direction of shunt in PDA
11Shunt Direction in PDA Using TCM Two TCM PO2 electrodesOne is placed pre-ductal and the other is post-ductalIf difference is greater than 15 mmhg, PDA is R-L
12TCM Does Not Replace ABGs It does cut down on the number of ABGs and is a good indicator of when they need to be done
13Pulse Oximetry in Neonates AdvantagesLess costly than TCMLess maintenance than TCMDisadvantagesDoes not give a direct indication of perfusionCan not assess ventilation/PCO2Does not give good indication of hyperoxiaAlarms should be set between 92% and 95%
14Pulse Oximetry Is Used More for Surveillance than Diagnosis