Training activity information
Details
Identify the requirement for, prepare and perform capnography
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- Limitations of techniques
- SOPs
- Local and national guidance
- Interpretation and validation of waveform
- Interpretation of the waveform for diagnostic value
- Patient centred care and support
- Communication with patients, relatives and the clinical team
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
What does success look like?
- Identify what is expected of you in relation to identifying when capnography is required, preparing the equipment, and performing the measurement.
- Consider how the learning outcomes apply, specifically in relation to applying techniques to monitor respiratory function and practicing safely.
- Discuss with your training officer to gain clarity of what is expected of you in relation to criteria defining successful performance of capnography and initial interpretation of the waveform and EtCO2 value.
What is your prior experience of this activity?
- Think about what you already know about carbon dioxide monitoring and capnography principles.
- Consider possible challenges you might face during the activity, such as obtaining a clear waveform or dealing with a discrepancy between EtCO2 and PaCO2.
- Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if you encounter a persistent issue with the sample line placement affecting the waveform quality.
- Acknowledge how you feel about preparing for and performing capnography. How confident do you feel in being able to accurately identify the need for capnography?
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as setting up capnography equipment and obtaining a reliable waveform.
- Identify the specific insights you hope to gain into the clinical indications for capnography or interpreting different capnogram waveforms.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of this activity or similar tasks.
- Identify important information you need to consider before embarking on the activity, such as device-specific setup, sample line placement, calibration requirements, or factors affecting EtCO2 readings (e.g., ventilation mode, cardiac output).
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst preparing and performing capnography?
- Are you encountering situations such as:
- You get an unexpected capnography waveform or EtCO2 value?
- You encounter difficulties with setting up the sampling line, connection to the patient/circuit, or monitor display?
- This capnography setup and monitoring process compares differently to previous experiences?
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to troubleshooting the setup by checking the sample line connection, kinks, or patient breathing pattern if the waveform or value was unexpected or absent? Did unexpected findings or issues affect your confidence in establishing correct capnography monitoring?
- Consider the steps you are taking in the moment, such as checking the sample line connection, kinks, or patient breathing pattern if the waveform or value was unexpected or absent.
- How are you feeling in that moment? For instance, are you finding it difficult to get a reliable capnogram? Is it affecting your confidence in establishing correct capnography monitoring?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully establishing capnography monitoring, adhering to protocols and working within your scope of practice? Or are you needing support because the discrepancy between EtCO₂ and PaCO₂ is clinically significant and requires specialist respiratory or medical review?
- What are you learning as a result of the unexpected development? For example, are you mastering a technique for interpreting capnography waveforms or troubleshooting setup issues from the unexpected event?
On action
What happened?
- Begin by summarising the key steps you took when identifying the requirement for, preparing, and performing capnography.
- Consider specific events, actions, or interactions which felt important, such as successfully obtaining a clear, stable waveform or correctly identifying the clinical indication for its use.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately checking for kinks in the sample line when the EtCO₂ waveform appeared damp or flattened.
- How did you feel during this experience, e.g., did you feel confident in interpreting the capnogram waveform or stressed by a significant discrepancy between EtCO₂ and expected PaCO₂?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding identifying the requirement for and performing capnography. What strengths did you demonstrate, e.g., accurate placement and connection of the sampling line to the breathing circuit?
- What skills and/or knowledge gaps were evident, e.g., difficulty interpreting complex capnogram waveforms associated with specific lung pathologies?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in troubleshooting electrode/sensor application?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding interpreting a waveform that suggested severe auto-PEEP or airway obstruction, and how you reacted to this.
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to reviewing the clinical indications for capnography and the common abnormal waveforms.
- What will you do differently next time you approach performing capnography, for instance, by proactively observing the patient’s cardiac output and ventilation mode, which are known to affect EtCO₂ readings?
- Do you need to practise any aspect of the activity further, such as interpreting capnography waveforms or key learning outcomes related to applying techniques to monitor respiratory function?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of scrutinising and troubleshooting respiratory monitoring or interpreting ventilation waveforms and flow loops since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, observing severe auto-PEEP causing an abnormal capnography waveform forced you to re-evaluate the depth of your initial waveform analysis and troubleshooting technique during your first attempt at this training activity.
- Considering what you understand about capnography principles, respiratory gas monitoring, and waveform interpretation now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your capnography setup, performance, and interpretation of waveforms based on further learning and experiences? For example, how you proactively integrated a systematic check of sample line integrity and connections to prevent waveform distortion based on further learning and troubleshooting experience.
- Has discussing unusual capnography waveforms (e.g., shark fin appearance) or the impact of EtCO₂ discrepancy on ventilation strategy with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior therapist about a case where capnography immediately revealed circuit disconnect refined your understanding of the critical utility of capnography.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent respiratory monitoring and ventilation experiences, contributed to your overall confidence and ability in waveform analysis, troubleshooting setup, and interpreting respiratory gas monitoring, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated skills in waveform interpretation, identifying clinical requirements, and troubleshooting technical setup now enables you to confidently scrutinise and troubleshoot respiratory monitoring issues (e.g., capnography setup) during a DOPS or related assessment.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to capnography monitoring and interpretation? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice from the Training Officer or Senior Respiratory Therapist immediately when a complex or persistent capnography waveform abnormality or significant discrepancy between EtCO₂ and PaCO₂ suggests an acute physiological issue requiring specialised clinical review.
- Looking holistically at your training journey, how has this initial capnography performance experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to applying techniques to monitor respiratory function? For example, how this foundational experience has supported your development in improving proficiency in gas monitoring, waveform interpretation, and troubleshooting equipment related to respiratory mechanics.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 5 |
Outcome
Apply techniques to monitor respiratory function in critically ill patients. |
| # 6 |
Outcome
Apply techniques to monitor temperature in critically ill patients. |
| # 8 |
Outcome
Practice safely in accordance with guidance and legislation to minimise risk in all elements of patient care. |