What type of CO2 sampling line?

You’ve finally decided on a monitor.  Now it’s time to decide on the method you will use to sample the CO2.

The first thing to consider when choosing the type of sampling line or “sampling” cannula for monitoring CO2 is the type of monitor that you have. Does it require a male or female luer on the monitor side of the sampling line or cannula. Continue reading “What type of CO2 sampling line?”

A Simple Way to Meet Capnography Guidelines

The new ADA 2016 Sedation Guidelines  include monitoring CO2.

NEW Video available!  

First, a statement about equipment:

“The equipment necessary for monitoring end-tidal CO2 and auscultation of breath sounds must be immediately available.”

Then, we have what actually needs to be monitored

The dentist must monitor ventilation and/or breathing by monitoring end-tidal CO2 unless precluded or invalidated by the nature of the patient, procedure or equipment. 

(Note a topic to be covered later:    In addition, ventilation should be monitored by continual observation of qualitative signs, including auscultation of breath sounds with a precordial or pretracheal stethoscope.)

Perhaps you already have a monitor that doesn’t include monitoring end-tidal CO2. If that’s the case, there is no reason to purchase an entire new monitor. The simple solution is to purchase a separate capnograph.

Nonin Capnography Monitor


SHOWN HERE:    Nonin Respsense CO2 Monitor with the Edan M3 SPO2/BP Monitor

  • Easy to read and use
  • Lightweight, portable and pole-mountable
  • Cost effective to purchase and operate with standard tubing
  • Additional pulse oximetry in the LifeSense capnograph
  • Made and serviced in the USA


Learn how easy and effective incorporating capnography into your dental practice can be!  Call to request your free white paper!  (800)753-6376




Monitoring Breathing in the Sedated Patient

By Rose Dodson    

Monitoring Ventilation with a Bluetooth Stethoscope

Not one of you reading this article would disagree with the importance of an open airway. It’s comforting to see the chest rise and fall in the middle of your procedure, or in some cases, the nitrous airbag inflate and deflate. But there’s been more than one case of a patient who stopped breathing while sedated in a dental chair, with no one aware of what was happening until it was too late. You’ve heard the stories.

It’s important to know if your patient—sedated or not—is adequately ventilating. But as you know, at a certain level of sedation, the natural drive to breathe can be inhibited. So it’s critical to pay close attention to a patient’s breathing when he/she is sedated. With a “truly” minimally-sedated patient, there should be no question as to whether he’s maintaining his airway. With conscious sedation, a patient should maintain all of his protective reflexes. Even with a moderately-sedated patient, the ADA states that, “No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate.”

The grey area comes in on the “deep” side of moderate sedation. Keep in mind that sedation functions in a continuum; and its slope gets more slippery as it progresses.  This is especially true with geriatric and pediatric patients. Therefore, if you intend to moderately sedate a patient, you must be capable of recognizing and managing “deep” sedation, should it inadvertently occur. With minimal-to-moderate sedation, one of the key components of managing sedation is knowing how to manage the patient’s airway. (Remember: Airway. Airway. Airway.) The ADA guidelines state that, during moderate sedation, ventilation must be “continually” evaluated.  The rules go on to list three ways in which this can be accomplished:

  1. Auscultation of breath sounds
  2. Monitoring end tidal CO2, or
  3. Verbal communication with your patient

Verbal communication is an obvious monitoring method. Not only does it confirm ventilation, but it also helps determine a patient’s level of sedation.

image on white paper

Monitoring end tidal carbon dioxide (ETCO2) is another way to way to make sure your patient is properly ventilating. For this type of monitoring, you’ll want to consider purchasing an ETCO2 monitor, known as a capnograph.  Every capnograph has some method of capturing moisture buildup from expelled air. Some units have a built-in water trap that require regular emptying. Others have a proprietary CO2 sampling line with a built-in adapter. Per-patient disposables are needed; the type will vary, depending on the manufacturer of the capnograph, and whether you’re using a nasal hood or delivering oxygen through a cannula.


Auscultation (listening to breath sounds) can be accomplished through a stethoscope. The familiar monitoring tool helps you recognize subtle changes in breathing and provides information that can alert you if a patient is about to obstruct his airway, allowing you to provide early intervention and prevent respiratory distress.

You may be familiar with the terms “precordial stethoscope” and “pretracheal stethoscope.” Traditionally, a clinician would go to an audiologist and have a mold made of his ear, so a custom earpiece could be made. The earpiece, along with four to five feet of tubing and a weighted bell called a Wenger chest piece, would be used to create a stethoscope for monitoring an anesthetized patient. If placed near the heart, the apparatus would be referred to as a precordial stethoscope; if placed near the trachea, a pretracheal stethoscope. In dentistry,  most doctors place the chest piece over the suprasternal notch, and therefore use a pretracheal stethoscope. For a dentist performing a procedure while tethered by four feet of tubing, this can be a challenge. Further, dental procedures can be noisy making it difficult to hear adequately. Fortunately, with the development of amplified Bluetooth® stethoscopes that are now readily available, these challenges can be overcome.


In one version, the weighted bell, or chest piece, houses the microphone. The housing cuts ambient noise down tremendously, and allows you to hear each breath without having to disturb your sedated patient. Another version utilizes the same Wenger-style chest piece, but has the microphone built in-line with the tubing. Both styles amplify breathing sounds, and have adjustable volume controls that allow you to hear over noise in the procedure area. The only thing a doctor or assistant needs to put on is a Bluetooth® headset—just like the ones used with cell phones.

Bluetooth Headset

The tether traditionally associated with the pretracheal stethoscope is eliminated, enabling you or your assistant to walk to the other side of the room, and still know that your patient is adequately ventilating. Though it may not be a tool you’d use with every sedation, it might be one you’ll take out for your geriatric and pediatric patients. In any case, you’ll find that having a “window” to the airway is an invaluable way to effectively monitor ventilation. Once you experience the comfort of hearing breath-by-breath that your patient is adequately breathing, a pretracheal stethoscope may well be a tool you’ll not want to be without.

How to Modify a Nitrous Hood to Monitor CO2

By Rose Dodson

nitrous hood CO2

It may sound complicated; however it’s actually quite simple. The same nitrous hood you use everyday can be adapted to monitor CO2. We’ll show you how.

 You will need only three items:

1. Nitrous Hood 


2. 1/8″ Hole Punch Pliers (commonly used for crafts)


3. Nitrous Hood Adapter 

nitrous hood adapter

First, use the hole punch or other cylindrical object to make a rounded hole in the nitrous hood near the top.  If you are using a hood with a liner,  then you will need to puncture through both the liner and the hood, as shown here.

porter nasal hood

You are now ready to attach your CO2 sampling line.  Attach the male luer lock end to the nasal hood adapter and the opposite end to the monitor.

Co2 LIne Nitrous Hood

Yep, it’s just that simple.

Good Luck and let us know if we can help.

5 Tips To Keep Your Crash Cart Current

By: Rose Dodson
1.  Two Key Symbols to look for on the packaging.
 manufacture date symbolThis image tells you when it was manufactured .
symbol for expired drug
This tells you the date it expires.
For the most part you will be more concerned about the latter.


2. Checking expiration dates. Expiration dates on certain consumable crash cart items, such as emergency drugs, is a given. However, there are other disposable items that could be questionable.  For example airway devices such as I-Gels, LMAs, and ET tubes all have a specific shelf life and you should be able to find an expiration date on the packaging.

bag-valve-mask-all3. Consider shelf life and update accordingly. On the other hand a bag valve mask resuscitator (Ambu Bag) doesn’t have a specific shelf life and while you do want to consider updating them every few years, you probably won’t find an expiration date. In this case the manufactured date might be of value.  I would say after 5+ years, it’s probably time to consider updating your BVM.


4. Check the dates on your IO Device. For example if you have the EZ IO intraosseous drill, the needles expire about every 4 years.

5. Your AED.
Your AED has two separate components to consider when getting it up to date–The electrodes/pads and the battery. 
The electrodes have a conductive gel that will dry out over time, so it’s important that you keep these current. The standard shelf life is about 2 years, however there are certain companies such as Zoll that will not expire for about 5 years.Then there is the AED battery to consider. The expiration date or usefulness of the battery can vary quite a bit depending on the manufacturer. The standard would be 4-5 years. In some cases there will be an expiration date on the battery and in others you will only see the date of manufacture.
Keeping your crash cart up to date can seem like a daunting task. Hopefully this will clear up a few questions.