Clinical instruction: mandatory use of capnography

A ‘preventing future death outcome’ has been issued by HM Coroner for Nottinghamshire. 

This relates to a case where intubation was performed and the endotracheal tube (ETT) became displaced and was not noticed. A number of actions have been agreed for ambulance services nationally.  

These relate to the availability and use of waveform capnography when intubating, from initial insertion and ongoing confirmation of tube placement.  

With IMMEDIATE EFFECT, when performing intubation end tidal capnography (waveform) MUST be available and used.  

Please ensure you do continuous monitoring until handover or the end of treatment. 

You should also have a bougie available to support effective intubation. 

When performing intubation you should record the: 

• size of tube used
• length of tube at the patient’s teeth
• grade of view of the cords
• auscultation results
• initial ETCO2 reading
• skill in your airway log.

This is in addition to your other assessments and treatment. 

Clinical engineering has ensured that capnography is available across the Trust; if there are any issues regarding availability please contact your line manager immediately.  

You can download a copy of this instruction to print and display in stations and offices.

Published 30th July 2015