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Nitric Oxide, Inhaled — Lab Monitoring — Clinical Pathway: ICU and Inpatient

Inhaled Nitric Oxide for Acute Hypoxemic Respiratory Failure Clinical Pathway — PICU

Lab Monitoring

Monitoring Frequency

iNO Phase Lab
Pre- initiation ABG x1 (*or SpO2 value immediately prior
Baseline co-oximetry for methemoglobin within 24 hours
30 min post initiation ABG x1 (*or SpO2 value at 30 minutes)
Co-oximetry for methemoglobin within 4-8 hours after starting iNO
Active weaning ABG per physician discretion (*or SpO2 value)

Potential iNO Exposure Side Effects

*If that patient does not have an arterial line, the SpO2 needs to be consistently documented at the time of the iNO wean. It should be the immediate value and may need to be entered separately as nursing only documents SpO2 values every hour.

Note: PaO2, FiO2 and SpO2 should be determinants for the ability to wean. Other lab values should not guide the decision to wean iNO.

For patients who are on iNO > 40 ppm and have not yet begun a wean, co-oximetry for methemoglobin is recommended every 24-48 hours after any dose increase.

 

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