PULSE OXIMETRY

MEANING

A pulse oximeter is a medical device that indirectly measures the oxygen saturation of a patient's
blood and changes in blood volume in the skin, producing a photoplethysmograph. It is often
attached to a medical monitor so staff can see a patient's oxygenation at all times. Although pulse
oximetry is used to monitor oxygenation, it cannot determine the metabolism of oxygen, or the
amount of oxygen being used by a patient. For this purpose, it is necessary to also measure
carbon dioxide levels.

HOW DOES AN OXIMETER WORK?

A source of light originates from the probe at two wavelengths (650nm and 805nm). The light is
partly absorbed by haemoglobin, by amounts which differ depending on whether it is saturated
or desaturated with oxygen. By calculating the absorption at the two wavelengths the processor
can compute the proportion of haemoglobin which is oxygenated. The oximeter is dependent on
a pulsatile flow and produces a graph of the quality of flow. Where flow is sluggish
(eghypopovolaemia or vasoconstriction) the pulse oximeter may be unable to function. The
computer within the oximeter is capable of distinguishing pulsatile flow from other more static
signals (such as tissue or venous signals) to display only the arterial flow.

INDICATIONS
INCLUDE
  Monitor adequacy of oxygen saturation; quantify response to therapy.
 Monitor unstable patient who may experience sudden changes in blood oxygen level.
 Evaluation of need for home oxygen therapy.
 Determine supplemental oxygen needs at rest, with exercise, and during sleep.
 Need to follow the trend and need to decrease number of ABG sample drawn.
 Increased body temperature, acidosis, and increased 2,3- DPG cause a shift in the curve
to the right, thus increasing the ability of hemoglobin to release oxygen to the tissues.
 Decreased temperature, decreased 2,3-DPG, and alkalosis cause a shift to the left, causing
hemoglobin to hold on to the oxygen, reducing the amount of oxygen being released to
the tissues.
 Increased bilirubin, increased carboxyhemoglobin, low perfusion or Sao 2< 80% may alter
light absorption and interfere with results.

ADVANTAGES

 A pulse oximeter is useful in any setting where a patient's oxygenation is unstable

including intensive care, operating, recovery, emergency and hospital ward setting.
 A pulse oximeter is used to monitor oxygenation, it cannot determine the metabolism
of oxygen, or the amount of oxygen being used by a patient. For this j it is necessary
to also measure carbon dioxide (CO2) levels.
 Pulse oximeters are of critical importance emergency medicine and are also very
useful for patients with respiratory problems, especially COPD, or for diagnosis of
some sleep disorders such as hypo apnea.

LIMITATIONS AND ADVANCEMENTS

 Oximetry is not a complete measure of respiratory sufficiency. A patient suffering from

hypoventilation (poor gas exchange in the lungs) given 100% oxygen can have excellent
blood oxygen levels while still suffering from respiratory acidosis due to excessive
carbon dioxide.
  It is also not a complete measure of circulatory sufficiency. If there is insufficient
bloodflow or insufficient hemoglobin in the blood (anemia), tissues can suffer hypoxia
despite high oxygen saturation in the blood that does arrive.

NURSING AND PATIENT CARE CONSIDERATIONS

 Assess patient's haemoglobin. Sao2 may not correlate well with PaO2 if haemoglobin is
not within normal limits.
 Remove patient's nail polish because it can affect the ability of the sensor to correctly
determine oxygen saturation, particularly polish with blue or dark colors.
 Correlate oximetry with ABG values and then use for single reading or trending of
oxygenation (does not monitor Paco2).
 Display heart rate should correlate with patient's heart rate.
 To improve quality of signal, hold finger dependent and motionless (motion may alter
results) and cover finger sensor to occlude ambient light.
 Assess site of oximetry monitoring for perfusion on a regular basis, because pressure
ulcer may occur from prolonged application of probe.
 Device limitations include motion artifact, abnormal hemoglobins (carboxyhemoglobin
and methemoglobin), I.V. dye, exposure of probe to ambient light, low perfusion states,
skin pigmentation, nail polish or nail coverings, and nail deformities such as severe
clubbing.
 Document inspired oxygen or supplemental oxygen and type of oxygen delivery device.
 Accuracy can be affected by ambient light, I.V. dyes, nail polish, deeply pigmented skin,
patients in sickle cell crisis, jaundice, severe anemia, and use of antibiotics such as sulfas.
BIBLIOGRAPHY
 S Lewis SM,HeitkemperMM,DirksenSR.medical surgical nursing, assessment and
management ed.missouri:mosby;2004.p547.
 Textbook of Medical-Surgical Nursing. 10thed.woltersklwwer; 2004.p.633
SilverstriLA..comprehensive review of nclex.rn.examination. 3rded.
pennylvania:saunders;2006.p.484.
 pulseoximetry - Wikipedia, the free encyclopedia [Online]. [cited on 2010 mar 22]
Available from: URL:en.wikipedia.org/wiki/pulse oximeter.