PULSE OXYMETRY

INTRODUCTION
• measurement of
HISTORY
 PHYSIOLOGICAL FUNDAMENTALS
• oxygen delivery is quantified as the product of arterial
oxygen content(CaO2) and cardiac output
CaO2= (1.34×SaO2×hb) + 0.0031×PaO2
• four species of hb in adult:
oxyhb(O2hb),deoxyhb(deO2hb),carboxyhb(COhb),methhb
• COhb(<1%-3%) and methb(<1%)
• functional oxygen saturation:
Oxyhb/deoxyhb+oxyhb ×100%
• efficient o2 transport- ability of hb to reversibly load nd
unload o2
ODC CURVE
 PHYSICS

• depends on for measurement of o2

saturation that is the of
components in solution by their unique
characteristics
• combines two techniques:
• solved for C
 OPTICAL PLETHYSMOGRAPHY
• absorption of light ∞ the amount of bld b/w the transmitter
and detector ,so,change in bld volume are reflected in the
pulse oximeter trace. Pulsatile expansion arterial bed-inc
light path length-inc absorbency.
• the signal displayed is proportional to light absorption
• ??during systole the amount of hb present in the fingertip
is increased and consequently light absorption is
increased. an inverse phenomenon observed in
diastole,therefore, the POP waveform depends on the
arterial pulse
 PRINCIPLES AND TECHNOLOGY

• light absorption:
ans a

for repective wavelengths

• emperically related to O2
saturation based on a
internal to
each pulse oximeter
 OXIMETER STANDARDS

• there must be means to limit the duration of continuous

operation at temp above 41deg C
• the accuracy must be stated over the
. if the manufacturer claims accuracy below
65%, it must be stated over the additional range.
• accuracy during tests must be enclosed
• accuracy during
• there must be an indication when the spo2 or pulse rate
data is
• physiological , for equipment faults, and for low
spO2(not less than 85% spo2)
• an indication for
TYPES OF PULSE OXIMETRY
1. PROBE
TYPES: (self adhesive probes are usually
not well shielded from ambient light)
 SITES
1.FINGER(m/c):
- d/t local hypothermia and .
-corneal abrasion
-relatively sensitive to
-
may improve performance(vigorously rubbing the
fingertip)
-dark finger or nail polish or synthetic nails
-slower detection
2. TOE
-alternate site
-epidural block→→increased amplitude→→successful
block
3. EAR
-when there is finger motion
-earlobe massaged for 30-45 sec with alcohol or vasidilator
to increase the perfusion
4.NOSE
-convenient location
-detects more rapidly
-recommended in hypothermia,hypotension and infusion of
vasiconstrictive drugs
-trendelenberg position, venous congestion→artificially low
saturation
5. TONGUE
-malleable aluminium strip
-disposable
-reflactance pulse oximeter-superior surface(mouth should
be closed)
-burn pts
-accurate
-quicker response
-no signal interference from electro surgical unit.
-tongue quivering
-head down and excess oral secretions
-easily dislodged
-placed after tracheal intubation or insertion of
supraglottic airway
6. CHEEK
-more accurate
-quicker response
-hypothermia, dec cardiac output,inc systemic vascular
resistance and other low pulse pressure states.
-burns and neonates
-difficult placement, awake pts and artifacts during airway
maneuvres
7. ESOPHAGUS
-reflectance oximetry
-core organ, better perfused
8. FOREHEAD
-reflactance pulse oximeter
-jst above eyebrows, slightly lateral to the iris
-less affected by vc from cold or poor perfusion
OTHERS:
-pharyngeal pulse oximetry
-palm,foot,ankle,calf,even the arm in infants
-fetal oxygenation during labor by attaching a reflactance
probe to presenting part
ADVANTAGES
DISADVANTAGES
-SCA and fetal hb- accurate
-low spo2- congenital variants of hb, hienz body hemolytic
anemia
-during aortic balloon pulsation, the augmentation of
diastolic pressure exceeds that of systolic pressure
leading to double or triple peaked arterial pressure
waveform
-unreliable in AF
-TR and neonates with hyperdynamic circulation-
inaccurate
-70% saturation-lowest accurate reading
 COMPLICATIONS

• CORNEAL ABRASION
• PRESSURE AND ISCHEMIC INJURIES
• BURN
 APPLICATIONS

• 1.MONITORING OF OXYGENATION
-anesthesising areas
-post anesthesia care
-transport
-other intrahospital areas-PACU,ICU,during CPR,fetal
oxygenation,tonic clonic seizures pt-risk of hypoxic
cerebral brain damage
-out of hospital
-controlling o2 administration
-monitoring peripheral oxygenation(ortho and plastic
surgery)
-detemining systolic BP(more accurate in peds pts)-in pts
of pulseless diseases of extremities
-locating arteries
-other uses
1)high frequency jet ventilation,therapuetic brochoscopy,
can be combined with mixed venous hbO2
2)CHD in neonates
2. ANALYSIS OF PLETHYSMOGRAPH WAVEFORM
heart rhythm

• impact of VT on pleth, bp
and ecg
• sudden reduction in the
amplitude of pulse
oximeter waveform
pulse amplitude

• directly proportional to the vascular distensibility

• increased due to vasidilation:
-pharmacological- nitroprusside
-physiologic-warming,sedation
-anesthetic-regional sympathetic blocks
• decreased due to vc:
-pharmacology-phenylephrine,ephedrine
-physiologic-cold,surgical stress
dicrotic notch position

• towards baseline during increasing vasodilation

• towards apex with vasoconstriction
RESPIRATORY VARIABILITY ANALYSIS

• with ventilation, fluctuation of both DC and AC

components
PULSE CO-OXIMETRY

• 1st multiwavelength oximeter,the rainbow Rad-57 pulse

CO-oximeter
• uses 8 wavelength-measure both COhb(±2%)and
Methb(±0.5%), with spO2 and PR