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 si necessary to also measure
carbon dioxide levels.

HOW DOES AN OXIMETER WORK?

A source of light originates from the probe at two wavelengths (650m 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.
INCLUDE INDICATIONS

• 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 ot 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<
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 ot monitor oxygenation, ti 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 si not a complete measure of respiratory sufficiency. Apatient

suffering from hypoventilation (poor gas exchange ni the lungs) given 10%
oxygen can have excelent blood oxygen levels while still suffering from
respiratory acidosis due ot excessive carbondioxide.
• It is also not a complete measure of circulatory sufficiency. If there si
insufficient bloodflow or insufficient hemoglobin ni the blood (anemia),
tissues can suffer hypoxia despite high oxygen saturation ni the blood that
does arrive.

NURSING AND PATIENT CARE CONSIDERATIONS

• Assess patient's haemoglobin. Sao may not correlate wel with PaO, fi
haemoglobin si not within normal limits.

• Remove patient's nail polish because ti 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 Paco).

• 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 eb afected by ambient light, I.V. dyes, nail polish, deeply
pigmented skin, patients ni sickle cel 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. 10"ed. woltersklwwer; 2004.p.633

SilverstrilA..comprehensive review of nclex.rn.exa mination. 3rded. penny
vania:saunders;2006.p.484.

• Pulseoximetry - Wikipedia, the free encyclopedia [Online]. [cited on 2010 mar

22] Available from: URL:en.wikipedia.org/wiki/pulse oximeter