PULSE OXIMETRY

DESCRIPTION
 Pulse oximetry is a noninvasive method of continuously monitoring the oxygen
saturation of hemoglobin (SpO2 or SaO2). Al-though pulse oximetry does not replace
arterial blood gas measurement, it is an effective tool to monitor for subtle or sudden
changes in oxygen saturation
 Provides an estimate of arterial oxyhemoglobin saturation by using selected wavelengths
of light to noninvasively determine the saturation of oxyhemoglobin. Oximeters function
by passing a light beam through a vascular bed, such as the finger or earlobe, to
determine the amount of light absorbed by oxygenated (red) and deoxygenated (blue)
blood.

 Calculates the amount of arterial blood that is saturated with oxygen (Sao 2) and displays
this as a digital value.

Indications

o Monitor adequacy of oxygen saturation; quantify response to therapy.

o Monitor unstable patient who may experience sudden changes in blood oxygen
level.

o Evaluation of need for home oxygen therapy.

o Determine supplemental oxygen needs at rest, with exercise, and during sleep.

o Need to follow the trend and need to decrease number of ABG sample drawn.

Nursing responsibility:
A probe or sensor is attached to the fingertip, forehead, earlobe, or bridge of the nose.
The sensor detects changes in oxygen saturation levels by monitoring light signals generated by
the oximeter and reflected by blood pulsing through the tissue at the probe.
 There is a potential error in Sao 2 readings of ±2% that can increase to greater than
2% if the patient's SpO2 drops below 80%. Oximeters rely on differences in light absorption to
determine Sao2. At lower saturations, oxygenated hemoglobin appears bluer in color and is less
easily distinguished from deoxygenated hemoglobin. ABG analysis should be used in this
situation.
 Assess patient's hemoglobin. Sao2 may not correlate well with PaO 2 if hemoglobin 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:

 Nettina, Sandra M.; Mills, Elizabeth Jacqueline(2006), Lippincott Manual of

Nursing Practice, 8th Edition Lippincott Williams & Wilkins,

Philadelphia. Page no: 312-314.

 Clochesy .J.M., Brew .C, et al., (1993), “Critical care nursing”, Philadelphia: W.B.
Saunders Company, Pp.842-845

 Fauci .A.S, Braunwald .E, et.al. (Ds.), (2001), “Harrison’s principles of internal
Medicine” - II, 15th edition, New York: McGraw Hill, Pp 967-974. .

 Suzanne. C.et.al., (2004),”Medical surgical nursing”, 10th edition, Lippincott

Williams and wilkins, p.no: 484- 485.

 Black .J.M. & Hawks .J.H, (2004), “Medical surgical nursing”, 7th edition, New
Delhi: Elsevier publication, Pp.1132-1134 .