American Thoracic Society

PATIENT EDUCATION | INFORMATION SERIES

Pulse Oximetry
Pulse oximetry is a way to measure how much oxygen your blood is
carrying. By using a small device called a pulse oximeter, your blood
oxygen level can be checked without needing to be stuck with a
needle. The blood oxygen level measured with an oximeter is called
your oxygen saturation level (abbreviated O2sat or SaO2). This is a
percentage of how much oxygen your blood is carrying compared to
the maximum it is capable of carrying. Normally, more than 89% of
your red blood should be carrying oxygen.

Why is it important to have my blood is carrying oxygen. It also provides a reading of your
oxygen level checked? heart rate (pulse). To make sure the oximeter is giving
If you have a lung disease, your blood oxygen level may you a good reading, count your pulse for one minute
be lower than normal. This is important to know because and compare the number you get to the pulse number
when your oxygen level is low, the cells in your body can on the oximeter. If they are the same, you are getting a
have a hard time working properly. Oxygen is the “gas” good signal.
that makes your body “go,” and if you are low on “gas,”
CLIP AND COPY

Should I get a pulse oximeter?

your body does not run smoothly. Having a very low
Most people do not normally need a pulse oximeter,
blood oxygen level also can put a strain on your heart
and brain. though during the COVID-19 pandemic, many people are
using them to check their oxygen levels. Some people
Most people need an oxygen saturation level of at
are prescribed a pulse oximeter if they have or could
least 89% to keep their cells healthy. Having an oxygen
have periods of low oxygen; for example, when you are
level lower than this for a short time is not believed to
exercising or if you travel to high altitude. Having a pulse
cause damage. However, your cells can be strained or
oximeter in these cases will allow you to monitor your
damaged if low oxygen levels happen many times. If
your oxygen level is low on room air, you may be asked blood oxygen level and know when you need to increase
to use supplemental (extra) oxygen. The oximeter can be your supplemental oxygen flow rate. Ask your healthcare
used to help see how much oxygen you need and when provider what oxygen saturation number(s) they want
you may need it. For example, some people need more you to maintain.
oxygen when asleep than when awake. Some need more Pulse oximeters are available online or by prescription
oxygen with activity than when at rest. (See ATS Patient from your local pharmacy or medical supply company. In
Information Series on “Oxygen Therapy” and “Oxygen some cases, your insurance company will cover the cost
Therapy for Children”) of a pulse oximeter.
How does a pulse oximeter work? What is the difference between the oxygen
A pulse oximeter comes either as a small unit with a built information reported from an oximeter versus from an
in finger/toe clip, or a small hand held device that has a arterial blood gas?
wire probe that can attach or be applied to your finger, An oximeter indirectly measures the amount of oxygen
toe or earlobe. The small unit is less expensive and more that is carried by your blood. An arterial blood gas (ABG)
practical for home use. directly measures both the amount of oxygen carried by
Beams of light from the device pass through the blood your blood and the actual amount of gases (oxygen and
in your finger (earlobe or toe) to measure your oxygen. carbon dioxide) that are in your blood. To get an ABG,
You will not feel this happen. The beams of light are blood is taken directly out of your artery (usually from the
“read” to calculate the percentage of your blood that wrist) and can be painful. Oximetry is painless but is not

Am J Respir Crit Care Med Vol. 184, P1, 2011

Online Version Updated March 2021
ATS Patient Education Series © 2011 American Thoracic Society
www.thoracic.org
 American Thoracic Society

PATIENT EDUCATION | INFORMATION SERIES

as accurate as an ABG. Also, a pulse oximeter does not what to do if you have oxygen problems with exercise.
measure your carbon dioxide level. ■ If you are flying or traveling to a high altitude location,
How accurate is the pulse oximeter? as your supplemental oxygen needs may increase
during these times.
The oxygen level from a pulse oximeter is reasonably
accurate. Most oximeters give a reading 2% over or 2% How can I get the best reading from
under what your saturation would be if obtained by an my pulse oximeter?
arterial blood gas. For example, if your oxygen saturation Your pulse oximeter measures your oxygen saturation,
reads 92% on the pulse oximeter, it may be actually or percentage of blood carrying oxygen. To get the best
anywhere from 90 to 94%. To get a good reading, you reading from your oximeter, you need to make sure enough
need to allow some time (a few seconds) for the pulse blood is flowing to the hand and finger wearing the device.
oximeter to capture your pulsations adequately. The best reading, therefore, is achieved when your hand is
There are many factors that can reduce the accuracy of a warm, relaxed, and held below the level of your heart.
pulse oximetry reading, including: If you are following this guidance and your pulse oximeter
■ Your hands are cold seems to be providing inaccurate readings, there could be
■ You are not holding still a problem with the probe. You can bring your oximeter to
■ You are wearing nail polish (especially black, blue or your healthcare provider’s office or equipment company
green) to have it checked against theirs for accuracy.
■ You are wearing artificial nails Authors: Bonnie Fahy RN, MN, Suzanne Lareau RN, MS.
■ Your oxygen saturation is very low (below 80%) Marianna Sockrider, MD, DrPH
■ Your skin is thicker than normal Reviewer: Fernando Holguin, MD, Mary C. Kapella, PhD, MS,
RN, Sarah Lyon, MD, Stuart Sweet, MD
■ Skin pigment can also impact the accuracy of pulse

oximetry. Recent studies show that in those with

darker skin pigments, pulse oximetry may miss below- R Action Steps
normal oxygen saturations. If you have a darker skin
✔ Ask your health care provider to show you how to use
tone, ask your provider about the accuracy of your your oximeter to get the best readings. Be sure your hand
oximetry readings. is warm and probe fits well.
■ If you smoke, the reading on your oximeter may be ✔ Ask your healthcare provider when you should use your
higher than your actual oxygen saturation. This is oximeter.
because smoking increases carbon monoxide levels in ✔ Ask your healthcare provider when you should turn up or
your blood, and the oximeter cannot tell the difference turn down your supplemental oxygen and when to call
with low readings.
between the gas carbon monoxide from oxygen.
✔ Do not smoke.
Always discuss your oximeter results with you providers
to check if they make sense, and what to do with the Healthcare Provider’s Contact Number:
information before making any medical decisions.
When should I use a pulse oximeter?
If you have been prescribed an oximeter by your
healthcare provider, ask them when they want you to Other Resources:
use the oximeter to monitor your blood oxygen level. American Thoracic Society
Ask your healthcare provider when you should change www.thoracic.org/patients
the flow rate on your supplemental oxygen and at what
American Lung Association
reading you should seek medical attention. https://www.lung.org/lung-health-diseases/lung-procedures-
Times when an oximeter reading may be helpful are: and-tests/pulse-oximetry
■ When you are first prescribed oxygen. This helps your Pulse Ox Info
healthcare provider know if and how your oxygen http://www.pulseox.info/pulseox/what.htm
saturation levels change when doing activities at home. British Lung Foundation
■ During or just after exercising. Your body, like your car,
https://www.blf.org.uk/support-for-you/breathing-tests/tests-
needs more oxygen (“gas”) when you are moving. Your measure-oxygen-levels
oxygen saturation might be checked during activity to
This information is a public service of the American Thoracic Society.
see if you have low oxygen that might not be an issue The content is for educational purposes only. It should not be used as a
at rest. Your healthcare provider will decide with you substitute for the medical advice of one’s healthcare provider.

www.thoracic.org