PULSE OXIMETRY

1. Introduction
 Pulse oximetry is a non-invasive, quick, and painless method used to monitor a patient's oxygen saturation (SpO2) and pulse rate. It is a
vital tool in assessing a patient's respiratory and circulatory status, providing immediate feedback on oxygenation levels.
 It is widely used in various healthcare settings, from emergency departments and operating rooms to general medical-surgical units and
home care, to detect hypoxemia (low blood oxygen levels) early, allowing for timely intervention.

2. Definition
 Formal Definition: Pulse oximetry is a non-invasive test that measures the oxygen saturation level of the patient's arterial blood (SpO2),
which is the percentage of hemoglobin carrying oxygen. It also provides the patient's pulse rate. The device, a pulse oximeter, works by
emitting and absorbing light wavelengths through a pulsatile vascular bed.

3. Purposes
o To assess the adequacy of oxygenation.
o To detect hypoxemia before clinical signs (e.g., cyanosis) are evident.
o To monitor the effectiveness of oxygen therapy.
o To monitor the patient's response to activity, medications, or respiratory treatments.
o To monitor oxygenation during sedation, anesthesia, or critical illness.
o To assess the stability of oxygen saturation during sleep or exercise.

4. Indications
o Patients receiving oxygen therapy.
 o Patients with respiratory conditions (e.g., COPD, asthma, pneumonia, acute respiratory distress syndrome).
o Patients with cardiovascular conditions (e.g., heart failure, myocardial infarction).
o Post-operative patients, especially those recovering from anesthesia or experiencing pain.
o Patients with altered mental status or neurological conditions.
o Patients at risk for hypoxemia (e.g., sleep apnea, obesity hypoventilation syndrome).
o During diagnostic procedures requiring sedation.
o Monitoring during exercise stress tests.
o Assessment of infants and children with respiratory distress.

5. Contraindications
o Motion Artifact: Excessive patient movement (shivering, tremors) can interfere with accurate readings.
o Poor Perfusion: Conditions causing vasoconstriction or low blood flow to the site (e.g., hypothermia, severe peripheral vascular
disease, shock, hypotension, use of vasoconstrictor medications).
o Nail Polish/Artificial Nails: Dark or opaque nail polish, or thick artificial nails, can block light transmission.
o Intravascular Dyes: Dyes like methylene blue or indocyanine green can artificially lower SpO2 readings.
o Anemia/Abnormal Hemoglobin: Severe anemia, carbon monoxide poisoning (carboxyhemoglobin), or methemoglobinemia can
lead to falsely high or inaccurate readings because the oximeter cannot differentiate between oxygenated and non-oxygenated
hemoglobin in these cases.
o Ambient Light Interference: Direct sunlight or bright fluorescent lights can interfere with the sensor.
o Edema at the site.
o Incorrect probe placement.
6. Equipment
o Pulse Oximeter Sensor/Probe:
 Adult/Pediatric finger probe: Most common.
 Ear lobe probe: For patients with poor peripheral perfusion or finger trauma.
 Forehead probe: Alternative site.
 Disposable adhesive sensor: For continuous monitoring, especially in neonates/infants (often on foot/hand).
 Reusable clip-on sensor.
o Alcohol swab or facility-approved cleaning wipe: For cleaning the sensor between uses.
o Nail polish remover (if applicable).
o Warm cloth/towel (if patient's extremity is cold).
o Documentation chart/form.

7. Before Care (Pre-Procedure)

 Patient Assessment:
o Assess the patient's overall condition, particularly their respiratory and circulatory status.
o Check for any contraindications (e.g., presence of nail polish, cold extremities, tremors).
o Identify the best site for probe placement (finger, toe, earlobe, forehead). Ensure the chosen site has adequate blood flow and is
free from injury or excessive hair.
o Verify physician's order for continuous or intermittent monitoring.
 Patient Education:
 o Explain the purpose of pulse oximetry to the patient: "This device will measure the oxygen level in your blood, which helps us
see how well your lungs are working."
o Inform them that it is painless and non-invasive.
o Instruct them to remain still during the reading, especially if using a clip-on sensor.
 Environment Preparation:
o Ensure the patient is comfortable and in a position that facilitates good circulation to the chosen site.
o Minimize direct bright light on the sensor.
 Hand Hygiene: Perform thorough hand hygiene.

8. Steps of Care
Perform hand hygiene.
1. Gather all necessary equipment.
2. Identify the patient using at least two identifiers (e.g., name and date of birth).
3. Explain the procedure to the patient and obtain verbal consent.
4. Prepare the site:
o If using a finger, ensure it is clean and free of nail polish or artificial nails. Remove if present.
o Ensure the chosen extremity/digit is warm and has good capillary refill. If cold, warm it gently with a cloth.
5. Select the appropriate sensor size and type for the patient and monitoring site.
6. Apply the sensor correctly:
 o Finger/Toe Clip Sensor: Place the sensor on the digit with the light emitter on one side and the photodetector on the other,
ensuring proper alignment. Ensure it's not too tight or too loose. Avoid placing it on the same arm as an automatic blood pressure
cuff.
o Ear Lobe Sensor: Attach to the earlobe, ensuring proper fit.
o Disposable Adhesive Sensor: Apply according to manufacturer's instructions, usually wrapping it around the digit, hand, or foot
for neonates. Ensure the light emitter and detector are opposite each other.
7. Turn on the pulse oximeter unit.
8. Allow the oximeter to stabilize and display a reading. Observe the waveform (if available) for consistency.
9. Assess the reading:
o SpO2: Note the oxygen saturation percentage.
o Pulse Rate: Compare the pulse oximeter's pulse rate to the patient's palpated or cardiac monitor pulse rate for accuracy. They
should be similar.
10. Interpret the reading in conjunction with the patient's clinical status. (e.g., A SpO2 of 98% is excellent, but if the patient is
struggling to breathe, it may still indicate a problem.)
11. Document the SpO2 reading, pulse rate, and the date/time of measurement in the patient's chart. Note the type of oxygen delivery (if
any) and flow rate.
12. Remove the sensor if intermittent monitoring, or secure/ensure proper placement if continuous.
13. Clean the reusable sensor with an alcohol swab or facility-approved disinfectant, as per policy, and store appropriately.
14. Dispose of disposable sensors according to facility policy.
15. Perform hand hygiene.

9. After Care (Post-Procedure)

 o Continuously monitor the patient's respiratory status and SpO2 if continuous monitoring is ordered.
o If a low SpO2 reading was obtained, re-evaluate the patient, check probe placement, and assess for clinical signs of hypoxemia.
Intervene as per physician's orders or nursing protocol (e.g., reposition, encourage deep breathing, administer oxygen).
o Assess the skin integrity at the sensor site regularly, especially with continuous monitoring, to prevent pressure injuries.
o Ensure the patient remains comfortable.
o Document any interventions performed in response to the SpO2 reading and the patient's response.
o Document the frequency of monitoring.
 Communication:
o Report any significant changes or abnormal readings to the physician promptly.
10. Complications
o Inaccurate Readings: The most common "complication," leading to missed hypoxemia or unnecessary interventions. Causes
include poor perfusion, motion, nail polish, ambient light, abnormal hemoglobin.
o Skin Irritation/Pressure Injury: From prolonged or improperly applied clip sensors, especially in fragile skin (e.g., elderly,
infants).
o Burns: Very rare, but can occur if the sensor generates excessive heat, particularly with certain types of sensors or in patients with
poor circulation.
o Circulatory Impairment: If the sensor is applied too tightly, it can impede blood flow.

11. Nurses' Responsibilities

 Pre-Procedure:
o Verify order and patient identification.
o Assess patient's respiratory and circulatory status.
 o Identify appropriate site and prepare it.
o Educate patient about the procedure.
o Gather and ensure equipment is functional.
 Intra-Procedure:
o Select and apply the correct sensor for the patient and site.
o Ensure correct placement and proper functioning of the oximeter.
o Monitor the waveform (if available) for reliability.
o Obtain and accurately interpret the SpO2 and pulse rate readings in the context of the patient's clinical status.
 Post-Procedure:
o Continuously monitor the patient and the oximeter reading (if continuous monitoring).
o Assess the skin site for integrity.
o Implement interventions based on readings and clinical assessment (e.g., administer oxygen, reposition).
o Accurately and thoroughly document all findings, interventions, and patient responses.
o Report significant findings to the healthcare team promptly.
o Troubleshoot inaccurate readings (e.g., check probe, warm extremity, remove polish).
o Maintain professional competence and seek assistance when needed.
 Ethical and Legal Responsibilities:
o Ensure patient safety by accurate monitoring and timely intervention.
o Maintain patient confidentiality.
 o Adhere to facility policies and procedures and professional standards of practice.
o Accurately document all care provided.

BIBLIOGRAPHY:-
 Brunner and Suddarth’s.(2016), Text book of medical surgical nursing; 12th edition: publish by. Lippincott Williums and wilkins, page no-
225-228
 Javed Ansari and Davinden kaur.(2011), Text book of medical surgical nursing volume-ii; 1st edition: publish by pee vee, page no-810-
815
 Lewis.Bucher, Heitkempeer, Harding, Kwong.(2017), Roberts medical surgical nursing, assessment and management of clinical
problems; 3rd south asia edition: publish by RELX India pvt.ltd , new delhi; page no-110-111
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