NONINVASIVE BLOOD-

GAS MONITOR
• Blood gases measurements measure how
much oxygen and carbon dioxide are in your
blood.
• Provide valuable information about:
• The efficiency of pulmonary gas exchange
• The adequacy of alveolar ventilation
• Blood-gas transport
• Tissue oxygenation
• Disadvantages of invasive

• Provides historical data valid only at the time

the sample was drawn
• Delays between blood samples taken and
blood gas values measured are allowed only
for 30 minutes
• Are painful and have associated risks.
• Advantages of non-invasive
• Provide continuous monitoring of blood gases
this makes it possible to recognize changes in
tissue oxygenation.
• There are various techniques used for
monitoring arterial O2 and CO2 some of these
are:
• Arterial oxygen saturation(SO2)
• Oxygen tension(PO2)
• Carbon dioxide tension (PCO2)
Skin Characteristics
• For a better understanding of noninvasive measurement of blood chemistry it’s important
to understand the structure of the human skin.
• The skin has 3 principal layers
• The stratum corneum
• Epidermis
• Dermis
• The layers form a cohesive structure that varies in thickness from 0.2 to 2 mm.
• The stratum corneum is a nonliving outer layer of the skin consisting of a protective
layer of dehydrated cells.
• Epidermis living tissue consisting of protein, lipids, and melanocytes. The average
thickness of skin is 0.1 to 0.2mm.
• The dermis consists of dense connective tissue, hair follicles, sweat glands, nerve
endings, fat cells, and a profuse system of capillaries. Thickness is 200 - 400µm
• Blood is supplied to the capillaries by arterioles and drained by venules.
• Normal gas diffusion through the skin is low, but with increased heat- at 40celcius and
above the skin becomes more permeable to gases.
TRANSCUTANEOUS ARTERIAL OXYGEN SATURATION
MONITORING(PULSE OXIMETRY)

• Oximeters can be used to measure SO2 non-invasively by passing light

through the ear’s pinna.
• Because of the complications caused by the light-absorbing
characteristics of the skin pigment and other absorbers, measurements
are made at eight wavelengths and are computer-processed.
• The ear is warmed to 41 Celsius to stimulate arterial blood flow.
• A two-wavelength transmission noninvasive pulse oximeter is shown
below
• The instrument determines SO2 by analyzing the time-varying or ac
component of light transmitted through the skin during the systolic phase
of blood flow in the tissue
• Measurement of arterial oxygen content is achieved by two
wavelengths(660 and 940nm).
• The dc component of the transmitted light which represents light
absorption by the skin pigments and other tissues is used to normalize
the ac signals.
• The pulse oximeter’s theoretical equation expresses the ratio of
amplitude (AC) to baseline (DC) obtained from the
photoplethysmographic signal of two wavelengths. This ratio cancels out
the difference in light absorption due to skin color, as the AC value is
normalized to the DC value of each wavelength. Thus, theoretically, the
skin color does not affect the accuracy of the oxygen saturation
measurement.
Transcutaneous SO2 Sensor
• The basic transcutaneous SO2 sensor for both the
transmission and the reflective mode makes use of a light
source and a photodiode.
• In the transmission mode the two face each other and a
segment of the body is interposed.
• In the reflection mode the light source and photodiode are
mounted adjacent to each other on the surface of the body.
• A pair of red and infrared light-emitting diodes are used for
the light source with peak emission wavelength of
660nm(red) and 940nm(infrared)
Applications of SO2 monitoring
• Direct assessment of the adequacy of tissue oxygenation
can be determined by SO2 value.
• Oximetry is applied during anesthesia intensive care,
pulmonary function tests.
• It is also used in the home for monitoring self-
administered oxygen therapy.
• Provide time-averaged blood oxygenation values that can
be used for immediate intervention.
• Its lightweight makes it suitable for monitoring newborns
and ambulatory patients
Transcutaneous Arterial oxygen
tension(tcPO2) monitoring
• The Clark sensor consists of two electrodes, a silver anode and a
platinum cathode.
• A clark electrode is used in a sensor unit that is placed in contact
with the skin.
• Only two known gas mixtures are required to calibrate the sensor
because the relationship between O2-dependent current and PO2 is
linear.
• Two calibration procedures are commonly used:
• Employes sodium sulfite and ambient air.
• Two precision medical gases such as nitrogen and oxygen
Transcutaneous PO2 Sensor (tcPO2)
• Clark-type tcPO2 sensor in which three glass-sealed
Platinum cathodes are separately connected via current
amplifiers to an Ag/AgCl anode ring.
• Buffered KCl electrolyte is used. Its low water content
reduces the sensor's drying during storage and provides a
medium in which chemical reactions can occur.
• Under normal physiological conditions PO2 at skin surface is
essentially atmospheric regardless of the PO2 in underlying
tissue.
Hyperemia
• Hyperemia refers to an increase in blood flow to different tissues in
the body.
• It causes the skin PO2 to approach the arterial PO2
• Can be induced by using:
• Some drugs
• Heating of skin
• Application of nicotinic acid cream
• Heating gives controllable and consistent effect.
• Heating element and thermistor sensor are used to control skin
temperature beneath the tcPO2 sensor.
• Sufficient arterialization results when skin is heated to temperature
between 43 - 44 degrees Celsius
• Heating the skin has two benefits:
• Oxygen diffusion through the stratum corneum increases
• Blood flow increases in capillaries (vasodilation)
• Increased blood flow delivers more O2 to heated skin region
• Amount of oxygen released to cells for a given PO2 is increased.
• Heat also increases local tissue oxygen consumption which tends to
decrease O2 level in skin tissue.
• These two factors cancel each other.
• Duration of monitoring is a function of skin’s sensitivity to possible
burns as well as electrode drift.
Application of tcPO2 monitoring
• Used in neonates with respiratory distress because of their thin skin.
• Vascular medicine after procedures like angioplasty or bypass
surgery, tcpo₂ is used to measure the restoration of oxygen delivery to
the affected limb, providing a real-time indication of perfusion
improvement.
• Wound care low tcpo₂ values in the skin around a wound can indicate
poor tissue oxygenation, suggesting a poor healing environment.
Transcutaneous Carbon Dioxide Tension
(tcPCO2) Monitoring.
• Monitoring tcPCO2 gives more accurate results than tcPO2 measurements in adult
patients because tcPO2 measurements are much less dependent on skin blood
flow.
• The tcPCO2 sensor is similar to the tcPO2 sensor except for the sensing element.
• Its operation is similar to that of the electrochemical PO2 sensor.
• The CO2 sensor is a glass pH electrode with a concentric Ag/AgCl reference
electrode that is used as a heating element.
• The electrolyte, a bicarbonate buffer, is placed on the electrode surface. A CO2-
permeable Teflon membrane separates the sensor from its environment.
• The CO2-permeable Teflon membrane would allow CO2 to pass through while
preventing other substances from doing so, depending on the material's properties
Cross-sectional view of a transcutaneous carbon
dioxide sensor
• The tcPO2 sensor operates according to the Stow-Severinghaus
principle
• In this principle a pH electrode senses a change in the CO2
concentration.
• The key idea of the Stow-Severinghaus principle is that heating the
skin increases blood flow and improves gas diffusion across the skin.
In this way, the sensor can measure the partial pressure of gases (such
as oxygen and carbon dioxide) in the blood capillaries just below the
skin.
• The system is calibrated with a known CO2 concentration solution and
because a CO2 electrode has a negative temperature coefficient,
calibration must be performed at the temperature at which the device
will be used.
Heating the skin beneath the sensor causes an
increase in:
1. PCO2, because the solubility of CO2 decreases
with increase in temperature
2. Local tissue metabolism, because cell
metabolism is directly correlated with
temperature.
3. The rate of CO2 diffusion through the stratum
corneum, which increases with temperature
• All the three effects works in the same manner to
increase the tcPCO2 value.
• Heating skin yields tcPCO2 increase compared
to arterial pCO2 but the correlation between
tcPCO2 and arterial PCO2 is usually satisfactory.
• The tcPCO2 sensor have longer time constants
than tcPO2.
• Response time of tcPCO2 electrode varies
inversely proportional to temperature
Application of tcPCO2 Monitoring
• tcPCO2 is higher than blood pCO2 because epidermal cell
CO2 diffuses to dermal capillaries in response to a diffusion
gradient.
• Arterial blood entering the rising segment of the capillary
loop picks up CO2 from the exiting Venous side.
• tcPCO2 is a valuable trend monitor for those who are not in
shock.
• It provides information concerning the effectiveness of
spontaneous or mechanical ventilation for individuals.
Common faults or problems
associated with tcPO2 sensors:
1. Electrode Failure
• Description: The sensor uses an electrochemical
Clark-type electrode that can degrade over time due
to regular use.
• Symptoms: Slow response times, erratic readings,
or complete sensor failure.
• Solution: Regular calibration and replacement of
the electrode as part of routine maintenance.
Cont’
2. Poor Sensor Calibration
• Description: The tcPO2 sensor requires regular calibration
to ensure accurate measurements. If it is not properly
calibrated, readings may drift or become inaccurate.
• Symptoms: Inconsistent or inaccurate PO2 readings that
do not reflect clinical reality.
• Solution: Perform routine calibration checks using known
gas standards. Follow manufacturer guidelines for
recalibration intervals.
• Inadequate Skin Contact
• Description: The sensor must make good contact
with the skin to measure transcutaneous oxygen
pressure accurately. Poor contact may result from
improper application or movement.
• Symptoms: Fluctuating or low tcPO2 values that do
not correspond with the patient's actual oxygenation
levels.
• Solution: Ensure proper attachment of the sensor
and avoid sensor displacement. Check adhesive or
mounting methods to guarantee good skin contact.
4. Skin Burns from Overheating
• Description: The tcPO2 sensor heats the skin to
promote blood flow, but excessive heating can lead
to burns or skin damage, especially in sensitive
patients.
• Symptoms: Skin redness, discomfort, or visible
burns at the site of sensor application.
• Solution: Verify that the sensor is operating at the
correct temperature (typically 43-45°C). Some
devices allow temperature adjustments to reduce the
risk of burns in sensitive patients.
5. Cable or Connector Issues
• Description: Worn or damaged cables and
connectors can lead to signal loss or interference,
resulting in faulty measurements.
• Symptoms: Intermittent readings or no response
from the sensor.
• Solution: Inspect the sensor cable and connector for
wear, bends, or breaks. Replace damaged
components as needed.
6. Temperature-Related Errors
• Description: The sensor is temperature-dependent,
and fluctuations in temperature may affect its
performance.
• Symptoms: Readings become unstable or
inconsistent when the ambient temperature or sensor
heating changes unexpectedly.
• Solution: Ensure that the sensor temperature is
maintained within the specified range. Some tcPO2
systems include a temperature correction
mechanism that should be checked regularly.
7. Battery or Power Supply Issues
• Description: If the device’s power source
(battery or external power supply) is faulty,
the sensor may not function properly.
• Symptoms: The sensor may power off
unexpectedly or provide unreliable readings.
• Solution: Ensure that the power source is
adequate and replace batteries or power
supplies as necessary.