Using Pulse Oximetry with Respiratory Patients

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Knowing how well your patients are maintaining oxygen saturation (O2 sats) while resting, sleeping or active can reduce the stress of oxygen deprivation by allowing oxygen titration based on the patient’s needs.

While most areas of nursing look on the oximetry as almost a sixth vital sign (temp, pulse, respirations, BP, pain and oximetry) it is important to note that only in the home care nursing field is a specific order required to perform this skill. 

Sad but true. 

Perhaps it was some bureaucratic dork who decided it was an invasive procedure and therefore required a physician order. Though, why it is any more invasive than measuring the interior arterial blood pressure, I’ll never know. Regardless, it is a fact.

pulse oximetermy beat up old pulse oximeter

Most monitors are a simple clam shaped, finger sized gadget. Some hospitals have the flexible “bandaid” looking type that can be stuck on to the finger for longer periods of time.

You can purchase them in drugstores, fitness equipment stores or online.  My only suggestion is, if you plan to buy your own, do not buy the kind with the rubber sleeve inside the clam shape. It makes it difficult for those with large fingers to get the monitor positioned correctly. 

How Pulse Oximetry Works

It shouldn’t matter if the person has nail polish on, though artificial nails may make a difference in ability to get any reading at all. 

Also, those with cold extremities need to warm their fingers or toes up or the pulse oximetry reading may not be obtained.

 If you can’t get a reading on the finger and you are able to clamp the monitor onto the earlobe, you may get a reading there.

Give the monitor a few seconds to stabilize the reading. 

Most monitors give pulse and O2 saturation percentage.

Usually, a consistent reading of 89% or less requires supplemental O2. In order to get oxygen concentrators or tanks covered by insurance in the home, there is usually a 6 minute long monitoring test performed by the durable medical equipment company demonstrating this low reading.

Those on O2 with chronic respiratory illnesses are usually titrated to about 90%-92% saturation according to specific physician orders. Higher saturation is usually not better for chronic illnesses.  

Most importantly, I have found that just because the pulse oximetry is greater than 90% and the patient should be doing fine, if you see your patient in respiratory distress, believe what you see in your patient above what you see on the monitor.

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