Monitoring Pulse Oximetry (Arterial Oxygen Saturation)

Monitoring Pulse Oximetry (Arterial Oxygen Saturation)

Equipment
■ Nail polish remover, if necessary.
■ Oximeter.
■ Oximeter probe sensor appropriate for patient age, size, weight, and for the desired location.

Assessment
■ Check patient history for allergy to adhesive.
■ Assess the patient’s need for SaO2 monitoring:
■ Risk factors, such as heart or pulmonary disease.
■ Low hemoglobin level.
■ Confusion, decreased level of consciousness.
■ Respiratory distress.
■ Assess the patient’s:
■ Respiratory status, including breath sounds.
■ Respiratory rate, depth, and pattern.
■ Tissue perfusion.
■ Skin and nailbed color.
■ Determine the optimal location for the oximeter probe sensor (e.g., the fingertip, earlobe, forehead, or bridge of the nose).
■ Check capillary refill and pulse at the pulse closest to the site.
■ Assess for factors that may interfere with pulse oximetry measurement, such as hypotension, hypothermia, and tremors.
■ Be Smart! To ensure accurate monitoring, choose a site that has adequate circulation, is free of artificial nails, and contains no moisture.
■ Be Smart! Use a nasal sensor if peripheral circulation is compromised.

Post-Procedure Reassessment
■ Evaluate the patient’s understanding of the procedure and the obtained values.
■ Compare pulse oximetry results with the patient’s clinical presentation.
■ Evaluate the effectiveness of therapy by comparing SaO2 results before, during, and after treatment.
■ Monitor skin integrity at the site every 4 hours if you are using an adhesive probe sensor or every 2 hours if you are using a clip-on probe sensor.

Key Points
■ Choose a sensor that is appropriate for the patient’s age, size, and weight and for the desired location.
■ Cleanse and dry the site. Remove nail polish, as needed.
■ Attach the probe sensor to the site. Photodetector and light-emitting diodes on the probe sensor should face each other.
■ Connect the sensor probe to the oximeter, and turn it on.
■ Check that the pulse rate on the oximeter corresponds with the patient’s radial pulse.
■ Read the SaO2 measurement on the digital display when it reaches a constant value (usually in 10 to 30 seconds).
■ Set and turn on the alarm limits for SaO2 and pulse rate, according to the manufacturer’s instructions, patient condition, and agency policy if continuous monitoring is necessary.
■ Be Smart! Patients with underlying pulmonary disease may be accustomed to low oxygen saturation levels, so you may need to adjust the lower limit alarm.
■ Be Safe! Rotate the site if monitoring is continuous.
■ When monitoring is no longer needed, remove the probe sensor, and turn off the oximeter.

Documentation
■ Most agencies use a flowsheet if frequent monitoring is necessary.
■ Record the date and time of each pulse oximetry reading obtained; state whether readings are intermittent or continuous.
■ If readings are continuous, record alarm parameters.
■ Chart the patient’s vital signs and SaO2 results, and indicate whether the patient is breathing room air or receiving oxygen therapy.
■ If the patient is receiving oxygen therapy, note the oxygen concentration and the mode of delivery.
■ Document acute decreases in SaO2, any precipitating factors, treatment interventions, and the patient’s response.

Pulse oximetry using a finger probe