1. Pulse Oximetry

2. What is Pulse Oximetry
Pulse oximetry is a non-invasive means of measuring oxygen saturation of arterial blood.
Oxygen saturation is defined as the amount of hemoglobin that is bound to O2 divided by the amount of total hemoglobin that is available to bind with O2.

3. What is Pulse Oximetry?
It uses two wavelengths of light to measure the saturation of oxygen. The lights shine through the vascular bed and measure the saturation via a probe.
Probe placements include: thumb, finger, bridge of nose, ear and for children the foot and hand. No calibration is required for the equipment.
Advantages to pulse oximeters are rapid response, non-invasive, and accuracy.

4. What is a Pulse Oximeter?
A device that provides a non-invasive (does not break the patient’s skin or body openings) method of allowing the monitoring of the amount of oxygen of a patient's hemoglobin.

5. What does Pulse Oximetry do?
Allows for further assessment of a patient’s respiratory status.
Let’s the evaluator know how much oxygen is flowing in a patient’s blood.
Is an indicator that a patient may be suffering from a more serious condition involving the cardiac and/or respiratory systems.

6. When do I Use a Pulse Oximeter?
Pulse oximetry may be performed to assess the adequacy of oxygen levels (or oxygen saturation) in the blood in a variety of circumstances such as:
surgery,
other procedures involving sedation (for example, bronchoscopy)
adjustment of supplemental oxygen as needed effectiveness of lung medications
and patient tolerance to increased activity levels.

7. Other reasons may include, but are not limited to, the following:
Recovery from a surgery requiring general anesthesia.
Whenever the physician orders it.
Patient has complaints of shortness of breath (SOB).
When the patient has signs and symptoms of hypoxia.
Patient exhibits signs and symptoms of myocardial infarction.
Patient has a disease/disorder involving the respiratory system
Patient has an order to wear an oxygen appliance.

8. How Do I Use a Pulse Oximeter?
Wash your hands!
Take off any nail polish. The pulse oximetry does not work as effectively if placed on a finger with nail polish.
Place the device on a finger. There are different types of finger probes. Some wrap around the finger. It’s important the finger comes in contact with the sensor which is usually indicted by a red light. The index finger or ring finger usually work best.

9. How Do I Use a Pulse Oximeter?
3. Stay still and wait for a reading. Moving your hand, fingers or arm will interfere with getting an accurate reading. Rest your arm on something firm to prevent it from moving. Remain still until a number appears on the device.
4. Be patient. The sensor may take anywhere from a few seconds to a minute to determine a reading. Some devices will have a green light flashing which indicates the sensor is working and will give a readout. If the light is flashing red it may indicate the device cannot get a reading.

10. How Do I Use a Pulse Oximeter?
5. Understand results. The amount of oxygen in the blood is given in a percentage. For example, if the reading is 100% your blood is saturated with oxygen at 100% which is as high as it can get. Most people who are healthy will have a reading of 90%or greater.
6. Document your findings on the Patient Contact Sheet.

11. What Reading Should I Get?
Most people who are healthy will have a reading of 90 percent or greater.

12. Importance as an assessment tool?
Helps to monitor oxygen levels in patients receiving O2 therapy.
Let’s medical staff know if O2 prescribed is not enough to relieve the patient’s symptoms.
Let’s the medical staff know when O2 levels are reached/maintained.

13. Importance as an assessment tool?
Let’s the medical staff know if the patient’s O2 level drops when the patient performs activities.
Mechanical ventilation: Use of a ventilator to support breathing.
Sleep apnea: Periods of cessation of breathing during sleep.
Medical conditions:
heart attack
congestive heart failure
chronic obstructive pulmonary disease (COPD)
anemia
lung cancer
asthma
pneumonia

14. Limitations/Errors of Use of the Pulse Oximeter?
The pulse oximeter is only one tool that helps in the assessment of a patient’s respiratory status.
Nail polish will alter the readings.
Will not get accurate results in patients with peripheral artery disease (poor circulation in the extremities).
The monitor must be checked regularly to ensure it is working properly. If it is not checked regularly, results may not be accurate!!!!

15. Limitations/Errors of Use of the Pulse Oximeter?
Improper probe placement – low numbers
Severe anemia (decreased red blood cells)
Hypothermia (decreased perfusion) – low numbers
Vasopressor drugs (vasoconstriction) – low numbers
Stray ambient light (sun light, bili light) – low numbers
Low Light transmissions (edema, dark skin, nail polish, nail coverings) – low numbers

16. OXYGEN DELIVERY SYSTEMS
Nasal Cannula Simple face mask Partial Non Rebreather Non Rebreather

17. Nasal Cannula

18. Oxygen Therapy – Delivery Systems
Nasal cannula
A disposable 2-pronged plastic device which is inserted
into the nares.
Attached directly to a flowmeter and/or humidifier
Humidifier is not necessary at flows of 4 lpm or less
A humidifier is used > 4 lpm to prevent nasal dryness
Range of us up to 6 lpm
Benefits: Simple, inexpensive, client can talk freely
Risks: May cause necrosis of nares and/or ears

19. Oxygen Therapy – Delivery Systems
The most commonly used reservoir systems. Three
types
Simple O2 mask
Partial rebreather mask
Non-rebreather mask
A disposable plastic unit which covers nose &
mouth
Body stores oxygen in between breaths
Patient exhales directly thru port holes
Normal flow range? 5-12 lpm 35-50%

20. Simple oxygen mask

21. Oxygen Therapy – Delivery Systems
Partial rebreathing O2 mask
Similar to simple mask with addition of a reservoir bag
Bag collects first portion of exhaled oxygen (dead
space)
Normal flow? 6-10 lpm
Total Oxygen delivery %
Non rebreather O2 mask
Addition of a one-way valve between bag & mask
Normal flow? > 10 lpm 55-70% (or higher)

22. Partial and Non Rebreather

23. Oxygen Therapy – Delivery Systems
Non-rebreathing reservoir circuit
A more elaborate system for delivery
From 21% to 100%
Utilizes large-bore aerosol tubing
Air is often warmed & humidified
May be used on …
a spontaneously-breathing patient via a mask
an intubated patient via endotracheal or
tracheostomy tube