Pulse Oximetry

  1. 0 I am not familiar with them much at all....what is a normal reading?
    What is abnormal. When do I notify a doctor?

    Thanks !

    _____________
    Praiser :heartbeat
  2. Visit  Praiser profile page

    About Praiser

    Praiser has '20' year(s) of experience and specializes in 'med/surg. geriatrics,school nursing'. From 'Mid-West'; Joined Jan '05; Posts: 1,472; Likes: 865.

    14 Comments so far...

  3. Visit  LiverpoolJane profile page
    2
    A lot would depend on your pt - I would expect in a healthy individual a SaO2 of 98-100%. If they had for eg a chest infection I would be aiming to keep SaO2 above 95%. In COPD I would be concerned about CO2 retention and would be taking advice from the Dr or Physio - sometimes they are happy to keep SaO2 around the 90% mark.
    I do not work on a respiratory ward so I may well be contradicted but these are roughly our guidelines.
    pagandeva2000 and Praiser like this.
  4. Visit  EricJRN profile page
    2
    The other thing to keep in mind is that pulse oximetry is one of the tools in your arsenal, but it can't be the sole determinant of whether or not a patient is hypoxic or unstable. There are several factors that may cause false high or low saturation readings (including dirt, poor probe-skin contact, certain types of nail polish, shock states, carbon monoxide poisoning, and others).
    Praiser and linzz like this.
  5. Visit  cardiacRN2006 profile page
    2
    Also, look at your pt. Do they appear to be in distress? If your pt looks to be in distress, but has a Pox of 92%, that doesn't mean that everything is alright.

    You have to take into account the whole picture. Pox is just one tool, as Eric said.
    leslie :-D and Praiser like this.
  6. Visit  Christie RN2006 profile page
    1
    The pulse ox of a healthy individual should read 96-100%. We are usually satisfied in the ICU as long as they stay above 90%. Some COPD patients live between 85-90%. The patients doctor should give you parameters for which to call. Most of ours say to either go by 02 protocol or call if less than 90%.

    Just remember to always treat your patient, and not the machine! If your patients pulse ox is reading 95%, but they are blue, something is obviously wrong! The biggest causes of false pulse ox readings are nail polish, dirt, shock, low H&H, carbon monoxide poisoning, and cold extremities.
    Praiser likes this.
  7. Visit  mcknis profile page
    1
    Different facilities will require different figures for SpO2 levels. Our facility wants an SpO2 of 92%or greater snd we are expected to maintain that during that entire stay. as floor nursing staff we are usually ok with anything 90% or greater, but if the RT team hears about it, they consider the pts' as having "bought a tube."
    Praiser likes this.
  8. Visit  Nightcrawler profile page
    0
    Quote from mcknis
    Different facilities will require different figures for SpO2 levels. Our facility wants an SpO2 of 92%or greater snd we are expected to maintain that during that entire stay. as floor nursing staff we are usually ok with anything 90% or greater, but if the RT team hears about it, they consider the pts' as having "bought a tube."
    Please don't tell me that your facility routinely intubates for any saturation less than 90%
  9. Visit  cardiacRN2006 profile page
    0
    Quote from mcknis
    , but if the RT team hears about it, they consider the pts' as having "bought a tube."

    Yikes! Keep those RTs away from my pts!:uhoh21:
  10. Visit  RazorbackRN profile page
    0
    It all depends on the pt.

    A healthy non-smoking individual without resp. compromise, we like to see > 92%.

    However, most of the babies I work with, (congenital heart defects) are blue babies and expected to stay between 75-85%. As a matter of fact, due to the physiology of their defects and repairs, one might be concerned if they were above 85%.
  11. Visit  Pipsqueak profile page
    0
    Quote from RazorbackRN
    It all depends on the pt.

    A healthy non-smoking individual without resp. compromise, we like to see > 92%.

    However, most of the babies I work with, (congenital heart defects) are blue babies and expected to stay between 75-85%. As a matter of fact, due to the physiology of their defects and repairs, one might be concerned if they were above 85%.

    Please explain this to me. I had a pt (infant) who had these exact parameters d/t a heart condition. We were to immed call the physician if the sats went (and stayed) above 85%. I can't seem to figure out why this is a concern or what harm could occur by having sats >85%.
  12. Visit  linzz profile page
    0
    My son and I are both asthmatic (under control) and he usually sats around 97 - 98% and I sat at 96 -98% when we are healthy. When either he or I are sick, the sats can go down to 95% without distress, he is more severe than I and when he is below 95%, he usually needs a nebulizer treatment and vigilant watching. So I must certainly agree with all the other experienced nurses that the sat number is only part of the picture.
  13. Visit  ZippyGBR profile page
    0
    the importantthing to remember is while the pulseoximeter is an analogue and NI substitute for the PaO2 it doesn't tell you anything else aobut the respiratory status

    normal values are to a point subjective

    normal fit healthy person with no respiratory compromise you'd expect 97- 100 % on room air

    add in bieng cold , being an arteriopath etc it makesthe readingun relaible

    addin respiratory disease either acute or chronic you will see a lower figure

    some chronic lung disease patients are usually saturated at 90 -93% even though that might trigger ascore on your track and trace warning scorefor obs...
  14. Visit  kmoonshine profile page
    4
    I work ED, so my mindset is focused on "fix it now" rather than long-term consequences. For example, if a COPD patient comes in with a SpO2 of 85% and is in respiratory distress, I give O2 right away - I don't think about "what if I take away their respiratory drive" because if they are in distress, then they won't be functioning for very long.

    Now, with that said, most healthy people should have a pulse ox >90%. If someone has a low pulse-ox but is not in distress, I check the fingers: are they cold? I also check the waveform on the monitor and might hook them up to the cardiac monitor to see if the monitor HR correlates with the pulse ox HR.

    If someone is dyspnic, I give O2. If a patient has asthma, faint wheezing, and an Sp02 of 98%, I might throw them on 2-4L O2 via NC until RT arrives (some asthmatics maintain high Sp02 because they are working hard to breathe - and then they poop out after they fatigue from breathing so hard). If someone is in respiratory distress, I bump up the oxygen and may get a mask or non-rebreather.

    You have to think about Sp02 as a tool, but also assess the whole situation. For example, what should you do if you have a patient with an Sp02 of 100% but they also have a hemoglobin of 5? You have to think about how hgb carries the O2, and if someone has a hgb deficit, then the patient could also have an oxygen deficit. Same thing with sickle-cell patients who are having a crisis - they may not be oxygenating normally, and oxygen will benefit them and help prevent further sickling.

    Here's my philosophy:

    To make a long story short: healthy patient, no respiratory problems: Sp02 >90%. No oxygen unless symptomatic.

    Hgb <7 or sickle cell crisis: 2-4 L NC, regardless of SpO2 reading.

    Hx of COPD, emphysema: if on home O2, apply same setting. Notify MD if unable to maintain baseline pulse ox after repositioning and coughing/deep breathing. If in respiratory distress, bump up oxygen and notify MD stat (you can always knock it down a notch - 5 minutes of extra oxygen won't kill them).

    New onset crackles/wheeze + fever: 2-4 L O2 if SpO2 <95%

    Confusion, disoriented (esp. if pt has unknown history of confusion): 2-4 L oxygen, assess if improvement in mental status (this is one of many things, such as blood sugar assessment and CT, but we won't go that route...)

    Drug overdose, post-ictal, or potential for mental status changes (ie high doses of morphine): 2-4 L oxygen

    Look at the patient - are they tri-poding? Retractions in ribs, neck? Cyanotic nailbed? Increased RR? SOB? Unable to speak in full sentences?

    If a pulse ox drops during a shift and the patient is resting, I sit them upright and ask them to take some deep breaths in; that will usually bring up their oxygen. Notify a doc ASAP if a patient has sudden respiratory changes. Also notify MD if pt has hx of respiratory illness and is being treated for a recent acute attack (ie COPD exaccerbation), and suddenly the pt is appearing very tired following a period of respiratory difficulties. This is a sign that they are ready to exhaust themselves and will need respiratory assistance soon (BiPap, ET tube).

    Hopefully I covered the bases!
    KaylaNelson07, IronMaiden, mcknis, and 1 other like this.


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