Help with Pulse Oximetry Question

I would put the pt back to bed. Continuing ambulating, even with O2, may just tire the pt. I wouldn't jump for an ABG for a O2 sat of 85%, see if the pt can bring himself up first.

Hello Purplestang I would put the pt back to bed to she if they recover on their own then if not I would contact the MD.

it would be helpful to have some patient hx (e.g. copd, heart failure, cor pulmonale, and so on). is your patient asymptomatic or has any rapid breathing, lethargy, or poor coordination.----> remember that a pulse oximetry monitor is not intended to replace any part of the patient assessment so assess, assess, and assess.

1. assess and tx the patient not the oximeter. reminder-----> never withhold oxygen if the patient has s/s of hypoxia iregardless of oximetry readings.

2. i would not ambulate a symptomatic pt with such sao2 reading.

hey purplestang..if im in your situation i`ll send the pt. back to bed becuase this will decrease the o2 demand...

I am a nursing student, soon to be RN, and I'm looking for tips and techniques from those more experienced than me in order to solve this frustrating issue before it burns me out! It seems like I spend half of my day sometimes just running around to different rooms to troubleshoot why the pulse oximetry monitor isn't reading correctly (I'm talking about those bandaid-like disposable finger monitors, not the plastic reusable ones). Either the patient appears to be suddenly desatting into the 70s for no reason and all the alarms are frantically sounding or the stupid thing just refuses to read all of a sudden. I spend way too much time moving it from finger to finger, then toe to toe. Then I go and get a couple new ones and try those. It just seems absolutely ridiculous- there must be something I'm missing because I never see the nurses doing this. Does anyone have any techniques or tips on how to get the best reading with these things? Especially for difficult patients, like those with circulation issues? If their fingers and toes are really cold, should I warm them up with a hot pack to maybe dilate the blood vessels and bring back circulation? Any advice would be most welcome! Thank you.

My unit has the ability to see the wave form from the station. If you don't have a good wave form, no matter how good or how bad the sat reading is, the number is NOT accurate.

UNTIL you get a good wave form, you DO NOT have an accurate reading.

The RN's are probably concerned, but you also have to look at the patient situation and appearance. If they are not cyanotic and gasping, they're probably not sat'ing in the 70's. If they're awake and talking or watching TV, they're *probably* not sat'ing in the 70's. I always tell people if the monitor alarms, put their hands down, stop moving their SPO2 hand and keep it still for 20 seconds. This makes it a LOT easier for you and a LOT less annoying for them.

As a final note, for some reason (in my experience) the sticky pleths are junk. The ones that are rubber and go on and off easily are a bit more accurate. If you have a person that's not moving much, that may be the way to go!

I work on the peds unit and we use the bandaide type pulse ox probes too. I think there is a couple of things we should do to make sure the equipment works well, first is to take time to clean the skin with alcohol where we are appling the probe- alcohol removes the skin oil and makes the probe adhere better, the second thing is that if you really want it to stay put- use an adhesive skin prep. once you have your probe placed make sure you check your equipment and that the alarms are set properly (on peds, sometimes people forget to change the settings and the alarm ranges are very different) then as the other person said, check your wave form, and the patient. The patient's condition is what should trigger your alarm, not the sound of the equipment alarm. Patients do have flucuations in sao2 levels, depending on their activity, strive to keep them > 94% and you will be fine.

Yep and also realize that every patient is an individual. While 70's for SaO2 is not acceptable for most people, for many with COPD & CO2 retention, mid to high 80's is not only acceptable, it's their life range. This could be where they hang out. If they're SOB or exceptionally tachypnic, then you def. should be more concerned.

A warm blanket on the monitored hand/foot is almost always helpful. I have found the ring finger best for patients with PAD- the bloodflow/waveform in the ring finger always seems to be the strongest. If all else fails there are headband pulse oximeter strips and nose bridge monitor strips. They attach to the same cable the finger monitor strips use. The biggest intervention you can try- don't get too worked up about intermittant poor signal pulse ox alarms. This isn't a rhythm monitor that is going to alert you to a sudden life threatening change in the patients status. A pulse ox is a trend monitor- if it is drifting downward the you need to assess what further interventions or assessments are warrented. A pulse ox reading of 70% with no other sign of distress or change in loc. or VS would prompt me to do nothing for a few minutes and see if it resolves- it is more often than not a momentary loss of signal due to patient motion artifact. If you go running into a patients room every time a maching beeps the patient and the nurse are both going to be nuts by the end of the shift.

Attached is my set of notes regarding pulse oximetry monitoring from my anesthesia program - it was the first time I truly UNDERSTOOD what was going on. :)

Holler if you have any questions, but I rewrote the notes that they're pretty self-explanitory.

Pulse Oximetry.doc