Not taking 0xygen Saturation on patients...???

[RN2B123]

I am a final year nursing student. I take 02 sats on all my patients as part of routine assessment at the beginning of the shift and then document in their chart the %

I've had some nurses tell me they almost never take routine pulseox on patients, they just look at the patient and document their visual findings. They've basically told me that the pulseox machines are finicky and often give wrong % readings anyways. (Just like if the 02 sat says 80% when you put it on the pt but the pt is pink, talking and alert).

I was wondering if this is usual practice for other nurses to not take 02 sats on their patients???

[cherrybreeze, ADN, RN]

We take O2 sats as part of our VS, and they are documented in the same place with them. While yes, there are outward signs that a patient may be low, you don't always see it, it varies greatly from person to person. Someone may look like they're poorly oxygenated because of their coloring, but have sats that are in the normal range. Goes the other way, too.

We got a pt up from the ER one night, had a peri rectal abcess or something of that nature. He was satting in the low 70's when he got to the floor, no one in ER or triage checked him, he wasn't *blue* or anything. Maybe seemed a LITTLE SOB, but easily looked like anxiety or pain breathing, too. It was minor. Tried different fingers, a toe, his ear...all low. A quick set of ABG's confirmed that he was very out of whack.

Sometimes the readers don't read very accurately, if the patient has poor circulation/cold fingers, whatever, but for the majority, they ARE accurate and are a VERY good piece of information to add to your overall assessment.

[caliotter3]

If the O2 sat is ordered by the MD, then one should take it and record it. Otherwise, it is not necessary and some doctors will not order it. I was told that O2 sat was routine if the patient is receiving oxygen, so I questioned a doctor about ordering it. She told me she did not use O2 sat readings because she wanted personnel to assess the patient and not rely upon machines. I routinely take O2 sats if I have a pulse oximeter available. If I had reason to believe that the oximeter was not working properly, then I would take action to have it fixed, and would not use that particular device.

[cherrybreeze, ADN, RN]

If the O2 sat is ordered by the MD, then one should take it and record it. Otherwise, it is not necessary and some doctors will not order it. I was told that O2 sat was routine if the patient is receiving oxygen, so I questioned a doctor about ordering it. She told me she did not use O2 sat readings because she wanted personnel to assess the patient and not rely upon machines. I routinely take O2 sats if I have a pulse oximeter available. If I had reason to believe that the oximeter was not working properly, then I would take action to have it fixed, and would not use that particular device.

I suppose that MD's do different things depending on where they are, that area's current practice...ours all want it documented with VS. I think it's a shame that the MD you speak of thinks that if you're doing an O2 sat, that you're not also assessing that patient...you don't go by JUST the number, right? They can be 'normal" but still have SOB, and you'd report that, even if the sat was WNL.

For us, too, if we call on a pt with respiratory complaints, we'd better know the sat before we get on the phone, cause our docs are going to ask!

[caliotter3]

In that particular case we were talking about pediatric patients and you're certainly right that I assess pediatric patients! I could have easily taken the response personally. But I wasn't going to get into any arguments with the doctor, especially in front of the patient's mom.

[veronicajr]

If I have a patient with a simple extremity injury, chronic back pain, toothache, etc....no, I most likely won't take an O2 sat reading.

[anurseuk]

I don't see why anyone would not do the so2... it takes seconds.

Also, by doing routine obs on pt's you can pick up other underlying (sometimes life threatening problems) which had not previously been picked up, or had nothing to do with what they had presented with.

At the end of the day it'll be your licence so you do things to your best ability, and give the maximum care possible to your patients. Taking ABGs I find that the so2 is usually very accurate. :)

[Tait, MSN, RN]

I work on a busy cardiac floor, so O2 is my bread and butter.

I am sorry but any nurse/MD that states "I don't want to rely on a machine" is not taking full advantage of all the wonderful monitoring devices we have out there. Because even if my patient is not in distress at 81% saturation, I want them to be getting the best possible perfusion I can give them. Plus, sticking a little probe on a finger never hurt any of my patients or gave them any stress.

It's a new day, and we have to be very aware of all levels of our patients, whether they be in the hospital, nursing home, rehab or home care.

[bethem]

I'm an ICU nurse, so the thought of not knowing my pt's SaO2 is downright scary! Of course there are signs of hypoxia which may be picked up in a good assessment, but why wouldn't you just pop a probe on a finger and make sure?

[JB2007, ASN, RN]

Just remember you are treating the patient not the machine. You need to do a good assessment along with checking the O2 sat. There have been many times that I have had a O2 sat. on one of my res. that were in the 70s, but they were pink and A&O X 3. Their fingers were cold and they have poor circulation. Would I alert the doctor of the O2 sat? Yes, but I would be sure to inform them of my other findings. I would also continue to monitor them very closely for other S/S of hypoxia. Like the OP stated it may be an early sign of something going wrong.

[Dolce, RN]

This is almost like not taking a temperature on a patient because we should be able to tell just by looking at them whether or not they are febrile. This is a simply, 5 second, non-invasive check of a patient's oxygenation status. There is no reason in the world not to check an O2 sat. I occasionally work home health and was told by supervisors not to check an O2 sat unless it was SPECIFICALLY ordered by the doctor. Well, I'm sorry, but to me the O2 sat is part of the vital signs. No, its not the only thing that we can use to determine oxygenation, but it is easy, quick, cheap and along with the physical assessment provides a good overall picture. I have had many patients who are pink, warm, breathing fine, look great, but will de-sat into the 70s or 80s.

[xos4eva]

I take the patients 02 sat in traige, it does not take any time away from you assesing the patient. As far as the person who said that it was pediatric patients. Sometimes they will present fine and are hypoxic, or breathing heavily or tachycardic, all assessments work together. It is also important for pt's with asthma, croup, epiglottis, and bronchiolitis to have routine 02 sat readings as their airway can be compromised.