O2 sat monitor question

[createun]

My question to the community is in regards to O2 saturation monitoring. I am a brand new nurse and have nothing to draw from except my peers.

I had a patient whose O2 level dropped signify after coming back to the room from a procedure. The monitor for O2 reads in a blue number when there is a good connection for the finger clip. In this case the monitor started to read a huge variation in the O2 stat 90-50, up and down sometimes with a loss of number and the back round was red. I moved the clip to both hands then got a et” O2 for his earlobe. Tried both lobes and his fingers again….even his toes. Tried a separate hand held machine. I also tried to use blankets to warm his extremities with blankets. I was told by more experienced nurses that the lack of pickup” was caused by his drop in temperature which went as low as 97.3. Any thought or tricks of the trade to help me keep a better O2 sat when I really needed it. It's hard to call a doctor with a situation report and not be able to give an accurate O2 level.

[Loo17]

Does your sat monitor also show the pleth? The monitor my hospital uses shows the O2 sat in blue with the pleth waveform below it.

[LessValuableNinja]

When you first get a wacky reading or one that varies a lot, ask the simple question, "Do you work with your hands much?" Often, thick tissue on hands from a person who "works with their hands" will cause issues with a pulseox. When they say "yes" most of the time if you are having that issue, say, "Do you work most with your right or left hand?" That will solve the issue 90% of the time, when you get a reading from the opposite hand. The other 10% of the time, see other comments.

[Mavrick, BSN, RN]

Number one answer is: Clinically assess your patient. Treat your patient not the monitor.

I totally agree with above posters. Try to improve circulation because that is what the probe is looking for. It's a complex color-match algorhythm.

But when you absolutely gotta have a number, it's a little gross but has been known to work. Place an ear probe inside the nose. Not the whole thing of course but on one flap of the nare.

I've also gotten results from slapping an adhesive probe flat on the forehead.

[Here.I.Stand, BSN, RN]

Putting on a forehead probe is my first step if I can't get a good pleth on the extremities.

At the same time, look at your patient. Does he look like he's in any distress--tachypnea, shallow breathing, anxious, have abnormal lung sounds, using accessory muscles? If your patient is in distress, call a rapid response/the MD & RRT.

[KelRN215, BSN, RN]

What did the patient look like through all of this? Some patients may be satting 90% and be fine- for some that may be their baseline. But I've never seen a patient sat 50% and, you know, be alive and fine. The patient's clinical picture is more important than the number.

[~PedsRN~, BSN, RN]

I hate pulse OXs. They are annoying and so unreliable. I work in pediatrics, and let me tell you how they just bling all night long simply because they aren't picking up. And then you have nervous parents looking at the monitor calling out "MY BABY'S OXYGEN IS 60%!!!!" only to have to explain to them for the 573647364 time that the monitor wasn't picking up because the 9 month old in the bed jumping around wasn't conducive to monitoring. :)

I have seen 15% once on a monitor. It was during a seizure.... my only rationale was the that the true level was NOT 15% (even holding your breath it's not going to drop as quickly as it did in this case!) but that the body was shunting all the blood from the peripherals into the stuff that mattered - that was, incidentally, not being monitored with an o2 probe. That 15% didn't last long obviously, and it was the craziest thing I have ever seen.

Like other posters have said - the best thing to do is to assess the patient. I think we get so hung up on the number! I mean, if you have a nice pink person who is satting at 89% asleep... that's probably their baseline. I would love to just stick everyone on a monitor every once in awhile at home, I think we would all be surprised where we sit in real life. We always monitor watch and as a result we teach our patients to monitor watch and we sit there and worry about the wrong things sometimes.

I have had a doctor come in (a resident) and sit and stare at the monitor and say "Well, she's oxygenating well." It read 95%. And it was accurate. But that number was worthless considering the kid was tripodding, grunting, and retracting. LOOK AT THE PATIENT. The kid was in distress.... and he was so busy looking at those numbers. Those numbers are meaningless so much of the time. Ugh.

I could write a book on how much I hate the pulse ox. :)

[ninja-nurse, BSN]

Pulse ox machines are notoriously unreliable. SO many things can interfere with the reading - nail polish, callused fingers, cool fingers, diaphoresis, gripping something tightly, the list goes on and on.

As everyone else has said, watch your patient. If he's breathing 6 times a minute no matter how deeply, he's not getting enough air. If he's breathing in the 30's, he won't BE getting enough for long. Is he drowsier than you would expect for whatever meds he's had? Or unusually agitated/confused? How's his color? Cap refill? There's a few big clues and a dozen little ones that will tell you if you need to worry about oxygen. If some of them are there, then an ABG is appropriate, if not, continue to monitor.

Lastly, I haven't done it myself, but a class I recently attended suggested that an adhesive finger probe can be placed inside the cheek. Not sure how you'd get it to stay, but... might be worth a try if you really need a number.