oxygen saturation for pediatric cardiology

Double-Helix, BSN, RN · Apr 14, 2012

Normal pulse oximetry readings are going to vary significantly for patients with congenital heart defects.

The type of defect, size of the defect, age of the patient, any previous surgeries or procedures, and supplemental oxygen are all going to affect what a "normal" pulse oximetry reading is.

Basically, the pulse oximetry reading is a reflection of how much mixing is taking place between oxygenated and deoxygenated blood. The more deoxygenated blood that is flowing to the body, the lower the O2 sat will be. A child with HLHS prior to completion of surgical revision is going to have more mixing of blood then a child with a VSD.

I've had patients that had "normal" saturations between 70-80. Others remain in the low-mid 80's. Still others may be in the low 90's. It's really impossible to say what the normal sat would be without knowing more about the patient and their physiology.

The important thing to remember is that you should not give supplemental oxygen to a patient with a congenital heart defect until you have discussed it with the cardiologist. Oxygen is a pulmonary vasodilator. Dilating the veins in the lungs can decrease pulmonary vascular resistance and shift the balance of pressures between the lungs and the body. Since blood follows the path of least resistance, this can cause flooding of the lungs and send the child into CHF.

wooh, BSN, RN · Apr 14, 2012

I actually had a kid whose normal sat was in the 50s. I didn't even know I could set the limits on the monitor that low. :) Apparently whenever mom took him swimming, other moms would freak out because he'd be underwater for minutes at a time. I tried to convince the docs to let us take him to a bathtub to see it, but they all seemed to think that was a bad idea. Can't imagine why!

Thankfully I don't do much cardiac, but the kids I've had have all had different acceptable sats.

Double-Helix, BSN, RN · Apr 14, 2012

I'm not really sure how having sats in the 50's enables you to go without breathing for several minutes. Blood continues to circulate, oxygen is used up, and sats drop when there is no new oxygen entering the lungs. I'd have to see it to believe it too.

KelRN215, BSN, RN · Apr 15, 2012

Many case for paediatric congenital cardiac disease. When i'm doing 4hourly observation including pulse oximetry for preoperative and postoperative cases, i'm confused about the oximetry reading for congenital cardiac cases. I'd been searching for oximetry reading for congenital case but couldn't find up until now. Someone can help me where i can find information for oximtery reading for congenital cases.

Remember that "congenital heart disease" is not one disease but a group of diseases of varying severity. Congenital heart disease can be anything from an ASD or VSD to the more serious things like hypoplastic left heart syndrome (HLHS) or transposition of the greater arteries (TGA).

When I worked inpatient, I worked in neurology but because there is some overlap (patients with congenital heart disease are more likely to have strokes, children who've had strokes are more likely to develop seizures, etc.) I did see some kids with a history of CHD. The lowest baseline sat I recall was in the low 70s.

What's important is to remember what's normal for that child. If you had a child with no PMH who was recovering from anesthesia and began satting in the 70s, you'd probably throw supplemental oxygen on them right away. If you had a child with congenital heart disease satting in the 70s, you definitely don't want to go there right away.

deepurple · Apr 16, 2012

these are part of important things in pediatric congenital cardiac disease. But there must be information about the Sp02 reading for pediatric congenital cardiac disease. i'm looking for that but still couldn't find yet. It is important when i'm doing 4hourly observation. Because different congenital cardiac disease has different Sp02 reading.

wooh, BSN, RN · Apr 16, 2012

It's different for each kid. There's no set number.

KelRN215, BSN, RN · Apr 16, 2012

these are part of important things in pediatric congenital cardiac disease. But there must be information about the Sp02 reading for pediatric congenital cardiac disease. i'm looking for that but still couldn't find yet. It is important when i'm doing 4hourly observation. Because different congenital cardiac disease has different Sp02 reading.

Not exactly. You can't find the information you're looking for because it doesn't exist. There is no specific spO2 reading for HLHS or TOF. Every kid is different, every kid's specific case of the disease is different and most kids are in various stages of surgical correction for their disease.

For example, an infant with HLHS would not have the same O2 sat as a child whose had all 3 stages of surgical correction completed or a child who is s/p heart transplant.

Double-Helix, BSN, RN · Apr 16, 2012

No, there is not a specific number or a set range, and I don't understand why you need this information. When a child is admitted with CHD, you should be asking the parents or cardiologist what the child's baseline sats are. If your assessment reveals different numbers and you are questioning whether this is acceptable, then call the doctor and check in.

deepurple · Apr 16, 2012

i want it because the congenital cardiac disease have acyanotic and cyanotic. In my ward, we need to do 4hourly observation for all patient to monitor pt whether for pre op or post op pt. That's why i need some information about spo2 reading for different diagnosis or post operative surgery. Of course after Tetralogy of fallot correction, the spo2 will 95% and above..but for example post operative blalock taussig shunt, the spo2 will not reach 85%.. it will 70% - 80% because it is palliative surgery not curative. There are a lot of procedure and surgery that had been done and it have different reading Spo2..

umcRN, BSN, RN · Apr 16, 2012

Like others have said, you will not find what you are looking for. I work in a pediatric cardiac ICU, you can have three infants, all post a norwood sano shunt for instance and they can all have DIFFERENT sat ranges. It's not just the heart defect and repair. First, every heart is unique, one child might fly through their sano with flying colors, another may linger on the unit for months struggling and wind up needing their shunt stented or revised. Another factor is pulmonary vascular resistance - how well they are able to get blood to their lungs, and then how are the lungs able to oxygenate that blood? If they have any degree of lung disease they are automatically going to have a lower baseline. Then what was the degree of heart failure before surgery? Some kids can have very poor ventricle function even before surgery so they will struggle after, others may have adequate ventricle function and be ok.

Add to that, it is quite rare to have a "straightforward" VSD or hypoplastic left ventricle (there can be quite a few combos of defects resulting in HLHS or HRHS). I took care of a patient recently who had a coarc, ebsteins anomaly (therefore with a weak right ventricle and tricuspid regurg), an ASD/VSD and a bicuspid aortic valve (that + coarc resulted in moderate left ventricular dysfunction). He had an extensive corrective surgery and prolonged intubation resulting in some pulmonary disease and baseline lower sats to start simply from the lung damage. You won't ever find a picture of his heart in a book or a simple "this is how we fix it and this is where the sats should be". It is much more complex than that.

Echoing what Ashley said these kiddos should have parameters set by the doctor before they even come in for surgery. Everyone on the medical team working closely with the child and the childs parents will know what the sats usually are and it should be documented somewhere. When in doubt make a phone call, don't give oxygen. And look at the patient. They may be satting 70 and be completely comfortable with that. If I however were satting 70 I think I would look to be in quite a bit of distress.

Pediatric Critical Care Columnist · Apr 16, 2012

what the others are saying is that the desired spo2 for a specific child will be determined and ordered by the cardiologist. children with unrepaired or partially-repaired cyanotic defects will have desired sats in the 70's to 80's. children with [color=#ff66cc]acyanotic defects will have desired sats >93%. you're over-thinking this.