Pulse ox reading poorly

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I work in LTC and all they use is the little pocket pulse ox sensors. I've had times where I sit there forever and can't get it to read or it gives me some ridiculous number or sometimes I get a number like 86 which is possible, but I don't think the patient looks like they're 86 so I recheck it on another finger to be sure and get a much better number. I am a new nurse so I haven't actually seen a real patient with a pulse ox that low so this makes me very nervous. Especially since in report one of the patients had dropped to 80 something and was waiting on a stat x ray. It's not the individual sensor that is the issue because I tried a second one and it was still difficult to read on certain people (unfortunately the people on O2 that I really need to know the right numbers). Secondly the pulse ox read just fine on me. I noticed that some of the people had really cold hands, not sure if that could play a factor.

So with that my question is do any of you have any tips for getting pulse oxs (particularly handheld/pocket ones) to read better.

Specializes in Acute Care Pediatrics.

Try having them pick up a decent reading on the foot of a kicking 4 month old. So frustrating. And the parents area freaking out and calling me because it's reading 65%... and it's JUST NOT PICKING UP. Ugh. Technology. I have to tell the parents every shift to not monitor watch, because they are notorious for just not picking up correctly. Look at the baby. :)

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Your facility should supply pulse oximeters that are calibrated. You can get in trouble in a legal matter if you are using equipment that is not facility approved and not facility maintained. False positives and negatives from uncalibrated equipment can cause treatment errors.

Troubleshooting tips:

1) Check the pulse ox to make sure the red light isn't being blocked by oil or crud. Test yourself to make sure the pulse ox itself isn't the problem.

2) Check cap refill. If the patient isn't getting circulation to the finger, no pulse oximeter will read it.

3) Cold causes blood vessels to clamp down. See number two. If the patient is cold, get a warm blanket on the area you are testing.

4) Test more than one area. If a particular finger doesn't read well, try another finger. Try a toe. Try the earlobe. Try the tip of the ear. For those readers in hospitals, if your facility uses the sticky sensors that wrap around a finger, you can actually put those anywhere on a finger/toe, not just on the tip.

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Specializes in Pediatric Critical Care.

Many older adults in LTC may have peripheral vascular disease, which is why brisk capillary refill is also not always present. As others have mentioned, cold and poorly perfused hands are difficult to get a good O2 sat reading on. There are pulse oximeters out there for monitoring on low perfusion sites...maybe your facility needs one. Otherwise you can do the tricks listed above like warming the extremity :)

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And NO amount of education on reading the pleth convinces them otherwise, does it? :rolleyes:

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Try having them pick up a decent reading on the foot of a kicking 4 month old. So frustrating. And the parents area freaking out and calling me because it's reading 65%... and it's JUST NOT PICKING UP. Ugh. Technology. I have to tell the parents every shift to not monitor watch, because they are notorious for just not picking up correctly. Look at the baby. :)

And NO amount of education on reading the pleth convinces them otherwise, does it? :rolleyes:

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And let's not forget shaky hands. In nursing school I FREAKED when a Parkinson's patient in no acute distress read 76%. I was so embarrassed when I yelled for help, grabbed the O2. The RN came in and put it on his earlobe... 94% RA. :facepalm:

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And let's not forget shaky hands. In nursing school I FREAKED when a Parkinson's patient in no acute distress read 76%. I was so embarrassed when I yelled for help, grabbed the O2. The RN came in and put it on his earlobe... 94% RA. :facepalm:

That could definitely be a factor as well.

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Specializes in Acute Care Pediatrics.
And NO amount of education on reading the pleth convinces them otherwise, does it? :rolleyes:

Of course not. LOL!!! They just see the number and wig out.

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