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Pulse oximetry accuracy

Pulmonary   (362 Views | 9 Replies)

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I’ve read about several things that can alter a pulse ox reading. If the apical HR is 85 and the pulse oximeter says 105, is the oximeter accurate? If it isn’t accurate, can I trust the 98% reading? Also,  many times I’ve put on the probe and wait for a reading and get 75%, which I know isn’t correct and as I wait a hit it comes up to 98%. Why does it do that? If I can’t get a reading at all would it be acceptable to just document that and add that color is good and Cap  refill Is brisk?

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MunoRN has 10 years experience as a RN and specializes in Critical Care.

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You really need to evaluate the waveform in order to know if the reading is correct.  There are pulse-oximeters that don't give a waveform which aren't all that useful although sometimes better than nothing.

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Where do you work?  In general, no I don't think just documenting that cap refill and color is good is acceptable.  

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13 minutes ago, murseman24 said:

Where do you work?  In general, no I don't think just documenting that cap refill and color is good is acceptable.  

I do private duty nursing. So it’s me, my patient and my hand held pulse oximeter. Sometimes her fingers are very cold and I can’t get a reading. 

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I work in extended care home hlth and will use my personal pulse oximeter when it suits me. Mgmt on more than one occasion, from different agencies, has stated if pulse oximetry is ordered on the care plan, we are to use the pulse oximeter provided by the DME provider as it is calibrated, etc. If we use our own device and oximetry not ordered on the care plan, we are not to chart it because our personal device is not calibrated or approved for pt use.

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9 hours ago, caliotter3 said:

I work in extended care home hlth and will use my personal pulse oximeter when it suits me. Mgmt on more than one occasion, from different agencies, has stated if pulse oximetry is ordered on the care plan, we are to use the pulse oximeter provided by the DME provider as it is calibrated, etc. If we use our own device and oximetry not ordered on the care plan, we are not to chart it because our personal device is not calibrated or approved for pt use.

Good point. But it would seem weird not to document a pulse ox in my nurses notes especially since every other nurses is documenting one. But what if there was an emergency? You would use your personal device if that is all you had. 

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You will need to speak to your nursing supervisor as to why one would not chart something that is not ordered.  Even so, you can't chart using your personal device.  Get your supervisor to clarify that for you too.  If they don't agree with what I have posted, then they can explain the rationale for what is policy at your agency.

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MunoRN has 10 years experience as a RN and specializes in Critical Care.

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On 3/2/2020 at 12:25 AM, caliotter3 said:

I work in extended care home hlth and will use my personal pulse oximeter when it suits me. Mgmt on more than one occasion, from different agencies, has stated if pulse oximetry is ordered on the care plan, we are to use the pulse oximeter provided by the DME provider as it is calibrated, etc. If we use our own device and oximetry not ordered on the care plan, we are not to chart it because our personal device is not calibrated or approved for pt use.

That's certainly true of some equipment, but oximeters are only calibrated as part of the manufacturing processes, they can't be calibrated after that point.  They also don't differ depending on whether they are for professional or personal use, all use the same light emitting, sensing, and processing components.

We've reviewed this with the FDA and regulatory surveyors since many of our RT's and PTs use their 'personal' oximeters, they've said readings from any device can be entered in the chart even if it's used to support things we bill for.

Edited by MunoRN

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2 minutes ago, MunoRN said:

That's certainly true of some equipment, but oximeters are only calibrated as part of the manufacturing processes, they can't be calibrated after that point.  They also don't differ depending on whether they are for professional or personal use, all use the same light emitting, sensing, and processing components.

I only reported what my employers have told me, I don't put forth that I know everything.

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amoLucia specializes in LTC.

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I used to use my own way back (long before all this nit-pickiness started). I wondered about my unit's accuracy, but it was MINE and MINE alone. I very rarely loaned it out to anyone and I took good care of it not to jostle/whack it around. So I trusted it.

When I had the luxury, I would dually check a reading (mine with the facility's). No problems.

My main concern was the infection control thinking involved, even though I would alcohol prep it between uses.

Personally, I have perpetually cold fingers. So getting a reading on me is tough. I have known them to be done using a big toe.

Edited by amoLucia

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