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Discussion

Question: What does "Continuous pulse ox monitoring" mean to you?

Question: What does "Continuous pulse ox monitoring" mean to you?

For me this means a pulse ox on the finger (or other usable area), continuously throughout the day and not just during vital signs. However, my preceptor says it doesn't mean a constant monitoring, just during v/s. (but everyone gets v/s q4h so what would be the point of having a separate order for continuous.)

Curious how others interpret this order. 

Thanks. 

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    Have always seen it interpreted the same way that you do. The other option is "spot checks". If "spot checks" is not specified, then there will be mention in the list of V/S, if the MD wants it checked and recorded at all. Now, I have had supervisors emphasize that if pulse ox is not ordered as at least as part of the V/S, we are not to mention it in our documentation.  Same for B/P.  Most peds patients don't get a B/P check unless it ordered in conjunction with a diagnosis.

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    If you see an order for "Continuous Pulse Ox" or anything with the word "continuous", it means that it needs to be monitored at all times during the order. Meaning, if there isn't any direction or space of time to monitor, it means "all the time". So, if you walk into that patient's room, there should be a monitor sitting on the desk or nightstand that shows the continuous result (the number) of their pulse ox monitor. I hope this helps! Let me know if you have any other questions!

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    • Expert

    Pulse ox (SpO2) can vary tremendously c even minor activity changes. When someone is on continuous monitoring, that’s what they’re looking for. You might find it’s OK/stable at rest but drops like a shot with sitting up, walking to the bathroom, or even turning in bed, times at which you’re not likely to check episodic signs.  This would be critical information as it indicates really poor reserves. The instructor who told you otherwise is wrong. 

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    On 6/26/2021 at 8:14 PM, Vicki17 said:

    However, my preceptor says it doesn't mean a constant monitoring, just during v/s.

    S/he is completely wrong, possibly scary.

    On 6/29/2021 at 1:32 PM, The Blatant Nurse Shannon said:

    So, if you walk into that patient's room, there should be a monitor sitting on the desk or nightstand that shows the continuous result (the number) of their pulse ox monitor.

    And....it isn't just that it has to be able to be seen if someone walks in the room, but continuous monitoring means that it needs to have an alarm with appropriate parameters that will be responded to in a timely fashion.

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    • Expert
    On 6/30/2021 at 8:51 PM, Hannahbanana said:

    Pulse ox (SpO2) can vary tremendously c even minor activity changes. When someone is on continuous monitoring, that’s what they’re looking for. You might find it’s OK/stable at rest but drops like a shot with sitting up, walking to the bathroom, or even turning in bed, times at which you’re not likely to check episodic signs.  This would be critical information as it indicates really poor reserves.

    I forgot to give an example. Sweet husband shot a chestful of PEs a few years back, sat 85 on RA in the triage area. They admitted him, d’oh, fir anticoagulation but even on 6 LPM (when he rated about 92 at rest, marginally acceptable), he would drop his sat to 80s after walking as far as the door to his room. Episodic checks c vs while he was resting in bed would not have revealed the serious VQ imbalance and may have led somebody like your preceptor to think he was doing fine to amb to BR unassisted, but NOT.

    He was able to come home on RA after awhile but got SOB very easily. Gradually resolved over 3-4 months but the hematologist and I took him for a good stroll c the SpO2 monitor when he went for follow up to check. He no longer desatted on RA with exercise, indicating his lungs were now perfusing much more normally.

    THAT’s why “continuous” means “continuous.” 

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    On 6/26/2021 at 8:28 PM, caliotter3 said:

    Same for B/P.  Most peds patients don't get a B/P check unless it ordered in conjunction with a diagnosis.

    Continuous means just that,stays on,and can be charted as VS but sudden changes can be  easily noted and reported, usually in the NICU, our patients all get bp with VS q 3h,I know thats  alot of squeezing for tiny limbs but so be it.

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