Sticky pulse-ox on forehead

[djmatte, ADN, MSN, RN, NP]

As a first choice RN, I work in about 6 different hospital's PACUs. One of them has a few PACU RNs and CRNAs who tend to place the pulse-ox across the forehead. The typical rationale is "their fingers are too cold and won't give me a waveform". These probes are designed to send IR through the finger which reflects off iron within hb and returns an estimation of the percentage that doesn't get read on the other side and interprets that as oxygen (even if the iron hb doesn't have O2 at that specific time). Hence the reason we put it on thin areas like fingers and toes. No amount of explaining that their current method is inaccurate or potentially detrimental to the patient changes the practice. PUBMED even has studies that shows 100% inaccuracy of 5% or greater in patients who had the finger ox on the forehead...which to me is too high when 5% can mean the difference between oxygenated and desaturation.

My concern with it is that a nurse recently had a patient with one on the forehead and it she thought the O2 was 94% and the patient was heavily drowsy for the 30 minutes she had been there. It turned out to actually be 80% once the hand was adequately warmed up with a heated blanket. It took a charge to step in and recommend the latter intervention which of course led to some O2 given and the patient turned right around.

We work with a lot of small inventions as we monitor our patients. I typically have a curiosity about how things work and why we do specific things. Just wish others had the same interest to make sure their practice was appropriate. :\

[BecomingNursey]

I've never heard of anyone using a pulse ox across a patient's forehead. Interesting thread. Thanks for the read!

[RN403, BSN, RN]

We use this trick sometimes. Never thought it was really accurate. Thanks for sharing.

[suanna]

There are pulse Ox probes designed for the forehead- they come with a cute terrycloth head-band and are placed around the temple area. Manufacturer does not attest to accuracy of finger probes used anywhere but the finger. If you have staff that continue to insist on this placement, see if your units can order some forehead probes. It would be interesting to see it using the probes designed for forehead monitoring, do your fellow nurses see better or worse O2 saturations. When a finger probe is used on the forehead, and then changed to a probe designed for the head, are the results better, worse, or the same? Even if your boss only orders a couple dozen head probes, it will be a learning experience for the nurses using the finger probes in the wrong place.

[Sun0408, ASN, RN]

I have seen many pts go south because of the finger pulse ox on the forehead. Sad. I educate every chance I get. Thankfully we are seeing less and less used incorrectly.

[Rose_Queen, BSN, MSN, RN]

I would seriously consider going to your management and requesting other types of probes be brought in. For those patients where we don't think the probe on the finger is accurate, we go to the ear probe. Sure, it's not disposable and a few have walked away, but much better than trying to use a finger probe in an inappropriate manner.

[dianah, ASN]

There ARE specially-designed sat probes for use on ear lobes and bridge of nose, in case for some reason digits may not/cannot be used for monitoring.

It is vital, for accuracy, to use the probe for its designed intent.

The finger/digit probes WILL work on the ear lobes (that is our second go-to area). They may fall off tho, as they are not designed for ear lobes.

Agree with above poster, check with manufacturer for other options when digits unable to be used.

Do not risk patient's safety by assuming something will work.

[jomana]

Just now I try to place finger puls ox on my forehead I got 100% with funny waveform it's like Lois's hair (Ginger's mother) lol! , l don't maybe cuz I but a thick layer of foundation!

-anyway we never use that in our hospital

there are a lot of studies indicate that finger puls ox on forehead is not accurate

[HeySis, BSN, RN]

I've never heard of that! We too use ear probes if for some reason the finger probes won't work.