I was really happy when I saw that a manuscript about pulse oximetry had been submitted to AJN. Pulse oximeters are everywhere in the health care environment, in both inpatient and outpatient settings, but—as a literature review published in the November 1 2006 issue of Australian Critical Care determined (click here for the abstract)—many clinicians don’t understand how they work. For example, a colleague told me that, one night when she was working, a physician wrote orders to replace continuous monitoring with once-per-shift monitoring for a patient whose condition had improved. She removed the probe from the patient and unplugged the machine, but kept it at the patient’s bedside. The patient care technician working that night documented the patient’s oxygen saturation level as 98% every hour from midnight to the end of the shift at 7 a.m., even though the patient was not hooked up to the oximeter. (The technician was terminated because of this).
This knowledge deficit can lead to inadequate treatment of low oxygen saturation levels. And monitoring patients who don’t need it wastes resources and contributes to a high rate of false alarms, which distress patients and family members and desensitize staff members to real emergencies.
Here are some important things to keep in mind when using a pulse oximeter:
• Ensure that continuous monitoring is used only on patients whose condition requires it, such as patients with a compromised airway. If your patient has an inappropriate order on the chart, alert the prescriber and ask that it be updated.
• Be aware of situations for which pulse oximetry is contraindicated, such as during CPR.
• Know causes of erroneous readings, such as movement or carbon monoxide poisoning.
• Choose the correct sensor size for the patient.
• Check the skin under the sensor and rotate the sensor site periodically.
• Explain the equipment and the reasons that alarms might sound to patients and family members, to reduce their anxiety.
All of these points—and much more—are discussed in depth in Claudia Valdez-Lowe and colleagues’ article “Pulse Oximetry in Adults,” featured in this month’s issue of AJN. As the old saying goes, an instrument is only as good as the person using it.
—Christine Moffa, MS, RN, AJN clinical editor