KASTURBA GANDHI NURSING

COLLEGE
SRI BALAJI VIDYAPEETH, SBV CAMPUS
PILAIYARKUPPAM ,PUDUCHERRY

ADVANCED NURSING PRACTICE

SUBMITTED TO: SUBMITTED BY:

MR.DHIVAGAR.S MS. ARTHI C

ASSISTANT PROFESSOR, I- YEAR,

DEPT OF MENTAL HEALTH M.SC NURSING,

NURSING, KGNC. KGNC.

SUBMITTED ON:
 PULSE OXIMETRY
INTRODUCTION:
 Pulse oximetry is a simple noninvasive method of monitoring the percentage
of hemoglobin which is saturated with oxygen. The pulse oximeter consists
of a probe attached to the patients finger or ear lobe or which is linked to a
computerized unit. The unit displays the percentage of Hemoglobin
saturated with oxygen together, a calculated heart rate.
 Pulse oximetry has become the standard of care in operating rooms. ICU and
hospital wards in the United States and many other nations before pulse
oximetry was available, physicians relied on invasive procedures. Such as
ABG to identify the presence of hypoxemia.
DEFINITION:
 It is a non invasive device used to measure blood oxygen levels and can also
display heart rate. A pulse oximeter is a medical device that indirectly
monitors the oxygen saturation of a patient's blood.
 A non invasive technology to monitor oxygen saturation of the
Haemoglobin.
HISTORY:
 MATHEES-father of oximetry
 20 papers in1934-1944
 HERTZMAN 1937-use of photoelectric finger plethsmography
 1975-concept of pulse oximetry-Japan
 YELDERMAN &NEW 1983 Nelloor pulse oximeter
PRINCIPLES:
 It is based on the red and infrared light absorption characteristics of
oxygenated and deoxygenated hemoglobin. A red light is in the 600-750 nm
wavelength light band. Infrared light is in the 850-1000 nm wavelength light
band.
 Pulse oximetry works by placing a pulsating arteriolar vascular bed between
a dual light (red and infrared) source and a photodetector. The photodetector
records the relative amount of each color absorbed by arterial blood and
transmits the data to a monitor, which displays the information with each
heartbeat.
  If blood is rich in oxygen, then it easily absorbs the infrared light and allows
it to pass.
 A healthy person has saturation level ranging from 95 to 99 percent.
 Absorbtion spectro photometry
 Beer lambert law
 Lambert's law states that when a light falls on a homogenous substance,
intensity of transmitted light decreases as the distance through the substance
increase
 Ber's law states that when a light is transmitted through a clear substance
with a dissolved solute, the intensity of transmitted light decreases as the
concentration of the solute increases
 Substances have specific pattern of absorbing specific wavelength-
Extinction coefficient.
Uses two lights of wavelengths
 660m-deoxy Hb absorbs ten times as oxy hb
 940nm-absorption of oxyHb is greater
  Labs oximeters use 4 wavelengths to measure 4 species of haemoglobin.

Operating principles
The pulse oximeter estimates Spo2 from the differential absorption of red and
infrared light in tissue. Reduced hemoglobin absorbs more light in the red band
than oxyhemoglobin, Oxyhemoglobin absorbs more light in the infrared band.

List out the purpose of pulse oximetry

ANATOMICAL REVIEW:
Hemoglobin is the iron containing oxygen-transport metalloprotein in the red
blood cell of vertebrates. Hemoglobin transports oxygen from the lungs to the rest
of the body, where it releases the oxygen for cell use.
PHYSIOLOGY:
Efficient oxygen transport relies on the ability of hemoglobin to reversibly load
and unload oxygen. The relationship between oxygen tension and oxygen binding
is seen in the oxyhemoglobin dissociation curve which plots the hemoglobin
oxygen Saturation against the oxygen tension.
PURPOSES:
Pulse oximeters measure:
The oxygen saturation of haemoglobin in arterial blood.
The pulse rate - in beats per minute.
 To relieve cyanosis by detecting hypoxia and severe respiratory failure.
FUNCTIONS:
It is a safe and simple method of assessing oxygenation.
It is noninvasive.
Acceptable normal ranges are from 95 to 100 percent.
Convenient andmeasurement can be continous.
INDICATION:
 Monitoring oxygenation
During anesthesia in ICU, PACU, during transport.
 Monitoring oxygen therapy
 Assesment of perfusion
 Monitoring vascular volume
 Sleep studies -24-h ambulatory recordings of SpO2 is useful for screening
for daytime sleep sequelae associated with the potential risk of this
pathology in OSAS during social activities
 Emergency department
 Reflectance pulse oximeters can be useful for assessing fetal status during
labor and delivery by applying a forehead probe.
 Pulse oximetry has been used during cardiopulmonary resuscitation Because
of artifacts and lag times, it is more useful in primary respiratory arrest than
in cardiac arrest. It is useful in assessing oxygenation during newborn
resuscitation.
 Out-of-hospital Use
Pulse oximetry is useful in the prehospital setting, including when
importing patients by helicopter or ambulance Controlling Oxygen
Administration.
CONTRA INDICATION:
There are no contra indication to pulse oximetry it is generally safe to use in
monitoring all patients.
ROUTES:
 Finger
 Toe
 Ear lobe
 Nose
 Tongue
 Cheek
 Esophagus
THE ARTICLES AND PREPARATION OF CLIENT FOR
 Pulse oximetry
 Equipment
 Alcohol swab
Oximeter consist of:
 Peripheral probe
 A microprocessor unit displays a waveform,
 The oxygen saturation and the pulse rate.
 Red and infrared light emiters detector
 Most oximeters also have an audible pulse tone.
Preparation for pulse oximetry
 Ensure that the patient is comfortable and warm enough especially if
continuous monitoring is needed.
 Make sure the probe and equipment are clean and in good working order.
  Select a suitable area for the probe (usually finger) and place the probe as
directed by the manufacturer's instructions.
 Position the probe carefully.
 Make sure it fits easily without being too loose or too tight.
 Switch the pulse oximeter machine on.
 Make sure that the probe sensor in detecting the pulse and that it
corresponds to the patients pulse.
 This will usually be indicated by a beep in time with each detected pulse or a
graphical indication of the pulse on a display, panel.
 Take the reading of the oxygenation saturation and document this in the
patients notes.
 Make a role of any oxygen administration.
 Ensure that any abnormal reading or observation is reported to the medical
team.
 Once oxygen saturation monitoring is completed, clean equipment and
rectum to storage as appropriate.
ADVANTAGES OF PULSE OXYMETER:
 Simple to use
 Non invasive
 Require no warm up time
 Especially in African & Asian patients
 Cost effectiveness over ABG
DISADVANTAGES OF PULSE OXIMETER:
 False Positives and Negative
 Burn Injury, pressure injuries.
NURSES RESPONSIBILITY:
 Describe detail about the procedure for pulse oximetry.
 Explain to the patient that an oxygen saturation reading is needed and obtain
consent to continue.
 Make sure the probe and equipment are clean and in good working order,
 Select a suitable area for the probe (usually finger) and place the probe as
directed by the manufacturer's instructions.
 Position the probe carefully,
 Make sure it fits easily without being too loose or too tight.
 Switch the pulse oximeter machine on.
 Make sure that the probe sensor is detecting the pulse and that it
corresponds to the patients pulse. This will usually be indicated by a beep in
time with each detected pulse or a graphical indication of the pulse on a
display, panel.
 Take the reading of the oxygenation saturation and document this in the
patients notes. Make a rote of any oxygen administration.
 Ensure that any abnormal reading or observation is reported to the medical
team.
 Once oxygen saturation monitoring is completed, clean equipment and
rectum to storage as appropriate.
 Remove any nail polish from any digits which will have a sensor applied as
it interferes with light transmission if it shows wrong reading check patient’s
BP and vital signs first – if they are acceptable for patient, then check for the
following.
 Wash site off with soap and water. Do not use alcohol.
 Documentation: document pulse oximeter readings (sao2), sensor placement
and alarm settings (continuous mode) on patient care record or flowsheet.
SUMMARY:
So for we have discussed about the definition uses, advantages, disadvantages,
indication, contra indication, purpose of pulse oximetry. I think you are all gain
knowledge about this procedure and applied this knowledge and skill during
clinical area whiles your practice.
CONCLUSION:
With this we have come to the end of procedure demonstration of pulse
oximetry. As a health care provider, you should know the basic principles &
techniques that should be followed in pulse oximetry. You should also be aware
of the indication and contraindication and complications arising out of pulse
oximetry, so that you can provide appropriate quality nursing care interventions
to manage them for achieving maximum safety of the client thank our Madam
for the guidance and I thank you for wonderful listening.
BIBLIOGRAPHY:
Books:
1. Potter and perry (2008), "Fundamentals of nursing", Seventh edition,
Elsevier Publications, Pp 729-735.
2. Bare G. Brenda & Suzanne, C. Smeltzer, (2005). Brunner and Suddarth's
“Text Book of Medical Surgical Nursing", Tenth edition, Philadelphia
Lippincott Williams & Wilkins, Pp 516-568.
3. Lisa Dougherdy, Sara Lister, (2004), "Manual of Clinical Nursing
Procedures", Sixth edition, Blackwell Publishing Company, Australia, Pp 132-
134.
4, Sr. Nancy (2006), "Principles and practices of Nursing". Fourth edition,
N.R.publishing House, Pg.No.107-113.
Net Reference:
1. www.proceduresconsult.com/emergency procedures
2. www.emedicine.medscape.com
3. www.medicineclinic.org
4. WWW.SCRIB.COM
5. WWW.MSN.COM