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Protocol - Pulse Oximetry (Rest)

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Description:

A trained technician places a sensor on a thin part of the patients body, usually a fingertip or earlobe, to monitor the oxygenation of the patients hemoglobin.

Specific Instructions:

None

Protocol:
1.0 PROCEDURE:

Pulse Oximetry (SpO2)

2.0 DESCRIPTION/DEFINITION:

Pulse oximetry provides estimates of arterial oxyhemoglobin saturation (SaO2) by utilizing selected wavelengths of light to noninvasively determine the saturation of oxyhemoglobin (SpO2).

3.0 SETTING:

Pulse oximetry may be performed by trained personnel in a variety of settings including (but not limited to) hospitals, clinics, and the home.

4.0 INDICATIONS:

4.1 The need to monitor the adequacy of arterial oxyhemoglobin saturation.

4.2 The need to quantitate the response of arterial oxyhemoglobin saturation to therapeutic intervention or to a diagnostic procedure (e.g., bronchoscopy).

4.3 The need to comply with mandated regulations or recommendations by authoritative groups.

5.0 CONTRAINDICATIONS:

The presence of an ongoing need for measurement of pH, PaCO2 (symbol for partial pressure of carbon dioxide in the arterial blood), total hemoglobin, and abnormal hemoglobins may be a relative contraindication to pulse oximetry.

6.0 HAZARDS/COMPLICATIONS:

Pulse oximetry is considered a safe procedure, but because of device limitations, false-negative results for hypoxemia and/or false-positive results for normoxemia or hyperoxemia may lead to inappropriate treatment of the patient. In addition, tissue injury may occur at the measuring site as a result of probe misuse (e.g., pressure sores from prolonged application or electrical shock and burns from the substitution of incompatible probes between instruments).

7.0 DEVICE LIMITATIONS/VALIDATION OF RESULTS:

7.1 Factors, agents, or situations that may affect readings, limit precision, or limit the performance or application of a pulse oximeter include:

7.1.1 motion artifact

7.1.2 abnormal hemoglobins (primarily carboxyhemoglobin [COHb] and met-hemoglobin [metHb])

7.1.3 intravascular dyes

7.1.4 exposure of measuring probe to ambient light during measurement

7.1.5 low perfusion states

7.1.6 skin pigmentation

7.1.7 nail polish or nail coverings with finger probe

7.1.8 inability to detect saturations below 83% with the same degree of accuracy and precision seen at higher saturations

7.1.9 inability to quantitate the degree of hyperoxemia present

7.1.10 Hyperbilirubinemia has been shown not to affect the accuracy of SpO2 (Pulse Oximeter Oxygen Saturation) readings.

7.2 To validate pulse oximeter readings, incorporate or assess agreement between SpO2 and arterial oxyhemoglobin saturation (SaO2) obtained by direct measurement--these measurements should be initially performed simultaneously and then periodically re-evaluated in relation to the patients clinical state.

7.3 To help assure consistency of care (between institutions and within the same institution) based on SpO2 readings, assess

7.3.1 selection of proper probe and appropriate placement (the probe is attached to its intended site, usually the finger);

7.3.2 for continuous, prolonged monitoring, the Hi/Low alarms are appropriately set;

7.3.3 specific manufacturers recommendations are complied with, the device is applied and adjusted correctly to monitor response time and electrocardiographic coupling;

7.3.4 strength of plethysmograph waveform or pulse amplitude strength; assure that device is detecting an adequate pulse.

7.4 SpO2 results should be documented in the patients medical record and should detail the conditions under which the readings were obtained:

7.4.1 date, time of measurement, and pulse oximeter reading; patients position, activity level, and location; during monitoring, assure that patients activity is according to physicians order;

7.4.2 inspired oxygen concentration or supplemental oxygen flow, specifying the type of oxygen delivery device;

7.4.3 probe placement site and probe type;

7.4.4 model of device (if more than one device is available for use);

7.4.5 results of simultaneously obtained arterial pH, PaO2, and PaCO2, and directly measured saturations of COHb, MetHb, and O2Hb4 (if direct measurement was not simultaneously performed, an additional, one-time statement must be made explaining that the SpO2 reading has not been validated by comparison to directly measured values);

7.4.6 stability of readings (length of observation time and range of fluctuation, for continuous or prolonged studies, review of recording may be necessary);

7.4.7 clinical appearance of patient--subjective assessment of perfusion at measuring site (e.g., cyanosis, skin temperature);

7.4.8 agreement between patients heart rate as determined by pulse oximeter and by palpation and oscilloscope.

7.5 When disparity exists between SpO2, SaO2 readings, and the clinical presentation of the patient, possible causes should be explored before results are reported. Discrepancies may be reduced by monitoring at alternate sites or appropriate substitution of instruments or probes. If such steps do not remedy the disparity, results of pulse oximetry should not be reported; instead, a statement describing the corrective action should be included in the patients medical record, and direct measurement of arterial blood gas values should be requested. The absolute limits that constitute unacceptable disparity vary with patient condition and specific device. Clinical judgment must be exercised.

8.0 ASSESSMENT OF NEED:

8.1 When direct measurement of SaO2 is not available or accessible in a timely fashion, a SpO2 measurement may temporarily suffice if the limitations of the data are appreciated.

8.2 SpO2 is appropriate for continuous and prolonged monitoring (e.g., during sleep, exercise, bronchoscopy).

8.3 SpO2 may be adequate when assessment of acid-base status and/or PaO2 is not required.

9.0 ASSESSMENT OF OUTCOME:

The following should be utilized to evaluate the benefit of pulse oximetry:

9.1 SpO2 results should reflect the patients clinical condition (i.e., validate the basis for ordering the test).

9.2 Documentation of results, therapeutic intervention (or lack of), and/or clinical decisions based on the SpO2 measurement should be noted in the medical record.

10.0 RESOURCES:

10.1 Equipment: pulse oximeter and related accessories (probe of appropriate size)--the oximeter should have been validated by the manufacturer by a comparison of its values (and consequently its calibration curve) with directly measured oxyhemoglobin saturation.

10.2 Personnel: Pulse oximetry is a relatively easy procedure to perform. However, if the procedure is not properly performed or if it is performed by persons who are not cognizant of device limitations or applications, spurious results can lead to inappropriate intervention.

10.2.1 Level I--personnel trained in the technical operation of pulse oximeters, oxygen delivery devices and related equipment, measurement of vital signs, and record keeping--may perform and record results of pulse oximetry but should be supervised by Level II personnel.

10.2.2 Level II--health care professionals trained in patient assessment, disorders of acid-base, oxygenation and ventilation, and diagnostic and therapeutic alternatives--evaluate patients and recommend and/or make changes in therapy based on assessment.

11.0 MONITORING:

The clinician is referred to Section 7.0 Validation of Results. The monitoring schedule of patient and equipment during continuous oximetry should be tied to bedside assessment and vital signs determinations.

12.0 FREQUENCY:

After agreement has been initially established between SaO2 and SpO2, the frequency of SpO2 monitoring (i.e., continuous vs "spot check") depends on the clinical status of the patient, the indications for performing the procedure and recommended guidelines. For example, continuous SpO2 monitoring may be indicated throughout a bronchoscopy for detecting episodes of desaturation, whereas a spot check may suffice for evaluating the efficacy of continued oxygen therapy in a stable postoperative patient. However, it must be emphasized that direct measurement of SaO2 is necessary whenever the SpO2 does not confirm or verify suspicions concerning the patients clinical state.

13.0 INFECTION CONTROL:

No special precautions are necessary, but universal precautions (as described by the Centers for Disease Control and Prevention) are recommended.

13.1 If the device probe is intended for multiple patient use, the probe should be cleaned between patient applications according to manufacturer recommendations.

13.2 The external portion of the monitor should be cleaned according to manufacturers recommendations whenever the device remains in a patients room for prolonged periods, when soiled, or when it has come in contact with potentially transmissible organisms.

Protocol Name from Source:

Availability:

Publicly available

Personnel and Training Required

Personnel should be trained in the technical operation of pulse oximeters, oxygen delivery devices and related equipment, measurement of vital signs, and record keeping. Personnel should be supervised by health care professionals trained in patient assessment, disorders of acid-base, oxygenation and ventilation, and diagnostic and therapeutic alternatives.

Equipment Needs

Pulse oximeter and related accessories (probe of appropriate size)--the oximeter should have been validated by the manufacturer by a comparison of its values (and consequently its calibration curve) with directly measured oxyhemoglobin saturation.

Requirements
Requirement CategoryRequired
Major equipment Yes
Major equipment Yes
Specialized training Yes
Specialized training Yes
Specialized requirements for biospecimen collection No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Physical Measurement

Life Stage:

Infant, Toddler, Child, Adolescent, Adult, Senior, Pregnancy

Participants:

All ages (including infants)

Selection Rationale

This protocol is supported by the American Association of Respiratory Care. This protocol was written by an expert panel of respiratory care professionals and has been utilized for many years.

Language

English, English

Standards
StandardNameIDSource
Common Data Elements (CDE) Person Rest Oxygen Saturation Measurement Text 2970255 CDE Browser
Logical Observation Identifiers Names and Codes (LOINC) Resp pulse ox rest proto 62733-1 LOINC
Derived Variables

None

Process and Review

Not applicable.

Source
American Association for Respiratory Care. (1991). AARC Clinical Practice Guideline: Pulse oximetry. Respiratory Care, 36(12), 1406-1408.
General References

None

Protocol ID:

91101

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX091101_SPA2 PX091101020000 Arterial oxyhemoglobin saturation (SaO2) N/A
PX091101_SPO2 PX091101010000 Saturation of oxyhemoglobin (SpO2) N/A
Respiratory
Measure Name:

Pulse Oximetry (Rest)

Release Date:

January 29, 2010

Definition

Pulse Oximetry (Rest) is a non-invasive method to monitor the oxygenation of a patient's hemoglobin.

Purpose

This measure is used to determine if study subject's oxygenation level is unstable.

Keywords

respiratory, lung, pulse oximetry, arterial oxyhemoglobin saturation, SaO2, oxyhemoglobin saturation, SpO2, oximetry, oximeter, American Association of Respiratory Care, AARC