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They should be asked to keep still while pulse oximetry is being performed so that an accurate result can be obtained (Hunter and RawlingsAnderson 2008). If the patient is vasoconstricted or has an occlusion superior to the pulse oximeter sensor then an inaccurate result will be obtained (Levine 2007). If the patient is having a seizure, shivering or moving then pulse oximetry will not be accurate (Levine 2007). Pulse oximetry must not be used on nails with nail polish or on patients who have received dye treatment such as methylene blue, indiocyanine green and indiocarmine (Levine 2007). It should be used in caution with those with arrhythmias, and only be used if there is a correlation between the actual and recorded pulse (Booker 2008).

Procedure guideline 12.4 Respiratory assessment and pulse oximetry

Essential equipment

Pulse oximeter

Power source

Cleaning materials (according to manufacturer’s recommendations and local policy)

Sensor applicable to the chosen site

Appropriate method of documentation and a pen

Optional equipment

Variety of sensors available for different sites

Preprocedure

Action Rationale

1 Wash hands thoroughly with soap and water and dry. To reduce the risk of crosscontamination (Fraise and Bradley 2009, E; Hunter and RawlingsAnderson 2008, E).

2 Explain the procedure to the patient, answering any questions they may have, and gain their consent. Consent must be gained prior to commencing any procedure (NMC 2008b, C).

3 While talking to the patient, assess their respiratory condition including their ability to talk in full sentences, the colour of their skin, whether they appear to be in distress or not, and whether they are alert and orientated. This initial assessment can give important information about the patient’s respiratory function and any potential problems (Higginson and Jones, 2009, E; Wilkins 2009, E).

4 Determine the site to be used to perform pulse oximetry. The site should have a good blood supply, determined by checking it is warm, with a proximal pulse and brisk capillary refill. The sensor requires a wellperfused area or it will not get strong enough signals to produce a result (Adam and Osborne 2005, E; Levine 2007, E).

5 Ensure that the area to be used is clean and free from dirt, and that the sensor is also clean (Moore 2004a). If using the patient’s fingers ensure that all nail polish has been removed. Dirt or nail polish may interfere with the transmission of the light signals, causing inaccurate results (Moore 2004a, E).

6 Select the correct pulse oximeter sensor for the site which is most appropriate for your patient, dependent on circulation and the manufacturer’s instructions. The correct sensor should be used for each site to ensure good contact and not apply too much pressure (Levine 2007, E).

Procedure

7 Position the sensor securely but do not secure it with tape, unless specifically recommended by the manufacturer (MHRA 2001) (see Action Figure 7). If the pulse oximetry is to be continuous then the site needs to be changed at least every 4 hours. If it is too tight it may impede the blood flow, leading to inaccurate results and the potential for pressure ulcer formation to the site (Moore 2004a, E).

8 Turn the pulse oximeter on and set the alarms on the device dependent on the patient’s condition and within locally agreed limits. To ensure that it is ready to use (Adam and Osborne 2005, E).

9 Check that the pulse reading on the device corresponds with their actual pulse. Ask the patient not to talk while you palpate their pulse. Once the pulse rate has been obtained, keep your fingers on their wrist and count their respiratory rate for a full minute. One breath is equal to one inspiration and expiration and is done by watching the abdomen or chest wall move in and out. Assess the regularity and depth of breathing, the shape and expansion of the chest, and look for any use of accessory muscles. Any large deviations in pulse may show that the device is not measuring accurately or is being affected by movement (Levine 2007, E).

The patient should