SDE: Clinical Guidelines Ch7U

Clinical Procedure Guidelines for Connecticut School NursesPrintable version | Back to Contents
7
Specialized Health Care Procedures

U. Pulse Oximetry

Definition

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

Purpose

Pulse oximetry is used in the school setting as an adjunct to the registered nurse or respiratory therapist’s clinical respiratory assessment. The SpO2 should never be used in isolation to determine the respiratory status of a student. Obtaining an accurate SpO2 is a skilled level of assessment that requires:

  • Demonstrated competency
  • A knowledge of the student’s baseline SpO2 (if known)
  • The ability to interpret the clinical significance of the SpO2 for an individual student and their clinical situation.

Methods

Pulse oximetry in the school setting requires a portable pulse oximeter with a probe that generally attaches to the student’s finger. These devices are either:

  • hand-held with the probe that attaches to the device by a cable; or
  • one-piece integrated fingertip devices

Equipment

Pulse Oximeter

Procedure

  1. Turn on pulse oximeter.
  2. Select a distal extremity (usually a fingertip) that can be held still and is void of nail polish, false nail, moisture, and sweat.
  3. Minimize excessive environmental light.
  4. An accurate SpO2 requires that the pulse oximeter is able to consistently detect the student’s pulse:
    1. all pulse oximeters have some form of light signal or bar graph that correlates with detecting the pulse; and
    2. a consistent high level of detection for at least 20–30 seconds is necessary to determine an accurate reading.
 

Continuous Pulse Oximetry

  1. If the pulse oximetry is indicated to be continuous, the probe needs to be secured in place per manufacturer’s instructions.
  2. An order for continuous pulse oximetry requires an oximeter with an alarm.
  3. An order for continuous pulse oximetry requires an oximeter with an alarm.

    Alarm parameters are to be set per the students IHCP.
  4. If the alarm sounds, the student requires immediate assessment to determine if it is a “false alarm” (commonly due to excessive movement) or a true emergency that reflects a sudden deterioration in the student’s respiratory status.

Delegation Consideration

Pulse oximetry may be performed by a RN, LPN, or RT.

Select Nursing Considerations

  1. Continuous pulse oximetry requires the rotation of probe sites, per IHCP.
  2. Pulse oximetry should be available for students who have a tracheostomy, require oxygen supplementation and/or mechanical ventilation, or frequent airway suctioning.
  3. The use of pulse oximetry for other common health problems, such as asthma, is generally not indicated.

Reference

Bowden, V.R., and Greenberg, C.S. (2008). Pediatric Nursing Procedures, 2nd edition. Philadelphia, PA: Lippincott Williams and Wilkins.

 




Content Last Modified on 3/29/2017 10:51:49 AM