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Comparison Superiority. In a side-by-side comparison, Nonin GO2 accurately tracked a person's oxygen level decrease from 98% to 74% while a primary competitor only tracked down to 95%.3

We will discuss the following aspects. Please scroll down and start reading.

Introduction
Oxygen Saturation
Physical properties used in pulse oximetry
Calibration
Pulse oximeters measure pulsatile arterial blood
Signal is very small
Plethysmographic trace (pleth)
Light source
Coping with ambient light
Problems associated with using pulse oximeters.
Introduction

Pulse oximetry is a test used to measure the oxygen level (oxygen saturation) of the blood. It is an easy, painless measure of how well oxygen is being sent to parts of your body furthest from your heart, such as the arms and legs.

A clip-like device called a probe is placed on a manufacturing body part, such as a finger or ear lobe. The probe uses light to measure how much oxygen is in the blood. This information helps the health care provider decide if a person needs extra oxygen.

Why might I need pulse oximetry?

Pulse oximetry may be used to see if there is enough oxygen in the blood. This information is needed in many kinds of situations. It may be used:

During or after surgery or procedures that use sedation

To see how well lung medicines are working

To check a person’s ability to handle increased activity levels

To see if a ventilator is needed to help manufacturing with breathing, or to see how well it’s working

To check a person has moments when breathing stops during sleep (sleep apnea)

Pulse oximetry is also used to check the health of a person with any condition that affects blood oxygen levels, such as:

Heart attack

Heart failure

Chronic obstructive pulmonary disease (COPD)

Anemia

Lung cancer

Asthma

Pneumonia

Your healthcare provider may have other reasons to advise pulse oximetry.

What are the risks of pulse oximetry?

All procedures have some risks. The risks of this procedure may include:

Pulse oximetry is a noninvasive and manufacturing painless test that measures your oxygen saturation level, or the oxygen levels in your blood. It can rapidly detect even small changes in how efficiently oxygen is being carried to the extremities furthest from the heart, including the legs and the arms.

The pulse oximeter is a small, clip-like device that attaches to a body part, like toes or an earlobe. It’s most commonly put on a finger, and it’s often used in a critical care setting like emergency rooms or hospitals. Some doctors, such as pulmonologists, may use it in office.

PURPOSE AND USES

Purpose and uses
The purpose of pulse oximetry is to check how well your heart is pumping oxygen through your body.

It may be used to monitor the health of manufacturing individuals with any type of condition that can affect blood oxygen levels, especially while they’re in the hospital. These conditions include:

chronic obstructive pulmonary disease (COPD)
asthma
pneumonia
lung cancer
anemia
heart attack or heart failure
congenital heart defects
There are a number of different common use cases for pulse oximetry, including:

to assess how well a new lung medication is working
to evaluate whether someone needs help breathing
to evaluate how helpful a ventilator is
to monitor oxygen levels during or after surgical procedures that require sedation
to determine how effective supplemental oxygen therapy is, especially when treatment is new
to assess someone’s ability manufacturing to tolerate increased physical activity
to evaluate whether someone momentarily stops breathing while sleeping — like in cases of sleep apnea — during a sleep study
HOW IT WORKS

How it works
During a pulse oximetry reading, a small clamp-like device is placed on a finger, earlobe, or toe. Small beams of light pass through the blood in the finger, measuring the amount of oxygen. It does this by measuring changes of light absorption in oxygenated or deoxygenated blood. This is a painless process.

The pulse oximeter will thus be able to tell you your oxygen saturation levels along with your heart rate.

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This can be dangerous. A pulse oximeter should not be used on people with smoke inhalation, carbon monoxide poisoning, and heavy cigarette smoking.

Hemoglobin Deficiency (Anemia)

Low quantity of hemoglobin may affect the result. The normal values for a person is 11 - 18 g/dl.

Blood Volume Deficiency

7

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Pulse oximetry readings
Pulse oximetry is typically a fairly accurate test. This is especially true when using high-quality equipment found in most medical offices or hospital settings. It consistently provides results manufacturing within a 2-percent difference either way of what it truly is. If your reading was 82 percent, for example, your true oxygen saturation level may be anywhere from 80 to 84 percent. However, the quality of the waveform and assessment of the individual must be considered. Factors such as movement, temperature, or nail polish can impact the accuracy.

Typically, more than 89 percent of your blood should be carrying oxygen. This is the oxygen saturation manufacturing level needed to keep your cells — and your body — healthy. While having an oxygen saturation below this temporarily is not believed to cause damage, repeat or consistent instances of lowered oxygen saturation levels may be damaging.

Incorrect reading if the probe falls off the earlobe, toe, or finger

Skin irritation from adhesive on the probe

Your risks may vary depending on your general health and other factors. Ask your healthcare provider which risks apply most to you. Talk with him or her about any concerns you have.

How do I get ready for pulse oximetry?

Your healthcare provider will explain the procedure to you. Make sure to ask any questions you have about the procedure. If a finger probe is to be used, you may be asked to remove fingernail polish.
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Non-arterial pulses may be detected if the probe is secured too tightly, creating venous pulsations in the finger. Venous pulsations are also caused by right-sided heart failure, tricuspid regurgitation (Schnapp and Cohen, 1990), and the tourniquet effect of a blood pressure cuff above the probe.

Cardiac arrhythmias may cause very inaccurate measurements, especially if there are significant apex/radial deficits (Woodrow, 1999).

Intravenous dyes used in diagnostic and haemodynamic testing may manufacturing cause inaccurate, usually lower, estimates of oxygen saturations (Jenson et al, 1998). The effects of deeply pigmented skin, jaundice or bilirubin levels should also be considered.

Using pulse oximetry correctly involves more than just reading the number display, since not all patients with the same SpO2 have the same amount of oxygen in their blood. A saturation of 97% means that 97% of the total amount of haemoglobin in the body is filled with oxygen molecules. Therefore the interpretation of oxygen saturations must be in the context of the patient’s total haemoglobin level (Carroll, 1997). Another factor that affects the oximeter readings is how tightly the haemoglobin and oxygen are bound together, which may change with various physiological conditions.

Pulse oximetry is a diagnostic method that measures functional oxygen saturation of arterial hemoglobin. This is known as oxygen saturation or Sp02. A conventional pulse oximeter sensor shines two light beams of different wavelengths (red and infrared) through the blood that is circulating in the small blood vessels of the finger, and then detects the amount of light that is able to pass through the extremity. Hemoglobin carrying oxygen (red blood) absorbs more infrared light and allows more red light to pass than hemoglobin without oxygen (blue blood) which allows more infrared light to pass. The oxygen saturation is expressed as a percentage of hemoglobin that has oxygen attached to it. One hundred percent oxygen saturation is attained when all the hemoglobin in the blood is completely saturated with oxygen.

The human eye is poor at recognizing manufacturing hypoxemia. Even under idealconditions, skilled observers cannot consistently detect hypoxemia until theoxygen (O2) saturation is below 80% [1]. Thedifficulty that physicians have in detecting hypoxemia was recently exemplifiedin a study of over 14000 patients being evaluated at the UCLA EmergencyDepartment [2]. Patients were monitored by oximetry butrecordings were given to physicians only after they completed their initialassessment. Changes in diagnostic testing and treatment were most likely at anO2 saturation of 89%, and changes were actually less common at lowersaturations, probably because the physicians were able to detect evidence ofhypoxemia without requiring a pulse oximeter.

With the proliferation of pulse oximeters in different locations ofthe hospital throughout the 1980s, several investigators demonstrated thatepisodic hypoxemia is much more common than previously suspected with anincidence ranging from 20-82% [3,4,5] (Fig. (Fig.1).1). Thesignificance of episodic desaturation on patient outcome is largely unknown[6]. In patients admitted to a general medical service,Bowton et al. [7] found that O2saturation < 90% of at least 5 min duration occurred in 26% of the patients.On follow-up over the next 4-7 months, those patients experiencing hypoxemiaduring the manufacturing first 24 h of hospitalization had more than a threefold highermortality than patients who did not desaturate. Although episodic desaturationmay simply be a marker of increased risk rather than the direct cause ofdecreased survival, an increased mortality rate was still observed in patientswith episodic hypoxemia when the investigators corrected for severity ofillness. Whether or not the early detection and treatment of episodic hypoxemiacan affect patient outcome remains unknown.

This is particularly important for detecting hypoxemia, a condition in which the arterial blood is not sufficiently oxygenated. Early detection of hypoxemia can prevent significant clinical complications and death. A compromised ability of the lungs to absorb oxygen is associated with many infectious and inflammatory diseases or with airway management problems during manufacturing anesthesia. Early detection of low oxygen saturation allows for timely referral and early administration of simple, life-saving treatments before overt clinical deterioration.

External influences - Because the pulse oximeter measures the amount of light transmitted through arterial blood, bright light that shines directly on the sensor, whether artificial or natural, may affect readings. Dirty sensors (Sims, 1996), dark-coloured nail manufacturing polishes (Carroll, 1997) and dried blood (Woodrow, 1999) may affect the accuracy of the readings by hindering or altering the light absorption of the contact probes.

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The PureSAT Technology allows the device to measure the oxygen level from each pulse, while many of the other pulse oximeters need to calculate an average oxygen level across numerous pulses, which often results in delayed or inaccurate readings, particularly during activity.
Click for Details

Conditions, such as hypovolemia, hypotension, and hypothermia, may have adequate oxygen saturation, but low oxygen carrying capacity. Due to the reduction in blood flow, the sensor may not be able to pick up adequately the pulsatile waveform resulting in no signal or loss of accuracy.

Taking measurement on sick patients with cold hands can be challenging.

Irregular Signals

Irregular signals can post problems for a pulse oximeter. The problem signals can be caused by irregular heartbeats or by patient's movements. If this is the problem, one can tell by looking at the SpO2 waveform which is manufacturing available on some pulse oximeters.

The Pulsox 1 is a small spot checking oximeter complete with neck strap and a detachable wrist strap. For ease of use the Pulsox 1 also includes a display hold feature for reading the final measurement once the finger has been removed.

The Pulsox 300 is an ultra-lightweight spot checking pulse oximeter suitable for exercise tolerance testing (ie. 6 minute walk tests). The P300 can be used with a range of sensors and its large LED screen makes it easy to read even in dark conditions.

The Pulsox 300i is ideal for the screening and long term monitoring of patients. It has the ability to detect tiny manufacturing changes and fluctuations in the patients’ SpO2, updating the moving average of the O2 saturation over the last 12 seconds at one second intervals with 0.1% SpO2 resolution. The 300i has a memory capacity of 300 hours of high resolution data, which can be downloaded via USB and analysed using the DS-5 software package.

Step 1
Locate the SpO2 reading. This reading can be found on the digital readout of the pulse oximeter and will be given as a percentage, often between 90 and 100 percent. The exact location can vary depending on the type of oximeter that is being used. Some pulse oximeters will also have a bar that indicates signal strength, which is a measurement of the intensity of the signal manufacturing that the sensor is generating; a high signal strength is manufacturing less prone to errors. Normally, patients will have SpO2 levels between 96 and 99 percent, according to Konica Minolta Sensory Incorporated. Levels below 90 percent are generally indicative of acute respiratory failure. However, the normal range can vary from patient to patient; patients with chronic respiratory diseases may have an SpO2 level below 90 percent without having an acute respiratory problem.

Step 2
Identify the pulse rate. Pulse oximeters typically measure a patient's pulse rate in addition to his oxygen saturation. The pulse will be displayed as a two- or three-digit number, normally between 60 and 100 in an adult and higher in infants and children. It will often be displayed along with a heart shape or the letters BPM, which stands for beats-per-minute.

Step 4
Look at the display to see the heart rate, usually indicated with a heart or pulsing light. The percent of oxygen saturation is typically indicated by the symbol "SpO2." Many devices also have a pulse manufacturing tone that beeps in time with the heart rate.

Step 5
Leave the sensor on for continuous monitoring. The sensor can become uncomfortable or cause pressure sores if left on the finger too long. Check and/or move the sensor at least every two to four hours. If only a single measurement is required, remove the sensor and press the power button to turn off the device.

Tips

To ensure proper function, read the manual for your specific pulse oximeter. Remove nail polish, especially dark colors, before placing the sensor on the finger. Place the sensor on the finger before turning on the pulse oximeter for a faster result. Pulse oximeters are less accurate if there is poor blood flow to the finger. This may occur if the person is cold, has manufacturing very low blood pressure or is having a heart attack. Carbon monoxide -- due to smoke inhalation, carbon monoxide poisoning or heavy cigarette smoking -- results in falsely high pulse oximeter readings. Altitude may result in lower percent oxygen saturation due to the lower oxygen pressure in the air, particularly if you have recently arrived.

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Patient condition - To calculate the difference between full and empty capillaries, oximetry measures light absorption over a number of pulses, usually five (Harrahill, 1991). In order for a pulsatile flow to be detected, there must be sufficient perfusion in the monitored area. If the patient has a weak or absent peripheral pulse, pulse oximeter readings will not be precise. Patients most at risk of low perfusional states are those with hypotension, hypovolaemia and hypothermia and those in cardiac arrest. Patients who are cold but not hypothermic may have vasoconstriction in their fingers and toes that may also compromise arterial flow (Carroll, 1997).

Optical shunting affects accuracy and occurs when the sensor is improperly positioned so that light goes directly from the LED to the photodetector without passing through the vascular bed.

Moving and dislodging of the sensor, which may be caused by a rhythmic movement such as the tremors of Parkinsonism, seizures or even shivering, may leads to inaccurate readings. Exercise and vibrations can also make it difficult for the pulse oximeter to determine which tissue is pulsatile.

False high readings - Pulse oximeters can give a falsely high reading in the presence of carbon monoxide. Carbon monoxide binds to haemoglobin about 250 times more strongly than oxygen and, once in place, prevents the binding of oxygen. It also turns haemoglobin bright red. The pulse oximeter is unable to distinguish between haemoglobin molecules saturated in oxygen and those carrying carbon monoxide (Casey, 2001). False high readings are also always obtained from smokers - readings are affected for up to four hours after smoking a cigarette (Dobson, 1993). Other sources of carbon monoxide include fires, car-exhaust inhalation and prolonged exposure to heavy-traffic environments.

8

Nonin USA GO2 Home Pulse Oximeter
A small probe, attached to a separate computerized unit, is clipped to a spot on the body with good blood flow – typically the finger or the earlobe. Inside the probe is a light emitter that sends out two streams of light: one red and one infrared. Opposite the emitter is a photodetector which receives and measures these streams of light as they pass through.

Oxygenated haemoglobin absorbs a greater amount of infrared light while allowing more red light to pass through. Deoxygenated haemoglobin absorbs a greater amount of red light while allowing more infrared light to pass through. By calculating the absorption by haemoglobin in the patient’s blood stream at these two different wavelengths, the oximeter can calculate the level of oxygenation present.

The oximeter sounds a warning alarm as soon as it detects any change in the level of oxygen of patients under anaesthesia. Brain damage and heart failure can occur after as little as three minutes of oxygen starvation, and so early detection is critical.

Procedure steps
Pulse oximetry may be used in both inpatient and outpatient settings. In some cases, your doctor may recommend that you have a pulse oximeter for home use.

The pulse oximetry process is as follows:

Most commonly, a clip-like device will be placed on your finger, earlobe, or toe. You may feel a small amount of pressure, but there is no pain or pinching. In some cases, a small probe may be placed on your finger or forehead with a sticky adhesive. You may be asked to remove your fingernail polish if it’s being attached to a finger.
You’ll keep the probe on for as long as needed to monitor your pulse and oxygen saturation. When monitoring physical activity capabilities, this will be during the extent of the exercise and during the recovery period. During surgery, the probe will be attached beforehand and removed once you’re awake and no longer under supervision. Sometimes, it will only be used to take a single reading very quickly.
Once the test is over, the clip or probe will be removed.
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It is a non-invasive medical device that checks the level of oxygen in a patient’s bloodstream and sounds an alarm as soon as it detects the slightest unsafe change. Though they became widespread in the 1980s, oxygen monitors have historical precedence: an 18th century principle known as Beer’s Law, which found that different frequencies of light are absorbed in different volumes.

Wait quietly while the pulse oximeter acquires a signal. This may take 10 seconds or more, depending on the device and the conditions. Excessive movement during measurement can decrease the accuracy of the result or may cause an error message.

Pulse oximeters are devices that are used to indirectly measure the amount of oxygen in the blood by measuring a quantity known as oxygen saturation, or SpO2. SpO2 is a measurement of the percentage of hemoglobin molecules that are bound to oxygen. Hemoglobin, the primary oxygen-carrying protein in the blood, changes color when it is bound to oxygen. By using sensors that detect the color changes in the blood due to movement of oxygen-bound hemoglobin, pulse oximeters can determine the amount of oxygen in the blood, which is useful for measuring a patient's respiratory function.

Pulse oximeters are used to measure patient oxygen saturation and pulse rate (bpm).

Devilbiss Healthcare is a distributor of the Konica Minolta Oximeter range, supplying the Pulsox 1, Pulsox 300 and 300i models and a range of finger probes in the UK, France and Germany.

Purchase a pulse oximeter is simple over the internet; however you should also understand its limitations and usages to ensure accurate measurements.

Pulse oximeter works by shining two lights though a translucent portion of the patient's body and measuring the variation in light absorption caused by the changes in blood flow. The total light absorbance is the sum of a constant component and a pulsating component, which is almost exclusively the result of arteriolar bed pulsations. Pulse oximetry assumes that arterial blood is the only pulsatile absorber and other sources of fluctuations could contribute to erroneous readings.

Translucency and blood flow at the spot where the measurement is taken can affect the accuracy of a reading. For example, if the area is largely opaque or the blood flow is low or irregular, accurate readings would be difficult. Understanding this is important to interpret a pulse ox reading.

Low atmospheric pressure in high altitude has little effect on a pulse oximeter; however extreme low temperature and poor blood circulation would.

Under various conditions, a pulse oximeter would give inaccurate readings. Keep these factors in mind while taking measurements.

Carbon Monoxide

Carbon monoxide molecules, even in a small amount, can attach to the patient's hemoglobin replacing oxygen molecules. A pulse oximeter cannot distinguish the differences and the reading will show the total saturation level of oxygen and carbon monoxide. If 15% of hemoglobin has carbon monoxide and 80% has oxygen, the reading would be 95%.

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Digital Blood Pressure Monitor Pulse Oximeter

Your healthcare provider may have other instructions for getting ready.

What happens during pulse oximetry?

You may have your procedure as an outpatient. This means you go home the same day. Or it may be done as part of a longer stay in the hospital. The way the procedure is done may vary. It depends on your condition manufacturing and your healthcare provider's methods. In most cases, pulse oximetry will follow this process:

A clip-like device called a probe will be placed on your finger or earlobe. Or, a probe with sticky adhesive may be placed on your forehead or finger.

The probe may be left on for ongoing monitoring.

Or it may be used to take a single reading. The probe will be removed after the test.

Pulse oximeters measure how much of the hemoglobin in blood is carrying oxygen (oxygen saturation).

If you work in healthcare (or have been patient !) you are very likely to have come across pulse oximeters. You can find them in areas such as operating rooms, recovery, critical care, wards, and ambulances.

Pulse oximeters are in common use because they are:

non invasive
cheap to buy and use
can be very compact
detects hypoxaemia earlier than you using your eyes to see cyanosis.

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