Do nursing textbooks accurately describe pulse oximetry? An audit of current literature.

BACKGROUND: The assessment of a patient's vital signs is a critical nursing task. Despite this, research has found that many nurses have a poor understanding of pulse oximetry. AIM: As undergraduate students rely heavily on textbooks as an educational resource, an audit was conducted of nursing texts to determine the quality of pulse oximetry descriptions. METHOD: The audit was guided by questions based on the findings of research examining nurses' understanding of pulse oximetry. Two researchers used these questions to appraise textbook content. FINDINGS: A convenience sample of 32 contemporary nursing textbooks was appraised. Text descriptions of pulse oximetry varied from brief to more extensive, with the content ranging from superficial to detailed. CONCLUSION: Superficial, inconsistent or misleading information within basic nursing textbooks may be one factor associated with nurses' knowledge deficits about pulse oximetry. Academics and nurse educators should appraise core content of textbooks carefully before recommending textbooks to nursing students.

Efeitos do banho no leito a seco e tradicional sobre as alterações oxi-hemodinâmicas: ensaio clínico randomizado cruzado / Effects of dry and traditional bed bathing on oxyhemodynamic changes: randomized crossover clinical trial

Em virtude dos riscos gerados para os pacientes pelo tradicional banho no leito, métodos alternativos como o banho a seco, vem sendo incorporados à prática clínica. No entanto, há carência de estudos que comparem os efeitos oxi-hemodinâmicos desses dois banhos. Assim, realizou-se esta pesquisa com o objetivo de avaliar os efeitos do banho no leito a seco em relação ao banho no leito tradicional sobre as alterações oxi-hemodinâmicas (temperatura corporal, frequência respiratória, frequência cardíaca, saturação transcutânea de oxigênio arterial e pressão arterial) em pacientes críticos. Trata-se de um Ensaio Clínico Randomizado, crossover, aberto, realizado com 50 pacientes críticos, entre os meses de setembro de 2018 e fevereiro de 2019. Cada paciente foi o seu próprio controle e recebeu, de forma aleatória, o banho no leito a seco e o tradicional, com um intervalo de 24 horas entre eles. As variáveis oxi-hemodinâmicas foram mensuradas em seis momentos: no início dos banhos, aos 10 minutos, no início e no fim da lateralização dos pacientes, ao final do procedimento e 15 minutos após o seu encerramento. Avaliou-se também o tempo de execução dos banhos e de lateralização dos pacientes. Realizou-se análise descritiva e inferencial, utilizando-se o modelo de Equações de Estimações Generalizadas. O tamanho do efeito foi verificado pela análise do d de Cohen e delta de Cliff. O estudo foi aprovado pelo Comitê de Ética em Pesquisas (parecer 2.550.114). Não houve diferença estatisticamente significativa das variáveis oxi-hemodinâmicas entre os diferentes banhos, mas ao longo do tempo, observou-se redução da temperatura axilar dos pacientes nos dois procedimentos (p<0,05). No banho tradicional, os pacientes também apresentaram, ao final da sua lateralização, elevação da frequência respiratória (24,58 incursões por minuto) (p=0,029). Em relação à significância clínica, o efeito gerado pelo banho a seco sobre as variáveis oxi-hemodinâmicas foi considerado desprezível. O tradicional banho no leito gerou um efeito de pequena magnitude sobre a redução da temperatura axilar e elevação da frequência respiratória. O banho no leito a seco foi considerado mais rápido (18,59 minutos) que o tradicional (26,45 minutos) (p <0,001). Nesse tipo de banho, os pacientes permaneceram lateralizados por um tempo inferior (6,59 minutos) ao do banho tradicional (7,59 minutos) (p<0,001). Concluiu-se que ao serem submetidos ao banho no leito a seco, os pacientes apresentaram, ao longo das mensurações, redução da temperatura axilar. Durante o banho tradicional, além da redução da temperatura axilar, houve elevação da frequência respiratória. Clinicamente, os efeitos gerados pelo banho a seco sobre as variáveis oxi-hemodinâmicas foram considerados desprezíveis, assim como a maioria dos efeitos do banho tradicional. No entanto, o tradicional banho no leito apresentou efeitos negativos sobre a temperatura axilar e frequência respiratória, que apesar de serem de pequena magnitude não devem ser negligenciados. O banho a seco foi superior ao tradicional pelo menor tempo de execução e lateralização dos pacientes. Os aspectos positivos desse método de banho poderão encorajar a sua incorporação nos serviços de saúde. Ademais, independentemente do tipo de banho realizado, espera-se que sejam mantidos o rigor metodológico e a monitorização oxi-hemodinâmica dos pacientes.

Em virtude dos riscos gerados para os pacientes pelo tradicional banho no leito, métodos alternativos como o banho a seco, vem sendo incorporados à prática clínica. No entanto, há carência de estudos que comparem os efeitos oxi-hemodinâmicos desses dois banhos. Assim, realizou-se esta pesquisa com o objetivo de avaliar os efeitos do banho no leito a seco em relação ao banho no leito tradicional sobre as alterações oxi-hemodinâmicas (temperatura corporal, frequência respiratória, frequência cardíaca, saturação transcutânea de oxigênio arterial e pressão arterial) em pacientes críticos. Trata-se de um Ensaio Clínico Randomizado, crossover, aberto, realizado com 50 pacientes críticos, entre os meses de setembro de 2018 e fevereiro de 2019. Cada paciente foi o seu próprio controle e recebeu, de forma aleatória, o banho no leito a seco e o tradicional, com um intervalo de 24 horas entre eles. As variáveis oxi-hemodinâmicas foram mensuradas em seis momentos: no início dos banhos, aos 10 minutos, no início e no fim da lateralização dos pacientes, ao final do procedimento e 15 minutos após o seu encerramento. Avaliou-se também o tempo de execução dos banhos e de lateralização dos pacientes. Realizou-se análise descritiva e inferencial, utilizando-se o modelo de Equações de Estimações Generalizadas. O tamanho do efeito foi verificado pela análise do d de Cohen e delta de Cliff. O estudo foi aprovado pelo Comitê de Ética em Pesquisas (parecer 2.550.114). Não houve diferença estatisticamente significativa das variáveis oxi-hemodinâmicas entre os diferentes banhos, mas ao longo do tempo, observou-se redução da temperatura axilar dos pacientes nos dois procedimentos (p<0,05). No banho tradicional, os pacientes também apresentaram, ao final da sua lateralização, elevação da frequência respiratória (24,58 incursões por minuto) (p=0,029). Em relação à significância clínica, o efeito gerado pelo banho a seco sobre as variáveis oxi-hemodinâmicas foi considerado desprezível. O tradicional banho no leito gerou um efeito de pequena magnitude sobre a redução da temperatura axilar e elevação da frequência respiratória. O banho no leito a seco foi considerado mais rápido (18,59 minutos) que o tradicional (26,45 minutos) (p <0,001). Nesse tipo de banho, os pacientes permaneceram lateralizados por um tempo inferior (6,59 minutos) ao do banho tradicional (7,59 minutos) (p<0,001). Concluiu-se que ao serem submetidos ao banho no leito a seco, os pacientes apresentaram, ao longo das mensurações, redução da temperatura axilar. Durante o banho tradicional, além da redução da temperatura axilar, houve elevação da frequência respiratória. Clinicamente, os efeitos gerados pelo banho a seco sobre as variáveis oxi-hemodinâmicas foram considerados desprezíveis, assim como a maioria dos efeitos do banho tradicional. No entanto, o tradicional banho no leito apresentou efeitos negativos sobre a temperatura axilar e frequência respiratória, que apesar de serem de pequena magnitude não devem ser negligenciados. O banho a seco foi superior ao tradicional pelo menor tempo de execução e lateralização dos pacientes. Os aspectos positivos desse método de banho poderão encorajar a sua incorporação nos serviços de saúde. Ademais, independentemente do tipo de banho realizado, espera-se que sejam mantidos o rigor metodológico e a monitorização oxi-hemodinâmica dos pacientes.

Pulse oximetry and the enduring neglect of respiratory rate assessment: a commentary on patient surveillance.

Clinical surveillance provides essential data on changes in a patient's condition. The common method for performing this surveillance is the assessment of vital signs. Despite the importance of these signs, research has found that vital signs are not rigorously assessed in clinical practice. Respiratory rate, arguably the most important vital sign, is the most neglected. Poor understanding might contribute to nurses incorrectly valuing oxygen saturation more than respiratory rate. Nurses need to understand the importance of respiratory rate assessment as a vital sign and the benefits and limitations of pulse oximetry as a clinical tool. By better understanding pulse oximetry and respiratory rate assessment, nurses might be more inclined to conduct rigorous vital signs' assessment. Research is needed to understand why many nurses do not appreciate the importance of vital signs' monitoring.

Factors which influence concordance among measurements obtained by different pulse oximeters currently used in some clinical situations.

AIMS AND OBJECTIVES: To evaluate both concordance among those measurements obtained by three different pulse oximeters currently used by nursing professionals in hospital units and the factors which can influence this concordance. BACKGROUND: Many models of wireless pulse oximeters in the present market do not offer possibility of calibration and, therefore, they do not ensure patients' safety in daily clinical practice. DESIGN: This is a descriptive and cross-sectional study. The sample of patients (140) was selected from such hospital units, and all of them had to fulfil inclusion and exclusion criteria for participation. METHODS: The instruments used to carry out this research were a monitor (calibrated), two models of portable wireless pulse oximeters (used for 3 years by the nursing staff, without being calibrated), a tympanic thermometer and a weather meter. The concordance correlation coefficient (CCC) was used to establish the concordance, whereas the Landis-Koch criteria were used to interpret the results. RESULTS: The concordance among the three devices was considered as "good" (CCC: 0.925 and 0.974 (95%)). The CCC (0.925) for saturation measures was regarded as "very good"/"almost perfect," and the pulse measure was considered as "very good" CCC 0.974, providing in both cases a high level of concordance (CCC > 0.91). CONCLUSIONS: The overall concordance as regards pulse and oxygen saturation among the three pulse oximeters analysed is considered as "very good" according to the Landis-Koch criteria. RELEVANCE TO CLINICAL PRACTICE: There exists a "very good" concordance among two wireless oximeters which have been used by the health staff for 3 years and which did not offer any possibility of calibration and one monitor which belongs to the healthcare institution. This aspect is of crucial importance in daily clinical practice, and it is also relevant to ensure patient's safety.

Clinical nurses' knowledge level on pulse oximetry: A descriptive multi-centre study.

OBJECTIVES: The aim of this study was to assess the level of knowledge on pulse oximetry among nurses. Understanding this is important because insufficient knowledge can lead to misinterpretation of pulse oximetry readings and consequently compromise patient safety. RESEARCH METHODOLOGY: The study was cross-sectional and included a sample of 198 nurses. A modified questionnaire by Kiekkas et al. was used as the research tool. SETTING: Intensive care units, anaesthesiology and emergency departments in two tertiary health care institutions in Serbia. MAIN OUTCOME MEASURES: Principles of pulse oximeter function and conditions that can affect accuracy and reliability of pulse oximetry readings. RESULTS: The lower percentage of correct responses about principles of pulse oximetry function was found in items related with the alarm reliability and understanding technical limitations. The factors that might affect pulse oximetry readings which were not identified by the nurses at a satisfactory level were the body position and specific kinds of ambient light. The mean scores of knowledge level were significantly different regarding departments (p=0.015). CONCLUSION: Since this study revealed a lower level of knowledge in some aspects of pulse oximetry, it can be concluded that the generally firm belief that "experience is everything" can be challenged. This fact is important for the quality of health care and the patient's safety.

Using pulse oximetry to assess oxygen levels.

Abstract Olive S (2016) Using pulse oximetry to assess oxygen levels. Detecting low oxygen levels in patients is important but not always easy; central cyanosis--when a patient's lips, tongue and mucus membranes acquire a blue tinge--can be missed, even by skilled observers, until significant hypoxaemia is present. Pulse oximetry can be undertaken to measure a patient's oxygen levels and help identify earlier when action must be taken. This article outlines the procedure and its limitations, as well as the circumstances in which it should be used.

Implications of Using Pulse Oximetry to Screen for Critical Congenital Heart Disease in Newborns.

In recent years, pulse oximetry screening for critical congenital heart disease (CCHD) in newborns has been added to the list of recommended uniform screening panels and recommended by several health care organizations. Most states use pulse oximetry to screen for CCHD. Studies have identified problems with compliance and higher failure rate at moderate altitudes than at sea level, suggesting the need for alternate algorithms. Altitude, time, health status of newborns and type of cardiac defect appear to affect results. Early detection of CCHD improves health outcomes and reduces morbidity and mortality. Barriers to screening include out-of-hospital births, cost and knowledge deficits among health care professionals.

Pulse Oximetry Screening for Critical Congenital Heart Disease: Bringing Evidence Into Practice.

Congenital heart disease is the most common and serious type of infant birth defect. Pulse oximetry screening has been supported in the literature as a valuable tool to aid in the prompt detection of critical defects. Pulse oximetry is easily accessible, inexpensive, and noninvasive, and can be readily performed by clinical nurses at the infant's bedside; however, it remains a technology that is underutilized in newborns. Nurses can be leaders in addressing the need to translate knowledge into practice to improve the morbidity and mortality rates in the newborn population.

O uso do oxímetro de pulso na avaliação hemodinâmica / El uso de oxímetro de pulso en la evaluación hemodinâmica / The use of pulse oximeter in hemodynamic assessment

Objective: Identify and analyze the scientific literature on pulse oximeter with plethysmograph for assessing hemodynamic perfusion. Method: this is an integrative literature review, conducted in January and February 2012 on the Virtual Health Library. Studies published from 2000 to 2011 were selected. Results: after evaluating titles, 24 articles were selected for reading of the abstracts; 17 articles were excluded for not addressing the issue at stake, something which resulted in the inclusion of 7 articles in the sample. Conclusion: nursing care and multidisciplinary team care for the patient using pulse oximeter with plethysmograph may associate non-invasive parameters for hemodynamic assessment of perfusion in everyday clinical practice.

Objetivo: Identificar e analisar a produção científica sobre o oxímetro de pulso com pletismógrafo para avaliação da hemodinâmica da perfusão. Método: trata-se de revisão integrativa de literatura, desenvolvida em janeiro a fevereiro de 2012 na Biblioteca Virtual da Saúde. Foram selecionados estudos publicados de 2000 a 2011. Resultados: após avaliação dos títulos, foram selecionados 24 artigos para leitura dos resumos; 17 artigos foram excluídos por não abordar a temática em questão, o que resultou na inclusão de 7 artigos na amostra. Conclusão: os cuidados de enfermagem e da equipe multiprofissional ao paciente em uso do oxímetro de pulso com pletismógrafo podem associar parâmetros não invasivos para a avaliação hemodinâmica da perfusão na prática clínica cotidiana.

Objetivo: Identificar y analizar la literatura científica acerca de oxímetro de pulso con pletismógrafo para evaluar la perfusión hemodinámica. Método: esta es una revisión integradora de la literatura, llevada a cabo en enero y febrero de 2012 en la Biblioteca Virtual en Salud. Se seleccionaron estudios publicados de 2000 a 2011. Resultados: después de evaluar los títulos, se seleccionaron 24 artículos para la lectura de los resúmenes; 17 artículos fueron excluidos por no abordar el tema en cuestión, lo que resultó en la inclusión de 7 artículos en la muestra. Conclusión: los cuidados de enfermería y del equipo multidisciplinario al paciente que utiliza oxímetro de pulso con pletismógrafo pueden asociar parámetros no invasivos para la evaluación hemodinámica de la perfusión en la práctica clínica cotidiana.

Implementation of critical congenital heart disease screening in Minnesota.

OBJECTIVE: To assess the level of preparedness and resources needed in Minnesota for the implementation of newborn screening for critical congenital heart diseases (CCHDs). METHODS: A cross sectional survey of all birth centers in Minnesota was performed to assess the capacity to deliver care essential for the CCHD screening program. Compliance with the screening algorithm, nursing workload, and cost were assessed by using a pilot program implemented in 6 normal newborn nurseries. RESULTS: Ninety-one of 99 eligible centers participated in the survey and 90 reported the ability to screen newborns in accordance with recommendations. Only 22 centers, with 63% of births, had access to echocardiography and routinely stocked prostaglandins for neonatal use. Our pilot study screened 7549 newborns with 6 failed screens and 1 CCHD diagnosis. Two of the failed screens were due to misinterpretation of the algorithm, 1 failed screen was not reported, and 4 failed screens were not recognized. Repeated screens were required for 115 newborns, with 29% of retesting due to misinterpretation of the algorithm. The mean nursing time required was 5.5 minutes, and the cost was $5.10 per screen. CONCLUSIONS: In Minnesota, two-thirds of newborns are born in centers with resources for initial diagnosis and management of CCHD. Implementation of a pilot screening program demonstrated minimal increase in nursing workload, but identified problems with interpretation of the algorithm and data reporting. This pilot project suggests the need for simplification of the algorithm, additional training of health care providers, and development of a centralized reporting mechanism.

ASPMN survey--nurses' practice patterns related to monitoring and preventing respiratory depression.

The American Society for Pain Management Nursing convened a taskforce to develop guidelines on monitoring for opioid-induced sedation and respiratory depression. Part of the guideline development was the determination of nursing practice patterns related to monitoring and preventing respiratory depression during the administration of analgesics for pain. One hundred and forty-seven responses were received from 90 unique institutions across the United States. Monitoring adults with intermittent pulse oximetry while using intravenous patient-controlled analgesia (IV PCA) was 58%. Adults were monitored with continuous pulse oximetry by 25% of respondents. When using continuous epidural analgesia, 56% of patients were monitored intermittently, and 40% were monitored continuously. The use of end tidal CO2 (ETCO2) monitoring was much less, with 2.2% patients on epidural therapy, and 1.5% of institutions were using ETCO2 with IV PCA. The survey also included the location of the alarm, respiratory parameters for alarms, changes in procedures reported by institutions, and definitions of high-risk patients.

Implementing pulse oximetry in the school health office: the time is now.

Pulse oximetry can be a useful tool for professional school nurses who daily assess students with a variety of health issues and injuries. Pulse oximeters are now smaller and more affordable and, therefore, an option for school districts to purchase. Before implementing this new tool into their practice, school nurses must have an understanding of how pulse oximeters work and how they measure the oxygen saturation of arterial hemoglobin. A review of the literature will guide a nurse in developing clinical guidelines for practice and facilitating competency in using a pulse oximeter with the ultimate goal of improving student health assessments.

A nurse-driven algorithm to screen for congenital heart defects in asymptomatic newborns.

Routine pulse oximetry screening (POS) performed on asymptomatic newborns after 24 hours of life, but before hospital discharge, may detect critical congenital heart defects (cCHD) when used as an adjunct to physical examination. Timely identification of this small percentage of newborns prompts early intervention and improves outcomes. New-generation, highly accurate pulse oximeters provide a simple, low-risk, low-cost tool to improve detection of potentially lethal cardiac lesions. The purpose of this study was to develop, implement, and test the utility of a nurse-driven algorithm that would support and serve as a guide for detection of cCHD in asymptomatic newborns using POS prior to discharge home from the hospital. Results showed that this collaborative protocol was easily implemented in a community hospital. The universal algorithm enhances POS and clinical examination to identify asymptomatic infants with undiagnosed cCHD prior to discharge from the hospital.

[Measuring pulse oximetry at the patient's bedside]. / Mesurer l'oxymétrie de pouls au lit du malade.

Pulse oximetry, or oxygen saturation, reflects the quantity of oxygen fixed to the haemoglobin. It is commonly measured in a non invasive way, with the aid of a digital sensor oximeter. The results can be distorted by a number of parameters, it is therefore necessary to eliminate the risk of errors and to check the results against clinical data.