You are on page 1of 2

What is a Pulse Oximeter?

A pulse oximeter is a device used to perform the diagnostic procedure known as Pulse Oximetry.
Pulse Oximetry is a way to measure the percentage of haemoglobin (Hb) that is saturated with oxygen.
This oxygen saturation (SpO2) is a measure of how much oxygen the blood is carrying as a percentage of the
maximum it could carry and is sometimes referred to colloquially as the "sats" reading.
It is a non-invasive technique which means there’s no need to actually take a sample of blood to perform the
procedure, so there’s NO FUSS and NO PAIN.
Pulse Oximeters vary tremendously in design, size appearance and price but fundamentally all perform the same
basic function of displaying the oxygen saturation and pulse rate measurements. The manner in which this
information is needed to be presented, analysed, stored or relayed for assessment or intervention will dictate the
type of pulse oximeter you require. The choice can be daunting but we hope that you will find all the answers you
need within these web pages. If you need any guidance, please feel free to contact us by phone or e-mail.

What does a Pulse Oximeter tell you?


A Pulse Oximeter can detect hypoxia before a patient shows signs of becoming cyanotic (bluish discoloration of the
skin and mucous membranes due to not enough oxygen in the blood).
For this reason, Pulse Oximeters may be used in all manner of situations but are of particular value for monitoring
a patient’s oxygenation and pulse rates when undergoing surgical procedure, particularly those involving
anaesthesia or conscious sedation.
They are also widely used after surgery during the recovery phase and in the ITU arena, Pulse Oximetry is used
extensively on mechanically ventilated patients, as it can frequently detect problems with oxygenation before
they are noticed clinically, as well as a valuable guide for weaning patients off ventilation and helping to assess
the adequacy of a patient's oxygen therapy. This continuing assessment process has been instrumental in the
introduction of Pulse Oximeter usage within the community and homecare environment.
Furthermore, Pulse Oximeters are routinely used on the wards and in casualty departments for immediate
assessment, triage and ongoing patient care.
However, using a pulse oximeter should ALWAYS be in conjunction with your own clinical judgement, whether an
experienced, fully trained Medical Practitioner or a private individual checking your own “sats”.
In this day and age, many of us take technology for granted and it is tempting to put our faith in it 100%. We can’t
think of any completely fault-free device available in the 21st Century; after all, if nothing broke down, many
domestic appliance technicians, garage mechanics and computer helpdesk staff would all be out of a job!
Also, in some situations a pulse oximeter reading may not be accurate, including but not limited to the following:
1. Reduced peripheral pulsatile blood flow. Perhaps caused by peripheral vasoconstriction (hypovolaemia,
severe hypotension, cold, cardiac failure, some cardiac arrhythmias) or peripheral vascular disease. These
result in an inadequate signal for analysis.
2. Venous congestion of an arm or leg may affect readings, as can a badly positioned sensor. If the readings
are lower than expected it is always worth repositioning the probe. In general, however, if the pulse
strength indicator or bargraph is good, then the reading should be accurate.
3. Bright overhead lights, such as in an operating theatre, may interfere with the sensors ability to read the
red or infrared light correctly and cause the oximeter to be inaccurate.
4. Shivering or significant, repeated movement of the sensor may cause difficulties in picking up an
adequate signal.
5. Pulse oximetry struggles to distinguish between different forms of haemoglobin, such as carbo-
xyhaemoglobin (haemoglobin combined with carbon monoxide) and methaemoglobin, and can prevent the
oximeter working accurately.
6. Nail varnish may cause falsely low readings with most pulse oximeters, especially those coloured blue or
black. However the units are not affected by jaundice, dark skin or anaemia.
For these reasons, we must stress that any medical monitoring or measurement device should really be used to
confirm what you suspect to be the case. If you think your own or a patient’s oxygen saturation level is lower than
“normal”, the oximeter should be used to confirm this.

But what is a "normal" reading?


But what is "normal"? Firstly, we would ask "normal for whom"?
A fit, healthy person should have an oxygen saturation level between 95% & 99%. Results lower than this, and
especially below 90% may be caused by problems including lung diseases, such as COPD, breathing difficulties,
cigarette smoking or circulatory problems such as excessive bleeding or blood vessel problems.
Bear in mind that pretty much all oximeters on the market, whether "budget" or "top-of-the-range", have an
accuracy usually quoted by the manufacturers as + or - 2%. In our own independent testing, it is extremely rare for
them to differ by more than 1% but it is important to remember this and not become too focused on a single "cut-
off" percentage figure.
This could be further misleading as oxygen saturation measurements may also differ slightly from one part of the
body to another. The fingers and toes are the most popular sites for taking pulse oximetry readings. However,
these are at the extremes of the body furthest from the heart and lungs and may give readings 1 or 2 % lower than
the earlobe or forehead, which are that much more central. It is important to remember this when comparing
measurements obtained using different oximeters in different locations.
Perhaps the question should be "How do the readings compare with what is normally expected for the person being
tested?" This approach uses the pulse oximeter as a means of checking for any changes over a period of time. This
could be anything from spot-checking a few minutes every day to look at long term trends or non-stop monitoring
for hour after hour to detect immediately for sudden deterioration in blood oxygenation.

How does a Pulse Oximeter work


The measurements are obtained by simply shining two wavelengths of light (1 is a visible red beam, the other an
invisible infrared beam) at the fingertip. By measuring how much light has been absorbed by the oxygen in the
blood, an oxygen saturation or “sats” reading is established and displayed as a percentage of the maximum
amount of oxygen the blood could carry.
The oximeter looks for minute changes in absorption as the blood is pumped past the measurement site by the
beating of the heart, so selecting somewhere with strong pulse is important. A weak pulse or restricted blood flow
may limit the oximeter’s ability to obtain accurate measurements.
In the same way, introducing false pulses of blood, such as extreme movement of the measurement site, could
equally affect the oximeter’s performance. It is important to understand what the oximeter is doing to ensure you
get the best out of your oximeter.

You might also like