Pulse oximetry in Pediatrics

Pulse oximetry is a noninvasive method allowing the monitoring of patient’s oxygen saturation.

Indications

• High risk for adverse events (respiratory failure/distress)
• Receiving supplemental ox/gen administration
• Children who are on patient-controlled
• anesthesia
• During post extubation period for at least 48 hours
• Children under sedation for procedure or therapeutic purposes
• Children with seizures, postoperative patients
• During transportation of critical/high-risk children

Equipment Needed

• Pulse oximeter monitor
• Probe
• Plaster
• Bedside oxygen delivery system

Sites for Placing Sensor

• Neonates: Sole of the foot below toes, palm of the hand, wrist, forehead
• Infants: Great toe, ball of foot, palm, wrist
• Child: Index finger, forehead
• The oximeter responds only to pulsations, such as those in pulsating capillaries of the area tested.

Preparation

• Identify the child and explain the procedure to the child and his/her parents as appropriate.
• Assess history, focusing on events that may have precipitated respiratory distress.
• Do respiratory assessment that includes observation of respiratory rate, use of accessory muscles, and auscultation for abnormal breath sounds.
• Ensure that child’s fingernail beds are clean and free of nail polish to reduce interference in providing accurate reading.
• Gather necessary equipment and check for working condition.

Procedure

• Perform hand hygiene.
• Select appropriate sensor and attach the cable to the pulse oximeter unit.
• Attach the sensor to the selected site with the light source on one side of the tissue pad and the sensor on the other, facing each other, for optimal performance; keep the sensor site at the level of heart.
• Tape sensor in place, loosely but securely.
• Cover sensor site with opaque material.
• Turn pulse oximeter on and verify if the child’s apical pulse corresponds to the pulse rate shown on the monitor. If machine has a visual waveform display or other bar graph indicator to indicate that an accurate signal is received, ensure that the reading is present at the highest level.
•  Alarm limits should be determined in conjunction with the healthcare prescriber and take into consideration child’s age, underlying condition, and past history of normal parameters. Set alarm limits as by manufacture’s instruction. Set sensitivity by high-rate button and low rate button simultaneously. Turn the wheel while depressing buttons to set the desired sensitivity.
• Set low saturation limit and low pulse alarm by simultaneously pushing each button and turning the wheel to the predetermined numeric value.
• Determine with the doctor when oxygen is administered, or flow rate is increased or decreased.
• Document the procedure with date and time and perform hand hygiene.

Limitations

• The pulse oximeter measures solely oxygenation, not ventilation.
• It is not a substitute for blood gases checked in laboratory, because it gives no indication of base deficit, CO, levels, blood pH, or COs concentration.
• Erroneously low reading may be caused by hypoperfusion of the extremity being used for monitoring; incorrect sensor application, highly calloused skin; or movement especially during hypoperfusion.
• Hb has a higher affinity to carbon monoxide than 0, and a high reading may occur despite the patient actually being hypoxemic. (In carbon monoxide poisoning, this inaccuracy may delay the recognition of hypoxemia.)
• Cyanide poisoning gives a high reading, because it reduces oxygen extraction from arterial blood.
• Methemoglobinemia characteristically causes pulse oximetry reading in the mid-80s.

REFERENCES

1. Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
2. Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
3. Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
4. Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
5. Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/

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