Oxygen Saturation Pulse Ox

  1. Perform hand hygiene.
  2. Position patient comfortably. If finger is chosen as monitoring site, support lower arm. Instruct patient to breathe normally.
  3. If finger is to be used, remove fingernail polish with acetone or polish remover from digit to be assessed.
  4. Attach sensor to monitoring site. Instruct patient that clip-on probe will feel like a clothespin on the finger but will not hurt.
  5. Once sensor is in place, turn on oximeter by activating power. Observe pulse waveform/intensity display and audible beep. Correlate oximeter pulse rate with patient's radial pulse.
  6. Inform patient that oximeter alarm will sound if sensor falls off or if patient moves sensor.
  7. Leave sensor in place until oximeter readout reaches constant value and pulse display reaches full strength during each cardiac cycle. Read SpO2 on digital display.
  8. Discuss findings with patient as needed, and record findings.
  9. If continuous SpO2 monitoring is planned, verify SpO2 alarm limits, which are preset by the manufacturer at a low of 85% and a high of 100%. Limits for SpO2 and pulse rate should be determined as indicated by patient's condition. Verify that alarms are on. Assess skin integrity under sensor every 2 hours. Relocate sensor at least every 4 hours and more frequently if skin integrity is altered or tissue perfusion compromised.
  10. Remove probe, and turn oximeter power off. Store sensor in appropriate location.
  11. Assist patient in returning to comfortable position.
  12. Perform hand hygiene.
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