Pulse oximetry may be performed by a respiratory therapist (RT) or registered nurse (RN), licensed practical nurse (LPN) or unlicensed assistant personnel (UAP) per healthcare prescriber’s orders or as an acute emergent evaluation of child’s status without a direct healthcare prescriber’s order (Chart 94-1). When pulse oximetry is completed by a UAP, and variance from baseline or deviance from previous measurement is reported to the licensed caregiver.
All children receiving continuous pulse oximetry are assessed by an RT or RN every 2 hours or more frequently as indicated by the child’s status. Assessment should include respiratory status, pulse oximetry reading, skin integrity at the site, circulation distal to the sensor site, and knowledge of the child’s baseline diagnosis and status.
All pulse oximetry intermittent checks are performed and evaluated by an RT or an RN.
The child receives pulse oximetry monitoring as per healthcare prescriber’s order, which specifies frequency (continuous or intermittent check). Orders may be written as guidelines to adjust oxygen administration based on pulse oximetry saturation level.
Continuous pulse oximetry monitoring will be employed on all children receiving sedation for diagnostic and therapeutic procedures, or when direct observation of the child may be difficult.
Acceptable ranges for the child’s saturation levels are prescribed by the healthcare provider or per unit protocol. Parameters are based on the child’s underlying clinical condition and past medical history. Normal saturation levels for healthy children are considered to range between 97% and 99% at sea level. Ranges for neonates and young infants are 93% to 100%.
Routine pulse oximetry is performed on asymptomatic newborns after 24 hours of life, but before hospital discharge to assist in the detection of critical congenital heart disease (CCHD).
All children on pulse oximetry will have appropriately sized oxygen-delivery devices readily available for emergency access by healthcare personnel (e.g., bag-mask, oxygen tubing, oxygen source).
Children at high risk for adverse events, apnea/bradycardic spells, cyanotic spells, or respiratory distress/failure
Children having an asthmatic exacerbation
Children hospitalized with pneumonia
Children with acute bronchiolitis (intermittent monitoring preferred)
During neonatal resuscitation
A screening tool for early detection of asymptomatic newborns with critical congenital heart disease (CCHD)
Children receiving supplemental oxygen administration
Children in the intensive care unit
Children receiving mechanical ventilation
Children undergoing sedation for procedural and therapeutic procedures
Children receiving patient-controlled anesthesia
Children with seizures
High-risk postoperative patients
Postextubation for 48 hours or longer as indicated by the healthcare prescriber
Transportation of all mechanically ventilated children
Children being weaned from oxygen therapy or mechanical ventilation
Identify the child and explain the purpose of the equipment to the child and family on the family caregivers’ role in assisting maintenance of proper placement of the sensor.
Assess pertinent history, focusing on events that may have precipitated respiratory distress. Also assess for recent intravascular use of lipids or dyes, which could interfere with the accuracy of pulse oximetry readings.
Assess physical findings, including respiratory rate and effort, use of accessory muscles, shape of chest, position of child (i.e., sitting, standing), breath sounds, perfusion, vital signs, and presence and degree of restlessness and anxiety. Also check for an elevated bilirubin level, if available, which may falsely lower oxygen saturation readings.
Ensure that the child’s fingernail beds are clean and free of nail polish to decrease interference in providing accurate oximetry readings (Chart 94-1).
Performing Pulse Oximetry