Evaluating the Accuracy of Off-Label Placement of Pulse Oximetry Sensors in Comparison to On-Label Placement in the Adult Cardiac Intensive Care Unit Patient Population.

BACKGROUND: Continuous pulse oximetry (Spo2) is a commonly utilized tool to obtain an indirect, noninvasive measurement of hemoglobin oxygen saturation. Difficulty obtaining measurement with Spo2 sensors can lead nurses to try off-label sites until they find placement that provides a signal. Currently, there is limited evidence to support this application. PURPOSE: The purpose of this study was to evaluate the accuracy of off-label placement of pulse oximetry sensors in comparison to on-label placement in adult cardiac intensive care patients. METHODS: Data were collected on 24 participants. At the time of a medically necessary arterial blood gas laboratory draws, 4 Spo2 measurements were gathered from an on-label finger sensor, an off-label finger sensor, an on-label ear sensor, and an off-label ear sensor. Results were analyzed using 4 Pearson correlation coefficients, Bland-Altman plots, and 2 linear mixed-effect models. RESULTS: Our study found that while both our on-label finger and off-label finger pulse oximetry sensor overestimated when compared to the arterial hemoglobin saturation (gold standard), there was greater overestimation found with the off-label placement. Though there was not a significant difference observed between the ear probe on the nose and the gold standard, figures examining off-label ear probe and gold standard measures show that, in lower ranges of oxygen saturation, the off-site probe substantially overestimates true oxygen saturation, while in higher ranges of oxygen saturation, the off-site ear probe underestimates true oxygen saturation. CONCLUSIONS: No changes should be made to the current practice of using pulse oximetry sensor placement.

Improving Patient Safety by Increasing Staff Knowledge of Evidence-Based Pulse Oximetry Practices.

BACKGROUND: Pulse oximetry is commonly used in critical care settings to monitor oxygenation status and assist with decision-making regarding oxygen therapy. Although it is imperative that nurses follow manufacturer guidelines, off-label use is common and could affect patient safety. OBJECTIVE: To increase staff members' knowledge and reduce the frequency of off-label pulse oximeter placement in the critical care setting. METHODS: A preintervention audit was completed to assess the frequency of off-label use, and a preintervention survey was given to staff. Health care staff in the critical care units received an educational intervention. A postintervention survey for health care staff and a postintervention audit were completed to assess outcomes. With the support of hospital management, 90 ear probes were purchased for critical care settings to address supply barriers to the use of appropriate pulse oximetry sensors. RESULTS: In the preintervention audit (508 observations), a finger probe was used off label on the ear in 77 patients (15.2%). In the postintervention audit (365 observations), a finger probe was used on the ear in only 3 patients (0.8%). CONCLUSION: Providing a brief educational session and making ear pulse oximeter probes readily available in the critical care setting increased compliance with manufacturer guidelines and helped ensure safe pulse oximetry monitoring.