Temperature compensate range is from +1.5℃ to -1.5℃,Both T1 channel
and T2 channel compensate windows as follows:
CHAPTER 17:
SpO 2 MONITORING
OVERVIEW
SpO2 measurement is based on two principles: Firstly, oxyhemoglobin and deoxyhemoglobin differ in their absorption of red and infrared light. Secondly, the volume of arterial blood in tissue changes during the pulse. A monitor determines SpO2 (oxygen saturation) by passing red and infrared light into an arteriolar bed and measuring changes in light absorption during the pulsatile cycle. Red and infrared low-voltage light-emitting diodes (LEDs) in the sensor serve as light sources, a photodiode serves as the photo detector.
Because oxyhemoglobin and deoxyhemoglobin differ in light absorption, the amount of red and infrared light absorbed by blood is related to hemoglobin oxygen saturation. To identify the oxygen saturation of arterial hemoglobin, the monitor uses the pulsatile nature of arterial flow. During systole, a new pulse of arterial blood enters the vascular bed, and the blood volume and light absorption increase. During diastole, the blood volume and light absorption reach their lowest point. The monitor bases its SpO2 measurements on the difference between maximum and minimum absorption (i.e., measurements at systole and diastole). By doing so, it focuses on light absorption by pulsatile arterial blood, eliminating the effects of nonpulsatile absorbers such as tissue, bone, and venous blood.
The monitor determines SpO2 and pulse rate by passing two wavelengths of light, one red and one infrared, through body tissue to a photodetector. During measurement, the signal strength resulting from each light source depends on the color and thickness of the body tissue, the probe placement,
105 RED LED AND INFRARED LED
the intensity of the light sources, and the absorption of the arterial and venous blood (including the time varying effects of the pulse) in the body tissue (Refer to Figure 17-1).
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The monitor processes these signals, separating the time invariant parameters (tissue thickness, skin color, light intensity, and venous blood) from the time variant parameters (arterial volume and SpO2) to identify the pulse rate and calculate oxygen saturation. Oxygen saturation calculations can be performed because oxygen saturated blood predictably absorbs less red light than oxygen depleted blood.
The monitor can be used under low perfusion with same accuracy as normal condition.
The monitor measures the patient’s SpO2 and displays:
■ Pulse rate (PR) value in the parameters area.
■ PLETH waveform and pulse intensity (perfusion indicator) in the channels area.
■ Oxygen saturation (SpO2 %) value in the parameters area.
As the following figure shows, the perfusion indicator (prorate with the pulse intensity) is located on the left side of the PLETH waveform while the measured SpO2 value on the right. The SpO2 value is displayed by percentage. Besides, the SpO2 label in the parameters area allows you to access the SpO2 menu.
The PR value is displayed in the parameters area only if:
1. SpO2 is selected in the HR Source menu; or
2. Auto is selected in the HR Source menu and the received ECG signal is bad.
PRECAUTIONS
WARNING
● The monitor can overestimate the SpO2 value in the presence of Hb-CO, Met-Hb or dye Perfusion indicator PLETH waveform SpO2 alarm limit SpO2 labelSpO2 value
MONITOR
DETECTOR
PERFUSION INDICATOR
FIGURE 17-1 SpO2 THETORY OF OPERATION
dilution chemicals.
● ES (Electrosurgery) equipment wire and SpO2 cable must not be tangled up. Carefully route patient cabling to reduce the possibility of patient entanglement or strangulation.
● Do not use this instrument and the sensors during magnetic resonance imaging (MRI).
Induced current could potentially cause burns. The monitor may affect the MRI image, and the MRI unit may affect the accuracy of the oximetry measurements.
● Do not put the SpO2 sensor on the limb with arterial catheter or venous syringe.
● Do not perform SpO2 monitoring and NIBP measurements on the same arm simultaneously. Obstruction of blood flow during NIBP measurements may adversely affect the reading of the SpO2 value.
● Before performing the testing, check the sensor cable. After unplugging the SpO2 sensor cable from the socket, the system shall display the flashing prompt information "Sensor Off" above the PLETH waveform.
● Prolonged and continuous monitoring may increase the risk of burns at the site of the sensor. It is especially important to check the sensor placement, and ensure proper attachment on neonates and patients of poor perfusion or skin sensitive to light. Check the sensor location every 2–3 hours and move to another location if the skin deteriorates.
More frequent examinations may be required for different patients.
NOTE
● Place the SpO2 sensor cable at the backside of the patient hand. Make sure the fingernail is just opposite to the light emitted from the sensor.
MONITORING PROCEDURE
Follow the procedure as below:
1. Power on the monitor.
2. Attach the sensor to the proper site on the patient.
3. Plug the connector of the sensor extension cable into the SpO2 connector on monitor.
The process of SpO2 plethysmogram measurement is generally the same. But the SpO2 sensor selection and placement depend on the patient type. When choosing a site for a sensor, refer to the directions for that sensor.
MEASUREMENT LIMITATIONS
If the accuracy of any measurement does not seem reasonable, first check the patient’s vital signs by an alternate method. Then check the instrument for proper function. Inaccurate measurements may be caused by:
■ Incorrect sensor application or use;
■ Placement of a sensor on the same extremity with a blood pressure cuff, arterial catheter, or intravascular line;
■ Exposure to excessive illumination, such as surgical lamps (especially ones with a xenon light source), bilirubin lamps, fluorescent lights, infrared heating lamps, or direct sunlight (exposure to excessive illumination can be
corrected by covering the sensor with a dark material);
■ Excessive patient motion;
■ Venous pulsations;
■ Intravascular dyes such as indocyanine green or methylene blue;
■ Defibrillation;
Other physiological conditions or medical procedures that may interfere with the monitor’s measurements include significant levels of dysfunctional hemoglobin, low perfusion, and dark pigment.
Loss of pulse signal can occur in the following situations:
■ The sensor is too tight;
■ A blood pressure cuff is inflated on the same extremity as the one with a SpO2 sensor attached;
■ There is arterial occlusion proximal to the sensor.
Select an appropriate sensor, apply it as directed, and observe all warnings and cautions presented in the directions for use accompanying the sensor. Clean and remove any substances such as nail polish from the application site.
Periodically check to ensure that the sensor remains properly positioned on the patient.
If patient movement presents a problem, try one or more of the following remedies to correct the problem.
■ Verify that the sensor is properly and securely applied.
■ Move the sensor to a less active site.