When assessing a patient with dark skin for oxygenation it is best to assess

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Dark skin decreases the accuracy of pulse oximeters at low oxygen saturation: the effects of oximeter probe type and gender
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Dark skin decreases the accuracy of pulse oximeters at low oxygen saturation: the effects of oximeter probe type and gender

John R Feiner et al. Anesth Analg. 2007 Dec.

Abstract

Introduction: Pulse oximetry may overestimate arterial oxyhemoglobin saturation (Sao2) at low Sao2 levels in individuals with darkly pigmented skin, but other factors, such as gender and oximeter probe type, remain less studied.

Methods: We studied the relationship between skin pigment and oximeter accuracy in 36 subjects (19 males, 17 females) of a range of skin tones. Clip-on type sensors and adhesive/disposable finger probes for the Masimo Radical, Nellcor N-595, and Nonin 9700 were studied. Semisupine subjects breathed air-nitrogen-CO2 mixtures via a mouthpiece to rapidly achieve 2- to 3-min stable plateaus of Sao2. Comparisons of Sao2 measured by pulse oximetry (Spo2) with Sao2 (by Radiometer OSM-3) were used in a multivariate model to assess the source of errors.

Results: The mean bias (Spo2 - Sao2) for the 70%-80% saturation range was 2.61% for the Masimo Radical with clip-on sensor, -1.58% for the Radical with disposable sensor, 2.59% for the Nellcor clip, 3.6% for the Nellcor disposable, -0.60% for the Nonin clip, and 2.43% for the Nonin disposable. Dark skin increased bias at low Sao2; greater bias was seen with adhesive/disposable sensors than with the clip-on types. Up to 10% differences in saturation estimates were found among different instruments in dark-skinned subjects at low Sao2.

Conclusions: Multivariate analysis indicated that Sao2 level, sensor type, skin color, and gender were predictive of errors in Spo2 estimates at low Sao2 levels. The data suggest that clinically important bias should be considered when monitoring patients with saturations below 80%, especially those with darkly pigmented skin; but further study is needed to confirm these observations in the relevant populations.

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References

1. Adler JN, Hughes LA, Vivilecchia R, Camargo CA Jr. Effect of skin pigmentation on pulse oximetry accuracy in the emergency department. Acad Emerg Med 1998;5:965–70
1. Bothma PA, Joynt GM, Lipman J, Hon H, Mathala B, Scribante J, Kromberg J. Accuracy of pulse oximetry in pigmented patients. S Afr Med J 1996;86:594–6
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1. Severinghaus JW, Koh SO. Effect of anemia on pulse oximeter accuracy at low saturation. J Clin Monit 1990;6:85–8

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Where should the nurse assess a dark

In dark-skinned people, cyanosis may be easier to see in the mucous membranes (lips, gums, around the eyes) and nails. People with cyanosis do not normally have anemia (low blood count).

What signs of cyanosis does a nurse inspect for in a dark

But in dark-skinned patients, cyanosis may present as gray or whitish (not bluish) skin around the mouth, and the conjunctivae may appear gray or bluish.

When assessing a dark

Terms in this set (66) answer a,b,d ........ In dark-skinned people, cyanosis can be best assessed by examining the palms of the hands, soles of the feet, tongue, conjunctivae, or the buccal mucosa. In light-skinned people, the nailbeds and the area around the lips can be used.

What type of light should you avoid when conducting a skin assessment?

An indirect light source may not help in the visualization of inside of the body cavity. The nurse should inspect each area for size, shape, color, symmetry, position, and abnormality to detect any changes. Checking for side-to-side symmetry ensures that the inspected area has no deviation.