Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [144], C).
2. 2.Show
   Wash and dry hands and/or use an alcohol‐based handrub.
   To prevent cross‐infection (NHS England and NHSI [124], C).
3. 3.Show
   Ask the patient to remain as still as possible during the procedure and ensure that a constant temperature is maintained in the patient's environment.
   Artefacts from movement, such as shivering, may adversely affect the accuracy of the measurement (Blows [21], E).
4. 4.Show
   While talking to the patient, assess their respiratory status, including their ability to talk in full sentences, the colour of their skin, whether they appear to be in distress or not, and whether they are alert and orientated.
   This initial assessment can give important information about the patient's respiratory function and any potential problems (Bickley [18], E).
5. 5.Show
   Determine the site to be used to perform pulse oximetry. The site should have a good blood supply, determined by checking it is warm, with a proximal pulse and brisk capillary refill.
   To ensure the sensor will receive strong enough signals to produce a result by being located in a well‐perfused area (Adam et al. [2], E).
6. 6.Show
   Ensure that the area to be used is clean and free from dirt, and that the sensor is clean. If using the patient's fingers, ensure that all nail polish and any artificial nails have been removed.
   Dirt, nail polish and artificial nails may interfere with the transmission of the light signals, causing inaccurate results (Peate and Wild [157], E).
7. 7.Show
   Select the correct pulse oximeter sensor for the site that is most appropriate for your patient, depending on their circulation and the manufacturer's instructions.
   The correct sensor should be used for each site to ensure that the contact is good, that excessive pressure is not applied and that an accurate reading from the chosen site is obtained (Appadu and Lin [6], E; Johnson et al. [89], E).

Procedure

1. 8.Show
   Position the sensor securely but do not fix it with tape (unless specifically recommended by the manufacturer) (Action figure 14.34). If the pulse oximetry is to be continuous then the site should be changed at least every 4 hours.
   If the probe is too tight, it may impede blood flow, leading to inaccurate results and the potential for pressure ulcer formation on the site, particularly in patients with compromised skin integrity (Appadu and Lin [6], E).
2. 9.Show
   Turn the pulse oximeter on and, if using it continuously, set the alarms on the device depending on the patient's condition and within locally agreed limits.
   To ensure that the pulse oximeter is ready to use (Adam et al. [2], E).
3. 10.Show
   Ask the patient not to talk while you palpate their pulse. Check that the pulse reading on the device corresponds with the patient's actual pulse.
   Any large deviations in pulse may show that the device is not measuring accurately or is being affected by movement (Blows [21], E).
4. 11.Show
   Assess respiration by keeping your fingers on the patient's wrist once the pulse rate has been obtained. Count their respiratory rate for a full minute – one breath is equal to one inspiration and expiration and is obtained by watching the abdomen or chest wall move in and out (Peate and Wild [157]). Assess the regularity and depth of breathing and the shape and expansion of the chest, and look for any use of accessory muscles. If possible, do not tell the patient you are counting their breathing.
   To determine the patient's respiration rate, depth and rhythm. E

   The patient should ideally not be aware that their breathing is being counted as this may produce inaccurate results (Brown and Cadogan [31], E).

Post‐procedure

1. 12.Show
   Document the results clearly, including the time and date of the reading.
   Records must be kept of all assessments made and care provided (NMC [144], C).
2. 13.Show
   Clean the pulse oximeter according to the manufacturer's recommendations and local policy.
   The pulse oximeter may become colonized and be a source of infection to another patient (NICE [127], E).
3. 14.Show
   Wash and dry hands and/or use an alcohol‐based handrub.
   To prevent cross‐infection (NHS England and NHSI [124], C).