Determining the Effects of Nail Polish in Pulse Oximetry Readings - @ JEMS.com


Determining the Effects of Nail Polish in Pulse Oximetry Readings

Street Science


 
 

Keith Wesley | | Wednesday, June 27, 2007


Review of: Hinkelbein J, Genzwuerker HV, Sogl R, et al: "Effect of nail polish on oxygen saturation determined by pulse oximetry in critically ill patients." Resuscitation. 72(1):82-91, 2007.

The Science

Pulse oximetry has been around for many years, and when they first came out, we were all taught to remove the patient's nail polish to improve the accuracy of the reading. The authors of this study undertook an experiment to determine whether or not the presence of nail polish affects the reading.

They applied nine shades of nail polish to the fingers of patients in the critical care unit who also had arterial lines established. They then compared the oxygen saturation level with that obtained from direct analysis of arterial blood samples.

They found that black, purple, and dark blue resulted in the greatest deviation from the arterial measurement, but it was less than 2%, which is within the margin of error for the device as stated by the manufacturer. If the probe was rotated 90 degrees and applied side-ways on the finger, the effect of the darker colors was eliminated.

When there was a discrepancy between the pulse oximeter and measured levels, the pulse oximeter tended to underestimate the oxygen saturation.

Their conclusion was that the presence of nail polish did not significantly affect the reading, and that routine removal of nail polish is not necessary.

The Street

It is amazing that there are so many things we do in EMS that we simply have not applied any type of scientific scrutiny to. We have all had the unpleasant experience of opening nail polish removal packets to get rid of every bit of polish, only to find the reading is normal.

According to these researchers, this practice is not necessary. However, there are some limitations to this study that needed to be examined. All of their patients were white, normotensive and not hypoxic. They only tested one model of oximeter, the Seimans Nellcor device that emits two wavelengths of light. What, if any, effect these variables would have on the result are not known and should prompt additional research.

Before reading this study, I had never heard of rotating the probe to get a better reading. Those that have done this tell me that sometimes they don't get a good pulse wave indication with normal positioning, but that if the probe is rotated, the pulse wave improves and provides a reading.




Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Patient Management, Research

What's Your Take? Comment Now ...

Featured Careers & Jobs in EMS

Get JEMS in Your Inbox

 

Fire EMS Blogs


Blogger Browser

Today's Featured Posts

 

EMS Airway Clinic

Innovation & Advancement

This is the seventh year of the EMS 10 Innovators in EMS program, jointly sponsored by Physio-Control and JEMS.
More >

Multimedia Thumb

D.C. Mayor Adds Ambulances to Peak Demand Period

10 additional ambulances will be on the streets from 11 a.m. to 11 p.m.
Watch It >


Multimedia Thumb

Utah Commission Privatizes Ambulance Service

Mayors in Iron County loose management fight.
Watch It >


Multimedia Thumb

Ambulance Delay Raises Concerns over Response Times

Officers give up after waiting 20 minutes for an ambulance.
Watch It >


Multimedia Thumb

Memphis Struggles to Keep Firefighters and Paramedics

Cost of training rises as the turnover rate of personnel increases.
Watch It >


Multimedia Thumb

Terror Attack in Tunisia

19 people killed outside of a museum.
More >


Multimedia Thumb

Patient Carry during Snowstorm

Firefighters, medics and officers lend a hand in Halifax.
More >