Accuracy of pulse oximeter readings from probe placement on newborn wrist and ankle

Abstract

Objective: To compare the accuracy of pulse oximetry oxygen saturation (SpO 2 ) measured on the wrist compared with the ipsilateral palm, and SpO 2 measured on the ankle compared with the ipsilateral sole.Study Design: In this prospective observational study, neonates admitted to the neonatal intensive care unit were enrolled. We recorded SpO 2 (Masimo Radical-7 pulse oximeter) detected at the palm and ipsilateral wrist initially, then at 30 s, and at 1 min, and we repeated the same procedure over the sole and ipsilateral ankle. We recorded the time to obtain the SpO 2 readings from all these sites. Regression analysis was performed to determine the relationship between paired SpO 2 measurements. The mean difference (bias) and standard deviation of the paired SpO 2 differences (precision) were calculated (Bland-Altman plots).Result: A total of 150 patients (birth weight 2381±1020 g, gestational age 34.3 ± 4.3 weeks, median postnatal age 3.5 days (25th-75th percentile 1-16 days)) were enrolled. There was a good correlation between SpO 2 measured at the palm versus the wrist (r ¼ 0.95, P<0.001 (right); r ¼ 0.97, P< 0.001 (left)) and between SpO 2 measured at the sole versus the ankle (r ¼ 0.92, P<0.001 (right); r ¼ 0.91, P<0.001 (left)). There was also a good agreement between paired SpO 2 measurements from these sites. The bias and precision for SpO 2 at the right palm and right wrist was 0.08 ± 0.94% and for the left palm and left wrist 0.22 ± 0.87%. Similarly, the bias and precision for SpO 2 at the right sole and right ankle was À0.03 ± 0.93% and for the left sole and left ankle was À0.01 ± 0.93%. Conclusion:Our results show that the wrist and ankle can be used as alternative sites to measure SpO 2 in newborn infants in place of the routinely used palm or sole.

Reliability of Pulse Oximetry during Progressive Hypoxia, Cardiopulmonary Resuscitation, and Recovery in a Piglet Model of Neonatal Hypoxic Cardiac Arrest

“…However, later postnatally at a median age 3.5 days (1-16 days), there was no significant difference between SpO 2 at the right wrist and the foot [23]. In our study, SpO 2 measured at the thigh showed a trend towards larger overestimation than SpO 2 measured at the right wrist; however, from a statistical point of view, significantly greater bias was only at two time points.…”

Pulse Oximetry

“…This finding is consistent with Phattraprayoon et al, 21 who found that there was a good correlation between SpO 2 measured at the palm versus the wrist and between SpO 2 measured at the sole versus the ankle. This finding is consistent with Phattraprayoon et al, 21 who found that there was a good correlation between SpO 2 measured at the palm versus the wrist and between SpO 2 measured at the sole versus the ankle.…”

“…17,18 Among the advantages of pulse oximetry are ease of application, self-calibration, rapid response time, and minimal risk of skin burns. 21 Among these artifacts are poor perfusion at the site of measurement, skin pigmentation, motion artifact, probe positioning, venous pulsation, and presence of abnormal hemoglobin molecules. 20 Interpretation of pulse oximetry readings depends different factors that may artifactually influence the results.…”

“…21 Although various studies are available for pulse oximeter measurement from the palms and the soles, there are few published data available for the wrist and the ankle. Furthermore, in sick preterm infants the choice of probe site might be difficult as have intravenous lines for fluid infusion, or heparin locks for medication infusions on the dorsum of the hands and the feet.…”

Determination of saturation, heart rate, and respiratory rate at forearm using a Nellcor™ forehead SpO2-saturation sensor

“…Saturation and HR have been measured successfully at wrist and palmar region in infants using sensors based on light absorbance. [10,11] However, in adults the skin thickness is too great to reach accurate measurements. One previous study described the performance of saturation sensors on the wrist area [10], but to our knowledge Nellcor forehead sensor has not been tested on distal forearm.…”