Pulse Oximetry in the Home

• By Christopher Morrissey, Duane Ridenour
• Sep 01, 2004

Pulse oximeters are used to monitor a variety of patient conditions in home health care. Numerous studies have shown the effectiveness of home pulse oximetry monitoring for patients with obstructive sleep apnea (OSA), chronic obstructive pulmonary disease (COPD) and even patients with more severe conditions including neonates with hypoplastic left heart syndrome (HLHS).

As pulse oximetry monitoring has become more commonplace outside of the acute care setting, the technology has evolved to meet the specific needs of home care use. The following is a list of recommendations for choosing a pulse oximeter to meet the needs of your home care customers.

1. Look for accuracy and reliability. The two most important words in patient monitoring are accuracy and reliability. Whether it is used for monitoring in an intensive care unit, or within the comfort of a patient's bedroom, a pulse oximeter must provide accurate, reliable results. As the technology has evolved over the years, advanced digital signal processing algorithms have been developed to ensure the oxygen saturation readings (SpO2) posted by the pulse oximeter are equivalent to the patient's blood gas values (SaO2). The best way to ensure quality pulse oximetry monitoring for your customers is to choose a pulse oximeter from a well-established manufacturer with a long track record of delivering clinically proven technology.
2. Overcome challenges. Patient motion and low perfusion are two of the most challenging conditions for pulse oximetry monitoring. When choosing a small, portable pulse oximeter designed for home care, look for one that features artifact-reducing algorithms and advanced digital signal processing. This technology enables the pulse oximeter to provide accurate, reliable results under challenging patient conditions. New developments in intelligent pulse oximetry sensor design offer enhanced monitoring capabilities for patients with low perfusion.
3. Know the variety of sensors on the market. Conventional pulse oximetry sensors are usually placed on a patient's digits—fingers and toes. For patients suffering from poor perfusion (low blood flow), conventional digit sensors can fail to provide accurate SpO2 readings and are sometimes incapable of providing any readings at all. Picture yourself outside on a cold day—the first parts of the body to grow cold and stiff are the fingers, toes, nose, and ears. These are the first parts of the body to lose perfusion. New intelligent pulse oximetry sensor technology has been developed to monitor SpO2 from the body's core—the forehead. Studies have shown that new intelligent forehead pulse oximetry sensors detect changes in SpO2 significantly faster than digit sensors for patients with poor pulse perfusion, compared with conventional digit and ear sensors.
4. Choose the right size. Pulse oximetry monitoring in the home requires technology that is small, lightweight and easy to maneuver. New handheld or compact bedside pulse oximeters are often equipped with the same features found in larger, more complex, acute-care pulse oximetry monitors. Some are compatible with the new generation of intelligent pulse oximetry sensors recently introduced to the market. The size and flexibility of these pulse oximeters make them ideal for sleep and exercise studies in the home.
5. Maneuver the learning curve. Since home pulse oximetry monitoring is often performed by a patient, or a patient's family member, it is important that the technology be easy to learn and easy to use. Helpful features include a bright and easy to read numeric display, audible and visible alarms, and an intuitive user-interface that enables the user to quickly understand and operate the pulse oximeter. Advanced alarm management features can help patients and caregivers take control of nuisance alarms triggered by mild and brief desaturation events.
6. Look for long battery life. Pulse oximetry monitoring in the home requires a pulse oximeter with a long battery life. This ensures uninterrupted access to important oxygen saturation values during home monitoring sessions. A long battery life also enables patients to travel with their pulse oximeters to and from doctors' offices.
7. Look for recording capabilities. Pulse oximeter recording capabilities are essential for documentation purposes of patients on overnight oxygen and patients undergoing sleep screening. Choose a pulse oximeter that is equipped with analog or digital output since this is required for integration into sleep lab diagnostic systems or downloading to trend analysis software.
8. Check for 24-hour trend memory. 24-hour trend memory enhances patient management and enables overnight studies in the home. This feature is essential for monitoring patients with obstructive sleep apnea (OSA) and other respiratory sleep disorders. Recent studies have detailed the many benefits of using pulse oximetry in home sleep studies. Pulse oximetry can help determine the severity of sleep-disordered breathing and is an accurate, economical means to detect sleep apnea.
9. Ensure your fiscal health. One of the greatest benefits of pulse oximetry monitoring in the home is its cost-effectiveness. Pulse oximetry has been proposed as a home screening test for sleep disordered breathing due to its low cost and accuracy. It is important to choose a pulse oximeter that is reliable, accurate and incorporates a variety of features to meet your customers' wide range of clinical needs, while providing a cost-effective means for home pulse oximetry monitoring.
   A pulse oximeter also should be durable. Home care usage can be particularly tough on pulse oximeters. They are often used during travel and are occasionally dropped or banged around. Find a pulse oximetry manufacturer whose products have successfully stood the test of time. A durable pulse oximeter will reduce the cost of ownership in the long run.
   
10. Explore new frontiers. As the technology continues to evolve, new features are developed to enhance pulse oximetry monitoring in home health care. Pulse oximetry that incorporates intelligence into both the monitor and the sensor, offers clinicians a level of performance and flexibility never before possible.

This article originally appeared in the September 2004 issue of HME Business.