Archives


The Reliability of Clinical Indicators of Oxygenation

A literature review

Julie Considine
School of Nursing, Faculty of Health and Behavioural Sciences, Deakin University, Epping NSW

Abstract

Despite oxygen being one of the most frequently administered substances in the hospital environment, there is little empirical data regarding its use. Review of the literature regarding the clinical assessment of hypoxia and hypoxaemia reveals inconsistency in the definition of terms and raises questions as to the reliability of the clinical indicators currently used to assess the need for supplemental oxygen.

Assessment of the need for supplemental oxygen and continued re-evaluation of the patient's oxygen requirements is a nursing responsibility. Physical assessment, in combination with pulse oximetry, is the most common method used by nurses to assess oxygenation status. This paper critically appraises the literature to examine the reliability of clinical indicators of oxygenation used by nurses in acute care settings.

Keywords

oxygen, nursing assessment, oximetry, hypoxia, hypoxaemia


Toggle references

References

Ahrens T (1993) Changing perspectives in the assessment of oxygenation. Critical Care Nurse 13(4), 78-83.

Albin RJ, Criner GJ, Thomas S and Abou-Jaoude S (1992) Pattern of non-ICU inpatient supplemental oxygen utilization in a university hospital. Chest 102(6), 1672-1675.

Bateman NT and Leach RM (1998) ABC of oxygen. Acute oxygen therapy. British Medical Journal 317(7161), 798-801.

Bell C (1995) Is this what the doctor ordered? Accuracy of oxygen therapy prescribed and delivered in hospital. Professional Nurse 10(5), 297-300.

Bota GW and Rowe BH (1995) Continuous monitoring of oxygen saturation in prehospital patients with severe illness: the problem of unrecognized hypoxemia. Journal of Emergency Medicine 13(3), 305-311.

Brown LH (1990) Pulmonary oxygen toxicity. Focus on Critical Care 17(1), 68-75.

Brown LH, Manring EA, Kornegay HB and Prasad NH (1996) Can prehospital personnel detect hypoxemia without the aid of pulse oximeters? American Journal of Emergency Medicine 14(1), 43-44.

Buist M, Gould T, Hagley S and Webb R (2000) An analysis of excess mortality not predicted to occur by APACHE III in an Australian level III intensive care unit. Anaesthesia and intensive care 28(2), 171-177.

Calianno C, Clifford DW and Titano K (1995) Oxygen therapy: giving your patient breathing room. Nursing 25(12), 33-39.

Camarata SJ, Weil MH, Hanashiro PK and Shubin H (1971) Cardiac arrest in the critically ill. I: A study of predisposing causes in 132 patients. Circulation 44(4), 688-695.

Crocco JA and Francis PB (1991) Acute oxygen therapy - when and how? Patient Care 25(14), 69-72.

Crocco JA, Francis PB and Lefrak SS (1987) When the patient needs oxygen - stat. Patient Care May, 83-89.

Doyle DJ (1992) The rational use of medical oxygen. Emergency Medicine 24(12), 214-229.

English I and Brown C (1994) Oxygen mask or nasal catheter? An analysis. Nursing Standard 8(Mar), 23-29.

Epstein D and Henning R (1993) Oxygen transport variables in the identification and treatment of tissue hypoxia. Heart and Lung 22(4), 328-345.

Fisher AB (1980) Oxygen therapy. Side effects and toxicity. American Review of Respiratory Diseases 122(5 Pt 2), 61-69.

Gaull ES (1993) Are you overlooking O2? Emergency Medical Services 22(6), 31-36, 78.

Goodfellow LM (1997) Application of pulse oximetry and the oxyhemoglobin dissociation curve in respiratory management. Critical Care Nursing Quarterly 20(2), 22-27.

Grap MJ (1998) Protocols for practice: applying research at the bedside -- pulse oximetry. Critical Care Nurse 18(1), 94-99.

Grap MJ, Glass C and Constantino S (1994) Accurate assessment of ventilation and oxygenation. MEDSURG Nursing 3(6), 435-444.

Jensen LA, Onyskiw JE and Prasad NG (1998) Meta-analysis of arterial oxygen saturation monitoring by pulse oximetry in adults. Heart and Lung 27(6), 387-408.

Kester L and Stoller JK (1992) Ordering respiratory care services for hospitalized patients: practices of overuse and underuse. Cleve-Clin-J-Med 59(6), 581-585.

Lewis D, Barnes TA, Beattie K, Beytas LJR, O'Donohue WJ Jr, Perlman N, Ritz RH and Salyer J (1991) Oxygen therapy in the acute care hospital... AARC clinical practice guideline. Respiratory Care 36(12), 1410-1413.

McCance K and Huether S (2002) Pathophysiology. The Biological Basis for Disease in Adults and Children (4th ed). St Louis, Mosby Inc.

McGloin H, Adam SK and Singer M (1999) Unexpected deaths and referrals to intensive care of patients on general wards. Are some cases potentially avoidable? Journal of the Royal College of Physicians, London 33(3), 255-259.

Melnykovich P (1994) Developing self-teaching packages for the emergency department staff. Journal of Emergency Nursing 20(3), 239-240.

Murphy R, Mackway-Jones K, Sammy I, Driscoll P, Gray A, O'Driscoll R, O'Reilly J, Niven R, Bentley A, Brear G and Kishen R (2001) Emergency oxygen therapy for the breathless patient. Guidelines prepared by North West Oxygen Group. Emergency Medicine Journal 18, 421-423.

Nerlich S (1997) Clinical update. Oxygen therapy. Australian Nursing Journal 5(3), insert 4p.

Nunn J (1993) Nunn's Applied Respiratory Physiology (4th edn ed). Oxford, Butterworth-Heinemann.

Oh TE and Duncan AW (1988) Oxygen therapy. Medical Journal of Australia 149(3), 141-146.

Palmer PM (1993) Prescribing supplemental oxygen. Nurse Practitioner Forum 4(1), 49-52.

Porth C (1990) Pathophysiology: Concepts of Altered Health States (3rd edn ed). Philadelphia, JB Lippincott Company.

Pruitt W and Jacobs M (2003) Basics of oxygen therapy. Nursing 33(10), 43-45.

Rutherford KA (1989b) Principles and application of oximetry. Critical Care Nursing Clinics of North America 1(4), 649-657.

Ryerson GG and Block ER (1983) Safe use of oxygen therapy: a physiologic approach... part 2. Respiratory Therapy 13(2), 25-30.

Shannon TM and Celli B (1991) Oxygen therapy. Emergency Medicine 23(21), 63-70.

Shrake K, Blonshine S, Brown R, Crapo R, Martineau R, Ruppell G and Wanger J (1991) Pulse oximetry... AARC clinical practice guideline. Respiratory Care 36(12), 1406-1409.

Small D, Duha A, Wieskopf B, Dajczman E, Laporta D, Kreisman H, Wolkove N and Frank H (1992) Uses and misuses of oxygen in hospitalised patients. American Journal of Medicine 92(6), 591-595.

Smart D and Mark P (1992) Oxygen therapy in emergency medicine (part 1): physiology and oxygen delivery systems. Emergency Medicine 4(3), 163-178.

Smoker JM, Hess DR, Frey Zeiler VL, Tangen MI and Rexrode WO (1986) A protocol to assess oxygen therapy. Respiratory Care 31(1), 35-39.

Snider GL and Rinaldo JE (1980) Oxygen therapy, oxygen therapy in medical patients hospitalized outside of the intensive care unit. American Review of Respiratory Diseases 122(5 Pt 2), 29-36.

Suljaga Pechtel K, Goldberg E, Strickon P, Berger M and Skovron ML (1984) Cardiopulmonary resuscitation in a hospitalized population: prospective study of factors associated with outcome. Resuscitation 12(2), 77-95.

Tinits P (1983) Oxygen therapy and oxygen toxicity. Annals of Emergency Medicine 12(5), 321-328.

Tittle M and Flynn MB (1997) Applied nursing research. Correlation of pulse oximetry and co-oximetry. DCCN: Dimensions of Critical Care Nursing 16(2), 88-95. http://www.cinahl.com/jrnls/DCCN/dccn1602.htm.

Tortora G and Anagnostakos N (1987) Principles of Anatomy and Physiology (5th edn ed). New York, Harper and Row Publishers.

Treacher DF and Leach RM (1998) Oxygen transport-1. Basic principles. British Medical Journal 317(7168), 1302-1326.

Wesmiller SW and Hoffman LA (1989) Interpreting your patient's oxygenation status. Orthopaedic Nursing 8(6), 56-60.

Yam LYC (1992) Clinical applications of oxygen therapy. Hong Kong Nursing Journal 60, 11-15.



Web Feed

Latest Articles

Call for Papers

Advances in Contemporary Nursing and Midwifery History in Australasia
Volume 30/2
Deadline: Closed


Advances in Contemporary Nurse Education
Volume 32/1-2
Deadline: 30th Sep 2008


Advances in Contemporary Nursing and Gender
Volume 33/2
Deadline: 15th Dec 2008


Advances in Contemporary Mental Health Nursing – Second Edition
Volume 34/1
Deadline: 2nd Mar 2009


Advances in Contemporary Modeling of Clinical Nursing Care
Volume 35/1
Deadline: 30th Apr 2009


Special Issues

Advances in Contemporary Modeling of Clinical Nursing Care
Vol 35/1, 1st Apr 2010


Advances in Contemporary Mental Health Nursing – Second Edition
Vol 34/1, 1st Dec 2009


Advances in Contemporary Nursing and Gender
Vol 33/2, 1st Oct 2009


Advances in Contemporary Nurse Education
Vol 32/1-2, 1st Apr 2009


Advances in Contemporary Nursing and Midwifery History in Australasia
Vol 30/2, 1st Oct 2008


Advances in Contemporary Transcultural Nursing (2nd edn)
Vol 28/1-2, 15th Apr 2008


Advances in Contemporary Palliative and Supportive Care
Vol 27/1, 1st Dec 2007


Advances in Contemporary Aged Care: Retirement to End of Life
Vol 26/2, 1st Oct 2007


Advances in Contemporary General Practice Nursing: Role of the Practice Nurse
Vol 26/1, 1st Aug 2007


Advances in Contemporary Nurse Recruitment and Retention
Vol 24/2, 1st Apr 2007


Advances in Contemporary Community and Family Health Care
Vol 23/2, 1st Jan 2007


Advances in Contemporary Indigenous Health Care
Vol 22/2, 1st Sep 2006


Advances in Contemporary Nursing & Interpersonal Violence
Vol 21/2, 1st May 2006


Advances in Contemporary Mental Health Nursing
Vol 21/1, 1st Mar 2006


Advances in Contemporary Child and Family Care
Vol 18/1-2, 1st Jan 2005


Advances in Contemporary Transcultural Nursing
Vol 15/3, 1st Oct 2003


Sponsored Links

Selected Articles

Enhancing access to and retention in the Bachelor of Nursing


Have you got an attitude problem? Caring for illicit drug-using patients


National Palliative care education and training needs analysis


Voices from the margins Part 1


The Need for Leadership


Reviews of Advances in Contemporary Nursing and Interpersonal Violence


Website Design by Arrowsmith Websites Maleny Sunshine Coast