Oximetry

Definition
Is the measurement of blood hemoglobin saturation using spectrophotometry. a procedure in which the oxygen saturation level (percent of oxygen in the blood) is determined.

OXYGEN SATURATION (SPO2)

Oxygen saturation is defined as the ratio of oxyhemoglobin to the total concentration of hemoglobin present in the blood (ie Oxyhemoglobin + reduced hemoglobin). Hemoglobin is a iron-containing protein bound to red blood cells and makes up nearly all the oxygen presence (there is a minute amount dissolved in the plasma). Hemoglobin is responsible for transporting oxygen from lungs to other parts of the body, where the oxygen can be used by other cells. Oxyhemoglobin (HbO2) is the bright red hemoglobin that is a combination of hemoglobin and oxygen from the lungs.

2 types of oximetry 1. Hemoximetry 2. Pulse Oximetry

Hemoximetry (co-oximeter)
Is a laboratory analytical procedure requiring invasive sampling of arterial blood. is the monitoring of hemoglobin and oxygen saturation, especially during procedures such as cardiac catheterization. 3 wavelengths (hemoglobin Hb, oxyhemoglobin HbO2, carboxyhemoblobin HbCo, methemoglobin metHb

Problem causing measurements errors with hemoximeters:

Incomplete hemolysis Sickle cell anemia Presence of vascular dyes High lipid level (e.g from parenteral nutrition) Presence of high levels of fetal hemoglobin Elevated bilirubin Dirty cuvette chamber

Pulse oximetry
A noninvasive a procedure in which the oxygen saturation level (percent of oxygen in the blood), is determined by placing a probe on a patients finger, toe, or earlobe. It is an inexpensive and portable non invasive monitoring device that provides estimates of arterial blood oxyhemoglobin saturation levels. Typically it uses two LEDs (light-emitting diodes) generating red and infrared lights through a translucent part of the body. Bone, tissure, pigmentation, and venous vessels normally absorb a constant amount of light over time.

Factors affecting the accuracy or precision of pulse oximeters Presence of HbCO Presence of high levels of metHb Presence of fetal hemoglobin Anemia Vascular dyes dark skin pigmentation Nail polish(especially black) Ambient light Poor perfusion MRI

Capnometry and capnograph

Capnometry- is the measurement of CO2 in respiratory gases. A capnometer is a device that measures the CO2. Capnography- is the graphic display of CO2 levels as they change during breathing Although it is applied to any patient, its primary clinical use is for monitoring during either anesthesia or mechanical ventilation.
A capnometer is an instrument for monitoring breathing rate and adequacy of ventilation. It attaches to the endotracheal tube and measure the carbon dioxide content in the inspired and expired air. It uses an infrared light to measure the amount of light absorbed by carbon dioxide molecules during breathing. It detects changes in carbon dioxide concentrations in patients who are hemodynamically stable, but not critically ill.

2 different methods to sample the respiratory gases

1. Mainstream sampling 2. Sidestream sampling Mainstream analyzer places an in-line analysis chamber between the patients airway and the ventilator circuit.

Sidestream analyzer uses a sampling tube to continually pump a small volume of gas from the ventilator circuit into the analysis chamber within the device.

Advantages and disadvantage of mainstream and sidestream capnometers

Advantages and disadvantages Mainstream sensor at patient airway fast response short lag-time no sample flow to reduce tidal volume
Secretions and humidity can block sensor window Sensor requires heating to prevent condensation Requires frequent calibration Bulky sensor at patient airway Does not measure N2O Difficult to use with non intubated patient Reusable adapters require cleaning and sterilization

Sidestream
no bulky sensors or heaters at airway ability to measure N2O disposable sample line ability to used in non intubated patients
Secretion block sample tubing Trap required to remove water from the sample Frequent calibration required Slow response to CO2 changes Lag in between CO2 change and measurement Sample flow may decrease tidal volume

Advantages

Disadvantages

Example of capnograph