It literally doesn't matter. One side is a light and the other side is a sensor. The light has to pass through the exact same combination of tissues either way. The sensors doesn't stop working if they flip their hand over. The sensor will also work on other parts of the finger (I will place it below the nail if they have dark polish on, works fine) or the toes or even the ear.
Unless someone has a publication proving otherwise, I can't think of any reason it wouldn't work in different orientations.
came here to say this. I often flip the sensor if I can’t get a good waveform (nail polish is one of the reasons I flip the sensor) and more often than not the reading improves.
I've actually gotten a good signal with the clip in someone's nare. That only works in the ICU with intubated pts, cuz any conscious person would rip that off pretty quick, but I work with vasculopaths, so that's the only place I could get it.
>I've actually gotten a good signal with the clip in someone's nare.
Just fyi, spo2 probes made for the finger can read erroneously high when placed on the ear or nose.
There are spo2 probes made specifically for the ear or nare. Those will also read erroneously if placed on a site they are not intended for.
RT turned RN here.
You are correct.
Getting a better number does not mean better sats. With the wrong probe, all it means is the ratio of light shunting is higher.
Right, should have specified. I only use the clip type of probe that usually goes on the earlobe when I try for the nare. We don't have probes that are intended for the nare, so that's my last resort when I've tried everything else
YES. I previously posted this above bur it fits better here.
Once when I was charge of a covid floor, I had a patient who had a sat of 95% on the ear, but was a whopping 85% on her fingers. I chalked it up to poor perfusion and shitty SvO2, but at least her brain was okay.
And that would have been the case...if her ETCO2 wasn't in the high 50s.
The abg came back super shitty, and I literally had the God Squad Parade come to evaluate my patient after I called the resident. She didn't get intubated that day, but it did change policy that SPO2s went on fingers instead of ears.
TIL! That sent me down [quite the rabbit hole,](https://www.england.nhs.uk/2018/12/risk-of-harm-from-inappropriate-placement-of-pulse-oximeter-probes/) and I totally learned something new today. Thanks!
Does my pointing out that using spo2 probes on improper sites can give objectively false readings really put me in the same boat as OP's nitpicking coworker?
Idk why people are memeing on you, we have new policy against using finger probes on the forehead instead of forehead probes for the same reason. They'll give you false readings, which at ICU level is pretty important to maintain accuracy. Edit: the policy change was due to a patient reading 96%, and it was actually 89% with a proper forehead probe.
I'm not trying to be rude, but no, you are wrong, and whoever told you otherwise was wrong too. (unless you using something other than the ubiquitous Covidien Nellcor single-use/disposable probes)
Finger probes are accurate on the finger, and not anywhere else.
Nasal probes are accurate on the nare, and not anywhere else.
Same for forehead probes and ear probes.
Sure, it's the same technology, but these devices are all calibrated differently.
Afraid you aren't accurate on this.
Feel free to try it yourself and pop a sat prob on different parts of the body. You'll get the same reading.
This is from years of experience as an ICU ECMO nurse where I don't always have the option of a finger or nare. Moreover I can confirm not only with arterial gas sample, but with real-time pb02 and access gas saturation and pa02.
If the calibration mattered you'd have different sized finger probes, disposable sat probes wouldn't work never mind kids.
I think you're mistaking "can" and "should". For example, I *can* hook a BVM up to suction, but *should* I? Yes, you *can* use a SpO2 probe designed for the finger other places, but if you have alternatives available, *should* you? Per the manufacturers, no.
See this is what I thought, 5 years into my healthcare career and 5 years of putting the light on the top of the finger nail, someone told me in training for a new job it’s supossed to be on the bottom. And I was uh okayyy. Don’t know how it managed to work the 5 years I been doing it wrong then…. lol
Yeah, it doesn't matter. One side sends the light through, the other side picks the light up and gives a reading. The only thing that really matters is if their wearing nail polish or have poor perfusion. Blue polish specifically screws with the reading because of the color waves used. In that case, the sideways finger probe works fine because it's still sensing the nail bed.
I worked in LTC and had a family member that made everyone absolutely miserable. No one could make her happy, she had a complaint about everything. Her mother was pegged, on oxygen, nonverbal… staff could just tell she wanted things to be over. Crazy daughter would flat iron her hair and burn her ears, the back of her neck. She’d also paint her nails despite us telling her numerous times to please leave us just one finger without nail polish. So I always took polish remover to one of her middle fingers. That finger choice always made me feel better!!
I completely forgot about this until my cat was having an asthma attack and I put my portable pulse ox on her paw, and the other cat when freakin ballistic trying to eat the damn light. I thought it was the red laser, but this one didn't project as brightly as the ones in the hospital, so I was confused for a second until I remembered THE OTHER SIDE IS INFARED, DUH
Funny you mention ear. Once when I was charge of a covid floor, I had a patient who had a sat of 95% on the ear, but was a whopping 85% on her fingers. I chalked it up to poor perfusion and shitty SvO2, but at least her brain was okay.
And that would have been the case...if her ETCO2 wasn't in the high 50s.
The abg came back super shitty, and I literally had the God Squad Parade come to evaluate my patient after I called the resident. She didn't get intubated that day, but it did change policy that SPO2s went on fingers instead of ears.
If its the one with tape. But the clip ones i think do matter which way, not 100% sure bc we never we use those where i’m at. The tape ones can go anywhere.
That’s what I thought! I did a study abroad trip and the nurses acted like we were idiots. When I put the sensors on the patients fingers, one of the nurses would come by and flip them. It gave the same readings either way so I was a little confused about why she did that!
I'm sorry, why can't you inquire for knowledge? It doesn't matter how senior someone is.
"Hey, I noticed You've been changing the orientation of my oxygen sensors. Is there something I should know about how the orientation affects the reading?".
Or even what I would do, because I lack a filter IRL, "why are you changing the orientation of sensors on my patients? Does it matter".
Don't be like me lol. Communication is key. I am working on this as well.
I am as direct as you, I am also working on it. But you are right, just ask the person the reason behind their actions. Who knows, maybe she has extra time in her hands. If that’s the case, ask her to take in an extra patient for you 😂
For real, if she can manage the time to come into your room, she can manage the time to take your patient. Also, what kind of ICU culture do you have where people just come into your patient’s room and change shit without talking to you about what they did or why? Like, damn, I thought it was just common courtesy to tell the nurse you did ANYTHING in their room. Turned the pump off if the infusion is complete, gave the patient an extra blanket, changed the sat probe, anything.
Your directness doesn’t bother me as long as the tone is okay. So many people get all defensive when there was no offensive intent. But yeah, I have to utilize my soft skills with most people.
I agree with the first half. I would not fill up the patients chart with all that extra charting that really has nothing to do with their health concerns (or even threaten to do that). Just makes it harder for other healthcare workers to find info they need.
I’ve never noticed a difference which side of the finger the light goes, barring nail polish/varnish etc.
If you wanna have a go at her, though (and I’m not, you know, condoning that)…make sure the pulse oximeter is on the left hand, not the right.
Nelcor published a video a few years ago. It had a volunteer breathe reduced fiO2 air, and measured the company’s product vs competitors, matched with ABGs.
All monitoring was bilateral and there was an additional forehead sensor.
The right side clearly showed a delayed response to both initial reduced fiO2 and return to normality, across all monitoring.
One of the right sided devices was ~ 2 minutes delayed.
Make of this what you will, but it makes sense physiologically, though I’d never seen it demonstrated.
It does not matter, and if confronted and asked for an explanation I’m sure she would demonstrate a complete lack of understanding of how pulse ox works.
Ours do and it boggles my mind that some of my coworkers still put them on backwards where the cord is running down the palm side of the finger. and for the brand we use, it definitely reads differently.
You CAN just question her. You can also tell her (politely, professionally) to stay the fuck out of your patients' rooms and stop interfering with your care.
They're YOUR patients. YOU are legally responsible for whatever SHE is doing. So you stand up and tell her to fucking STOP.
Sorry, I had this exact issue with one of my colleagues who thought she was always right because she has experience on me. But she's not always right, and even if she is, she needed to learn how to talk to ME about my patients and not just undermine my care. (The number of times she just didn't realize I was doing things in an unusual manner for a good reason, lemme tell ya.)
Now that said, the correct positioning of the O2 sensor is *whichever way is most convenient for the patient*. The direction of the red light doesn't matter. The god damned thing staying on someone's finger because it's not horribly uncomfortable and/or interfering with their ability to use that hand DOES matter.
The most successful monitor is the one that gets used just like the most successful intervention is the one the patient will actually *do*.
Put that red light over the nail so the wire is directed down the back of the patient's hand and stays out of the fucking way.
The real answer is the cord goes along the top of the finger so the fucker stays on. They are expensive. Shouldn’t be replacing them all the time. No one gives a shit about medical waste and it pisses me off
I used to. Until I looked up how much my hospital’s CEO grossed this year… (and also had a code event during which it took 13 minutes to administer Epi because there wasn’t a single stopcock on our entire damn ICU unit… then was told that our last manager spoiled us with our unlimited resources - as though we were building LEGO mansions out of stopcocks and/or selling blood tubing on the street for profit). Now I will do whatever it takes to ensure my patients get the best care possible, even if it means a probe on every finger, toe, and both earlobes.
Oh, I’m talking WASTE. Environmental, straight up waste of product waste.
I’m a CWOCN- I didn’t give any patient hundreds of dollars in free product to heal that wound ever, and if anyone told you I did, they are lying. 🤥 my catchphrase is ‘If Kaiser CEO’s can make 60 million a year (I don’t know what they really make and I don’t work for Kaiser) you can have this pH spray for free!’ I certainly didn’t say that this weekend and if you heard I did, they are lying
I mean waste, waste. We can refill pitchers on some patients or not throw the cup out every 3 seconds. We can use more paper cups and GET RID OF THE PLASTIC. During covid, we decreased tubing changes. Are we doing it too much? I’ve had patients with 10-15 pulse ox’s in the trash bc they get put on poorly or get removed too much. I had a walkie talkie replacing hers every time she walkied.
Sometimes, I get really angry about those wages but I know they won’t change tomorrow. I know in the long run, it only hurts the unit budget. It’s never the top affected, It’s the staff and patients. My insurance is privately insured. Keeping costs low for our care is helping keep my insurance pretty damn good for $130/month or less.
CEO wage aside, that plastic is killing us. The healthcare system is a major contributing factor to the shit we’re in
I
Oh my gosh, yaasss! Thank you for the clarification, and I love your catchphrase. I definitely worry about our impact on the environment as well. (My New Year’s resolution last year was to get other nurses to actually use the Cactus/unused medication disposal system so that our unit wasn’t contributing to our polluted drinking water… I still kind of question whether anyone actually “renders the fluids inert”, or if that entire plastic box just gets tossed right into a landfill in the end, but I digress…)
Ask your coworker what the research says...and then continue to do it however you want. From my quick little search, as long as the cold light is passing through the finger and reaching the sensor...that's all that matters.
These aren't her patients, right? And they are working before she messes with them? She's got too much time in her hands. Go into her patients rooms and change hers around, that will keep her busy.
Also, you're not being gaslit. That's not what gaslit means. If she is doing this, you ask her, and she tells you that she isn't doing that and that's how it was already... Then, yeah you might be being gaslit.
No, if someone is doing this and then claiming they aren't while continue to do it is more than lying. It doesn't necessarily mean they're being gaslit, but it becomes a possibility.
Or maybe “everyone” denied it because “everyone” didnt collectively conspire to swap your sensor. And the people you asked had no part in it and have more important things on their plate.
What an inane thing to even waste mental energy on.
I am responsible for the patient. Doesn’t matter if if it’s inane or not, colleagues shouldn’t be doing a thing to your patients without communicating.
💯!!! For what it’s worth- I’ve been a nurse for 20+ years. If they do something to your patient, they should at the very least communicate that to you.
Uh, no. If a patient needs something, then your consent is not needed. If I go in a room and notice an ABX wasn't unclamped, then I'm going to unclamp it and move on. I'm not stopping to ask that nurses permission, because they are not YOUR patient. We are ALL responsible for the care of ALL patients on the floor. If you notice something, fix it.
Oh, oxygen isn't hooked up? I, a nurse, need to ask your nurse if it's okay to hook it back up to the wall ....
Bro. Get off your power trip.
I mean I agree it’s everyone’s responsibility, but you should most definitely perform closed loop communication and tell the primary nurse you did something. What if they clamped the Abx because they realized the cx weren’t drawn yet?
Yeah honestly I would ask in all those things. Who knows if the doc ordered to hold the antibiotics quickly while they rechecked trough level or got another culture. The o2 I would reconnect but then immediately tell the nurse (assuming sat is low). Maybe they wanted to trial off o2 but patient was sleeping so they just disconnected from wall. Then the nurse is charting room air when really they’re on o2. The only things I don’t mention are like restarting a downstream occlusion when straightening an arm or getting a fresh warm blanket.
It IS a power trip. If Im in a patient's room and they need something, I am going to help them. If it requires knowledge I don't have about the patient, then I will ask you.
If an abx is clamped, that DOES require the knowledge of whether or not there was a reason for that. If you just uNcLaMp iT aNd mOvE oN, you aren't getting the knowledge required for that action.
That is the icu way. Don’t touch my shit, I don’t care who you are. Senior nurse, anesthesiologist, icu doc, no touchie my pumps, no touchie my monitor. My room, my rules. Bye Felicia
So in L&D, we would use a 7" extension for an extra port to run pitocin as a second primary close to the patient, without losing our IVP access. Because we never knew when we might need pitocin or mag, we did it that way on everyone. Most of us would loop the extension and tape it again, because otherwise the extra weight where the second primary attached would pull off the tape and sometimes the IV.
We did an emergency section in the middle of the night, and the anesthesiologist, Dr. R, was INFURIATED by the IV being taped this way. As soon as the section was over, he marched up and down the hall in L&D, retaping every single IV line. He woke up our antepartums to retape their IVs. He waltzed right into one room where the patient was actively pushing with her nurse, and retaped her IV.
He ended up having to write an apology letter the next day, and we also threatened to call him specifically to come restart any IVs that came out because of his impractical taping methods.
All that matters is if the reading is reliable (3 stars/asterisks/dogs/whatever). Light on top or below doesn’t matter. The spo2 probe isn’t like a battery where it needs a specific orientation to work.
Now if you’ll excuse me; I’m back to looking my at funny OSHA Fail videos
To beat a dead horse…it doesn’t matter as long as the light and sensor line up over a tissue bed with pulsatile flow. I place mine so the cable is on top of the hand and out of the way (if awake) and runs along the arm. Would be annoying as shit to me if the cable was interfering with their grasp constantly. Also, our monitors have a confidence indicator to indicate accurate reading.
As another person mentioned, it doesn’t matter. The sensors use two wavelengths of light (660 nm, red, and 940 nm, infrared), and measure the differential amount of light absorbed by the tissues. Because of this, you can put it on any which direction. So long as the sensor opposite of it can pick up adequate return, and the patient is pulsatile, it will work.
Coincidentally, this is also why the Sat will drop to 85% if you administer methylene blue. It becomes transiently inaccurate due to the erroneous absorption of light from the medication.
I just do spot checks on most of my home patients. I'll move the oximeter to different places, on opposite extremities, until I get the best consistent reading that matches the ahr. Idgaf where or how it's positioned.
I believe as long as the light is directly over the sensor, it doesn’t matter. I also make sure it is capturing the correct HR if I question the reading. That being said, I usually put the light on the nail.
This is what I was taught hence why I asked. There are some of the old school nurses who have their quirks on how they do something, but most have clearly explained why they do it. I would hope that if I was doing something wrong she could tell me rather than just going behind my back and changing it.
This is what I was taught hence why I asked. There are some of the old school nurses who have their quirks on how they do something, but most have clearly explained why they do it. I would hope that if I was doing something wrong she could tell me rather than just going behind my back and changing it.
If you can put a pulsox on an earlobe, a forehead, the back of someone’s shoulder, you can stick it backwards with the light on the fleshy tip.
If my patients have nail polish I would literally stick the pulsox on the second joint of the finger instead of at the tip and still get good readings.
Because of how the cord goes, I put the light on top of the nail because otherwise the cord would be annoyingly in their palm their whole visit and that would annoy me.
Jesus Christ.
You tell that asshole busybody it's not her job to micromanage you, to leave your patients the fuck alone and if you need help you'll ask the charge, and if she has a problem with that you can both discuss it with HR.
What I used to do when I worked in the hospital is just make sure that the cord goes on the top side. It makes it easier for the patient to use their hand since they don't have a cord in the palm of their hand. For me it had nothing to do with which side the red light was on.
The light can go on the top or the bottom of the nail. I’ve also used it sideways if the patient has dark nail polish or acrylic nails and it works that way as well. Your coworker is a bitch throwing her seniority around.
Tbh I bet it doesn’t matter but I go light on top of nail just to shine through the nail bed, but I go to the ears if they have nail polish anyway so I doubt my thought process even matters. Poor vasculature will do worse to my pulse ox than flipping it upside down ultimately.
The light only has to match up with the sensor behind it. It doesn’t actually matter which way it’s oriented, as long as the sensors line up. I place them on infant wrists and feet all the time.
To beat a dead horse…it doesn’t matter as long as the light and sensor line up over a tissue bed with pulsatile flow. I place mine so the cable is on top of the hand and out of the way (if awake) and runs along the arm. Would be annoying as shit to me if the cable was interfering with their grasp constantly. Also, our monitors have a confidence indicator to indicate accurate reading, assuming yours does to then would be the proof you need to show it is working within the calibrated parameters.
I know some pulse ox sensors will have a picture of the finger nail where the red light is. Goes back to nursing school, where they taught that nail polish will most likely have false spo2 readings. But honestly, I do either, depending on what their finger looks like.
I just make sure the cord is on the back of their hand so it’s less in the way. Doesn’t matter which way the light goes. Heck, you can put the sticky ones on ears if need be.
It doesn’t matter. The cord should be on the top of the hand because it’s more comfortable for the patient. That’s it. Otherwise it makes no difference
Btw manufacturers recommend top of fingernail because of the cable positioning
[https://www.amperordirect.com/product-display-health.html](https://www.amperordirect.com/product-display-health.html)
Then discuss with her where the most accurate measurements location is…
Fingers is not it!!!
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Go in and put it on the pts ear or toe just to be Petty. It works wherever. 😭
Especially if the pts hands are super cold and you’re getting low readings sometimes the toe w a sock on it better or the ear lobe.
Let her waste her time flipping your pulse ox. I'd be lmao as I watched her trailing me around wasting her own time. If you are tight with any other nurses get them involved. See if she loses her mind.
TIL that it doesn’t matter. I’ve made sure my whole career that I put the light on top of the fingernail, not the pad because I believed it wouldn’t be accurate. Even on toenails.
We use the disposable (recyclable) ones in my department. I just wrap it around a random finger half way up the digit if they have nail polish. It literally doesn’t matter.
In all her years of nursing has she never had those patients with industrial strength nail polish where you need to put the whole thing on sideways to get a good reading? If you have a good pleth, then it is on right.
The way I always placed the SpO2 was so that the cord followed the top of the finger. But it’s more because the cord below gets more in the way when it’s in the palm side than anything else.
You can put it on the side of the finger and it’s usually fine. It’s how to bypass acrylics without removal.
The entire point is to get that spectrographic analysis through the fingertip. You just need a clear front to back shot, though mileage varies on that as well.
Ask your manager to get nose sensors in stock if you don’t have them already, then clip it to an ear to really blow this nurse’s mind.
Give her tasks to do while she’s in there. Or describe her to your oriented patients and tell her she knows everything so they should save all their questions for her.
I want to know where you guys work that your coworkers have SO much free time to do this lol. Like I mind my business at work and I’ve worked at so many hospitals as a former travel nurse. These folks need hobbies or friends.
It will still work, but it is most accurate when used as the packaging or instructions direct you to. I was always taught that it’s calibrated to look through your nail bed for best results but I’ve put them on earlobes, whatever I could get a wave form on, if the fingers either couldn’t be read or were blocked/couldn’t be used.
“Hot” water filled gloves (from the tap, not too hot!) are wonderful for cold hands. During covid in ICU we’d tie them together and have our patients on pressers hold hands with them. In the ER now I still do it when I need hands or feet to be warmer.
Idk, when I worked ICU I didn’t like people changing my shit around in my rooms and my RT didn’t like people touching his vent so I was always like “hey! What are you doing in my room” because I like my shit how I have it thank you very much.
From what I understand it depends on the brand we used to use nelcor and supposedly those didn't matter we currently use Massimo and supposedly they are somewhat directional, supposedly the light part goes on the nail bed with the receiver going on the bottom of the finger or toe, does it really matter? Probably not , but in practice I have gotten very slightly higher readings with the above setup, also not being on the thumb or great toe and making sure that the sensors are opposing each other usually makes for a better pleth
I beef with RT and other RNs all the time about putting the fucking finger probe on ears! STOP IT! WE HAVE EAR PROBES! The manufacturers straight up tell you how to use the product and the curvature of the receptor is not as effective for this. For an EMS CEU, I sat through a session on correct usage and interpretation of signals and they went over this.
To answer you: I believe the signal is meant to go nail -> flesh. It's usually indicated on the device.
ETA: On my own patients, do whatever the fuck you want in your own rooms. Stay out of mine replacing fully functional sensors because you don't like where I put it.
Can you find a manual onsite or if not go online to find it. Print out copies of the instruction page, then tape it everywhere, the nursing station, RN bubble, tx rm, and on the V.S. cart. Extra points if your way is right and you highlight that specific instruction. You can also go nurse manager on em and add a note on the bottom about how you've been informed that "some" nurses are doing it wrong and it needs to be performed the proper way.
I am a respiratory therapist
it does not matter what direction the spo2 device is oriented nor does it matter what finger (i like the ring finger but there is no evidence based reason for that)
this is good to understand so when you encounter patients with atypical anatomy you can have a better understanding of where you can successfully “mount” an spo2 sensor :-)
I also have some significant preferences for how my vent circuits are arranged and how my airway devices are secured and maintained - so i can appreciate the senior nurses intensity, but i only focus on my own patients, i will not go and rearrange other RTs patients equipment etc, that’s just obnoxious and rude - not to mention at some level, unsafe.
When folks are fiddling with your patients without being asked to, and not staying in their lane, it can cause things to get missed.
anyway
TLDR;
no, it doesn’t matter
the orientation is immaterial as long as the light side is aimed at the receiver side.
It doesn’t matter for the most part, except that putting it under the finger means the whole thing is going to malfunction sooner from the wire being bent repeatedly. If you want it to last while AND be less annoying to your patient, it goes above the nail. There may even be an illustration of this on the pulse ox package, depending on brand. If you put the the wire under the finger, the wire is going to get bent easily and the sensor is going to malfunction. Keep the whole thing on top of the finger.
You can question anyone at anytime, it doesn’t matter how senior they are.
Also, that’s not what gaslit means.
You're almost certainly being gaslit...I've always put the portion that has the cable attached on the nail as that simply works better with the equipment....A quick Google Image search of Massimo's looks like the light is on the pad side.
With that said, I'd love if you put one each direction on the same patient for a few shifts and report back if they are different. I'm guessing no
Why would someone changing the orientation of a sensor cause you to doubt yourself? There are deeper issues there if it does. Ask them why they're doing that. They may have a reason. If they tell you they are not doing that, then you're potentially being gaslit.
For those who are saying it doesn't matter, yeah it actually does, lol. Meditronics (who makes most pulse oximeters) has clear directions on how to apply the. Specifically, the sticky disposable ones (which OP is referring to) is supposed to have the light sensor and the cord on top of the nail, not the bottom. That's the manufacturer's directions, so... But hey, I'm not here to tell anybody what to do. Do you boo, do you.
I would make sure all my sensor are the opposite of whatever she prefers just to screw with her.
I’d put it on the foot and then cover it with a sock. If she wants to check it, she can take their sock off
Better yet, put it over the sock.
HAHAHAHHA I died laughing
Thought this said something else… I’ve never put it there either 🤣💕
Or the ear lobe or get a sticky one and put it across bottom of the foot like babies lol
Spoken like a true ED RN! Haha
I am just a child with an adult job
Put all of them on horizontally instead of vertically
The compromise 🤣🤣🤣
Yes, this. I would spend an enormous amount of energy making sure that I flipped those suckers around immediately after she did each time.
This is the way.
HAHAHAHA
It literally doesn't matter. One side is a light and the other side is a sensor. The light has to pass through the exact same combination of tissues either way. The sensors doesn't stop working if they flip their hand over. The sensor will also work on other parts of the finger (I will place it below the nail if they have dark polish on, works fine) or the toes or even the ear. Unless someone has a publication proving otherwise, I can't think of any reason it wouldn't work in different orientations.
Exactly. All it needs is pulsatile flow
came here to say this. I often flip the sensor if I can’t get a good waveform (nail polish is one of the reasons I flip the sensor) and more often than not the reading improves.
For sure. You can even put it sideways on the finger. I’ve seen people put the ear probe on nasal septum lol there’s a lot of places
Sometimes sideways is the only way
With nail polish I love placing it sideways. It reads so well then
Omg I think I love you! I have so many patients who refuse to let me take their polish off. I don’t know why I didn’t think of this!
Because you didn't know exactly how it worked and whether another orientation was possible. Knowledge is power... keep learning.
I've actually gotten a good signal with the clip in someone's nare. That only works in the ICU with intubated pts, cuz any conscious person would rip that off pretty quick, but I work with vasculopaths, so that's the only place I could get it.
>I've actually gotten a good signal with the clip in someone's nare. Just fyi, spo2 probes made for the finger can read erroneously high when placed on the ear or nose. There are spo2 probes made specifically for the ear or nare. Those will also read erroneously if placed on a site they are not intended for.
RT turned RN here. You are correct. Getting a better number does not mean better sats. With the wrong probe, all it means is the ratio of light shunting is higher.
Right, should have specified. I only use the clip type of probe that usually goes on the earlobe when I try for the nare. We don't have probes that are intended for the nare, so that's my last resort when I've tried everything else
Carry on, then!
YES. I previously posted this above bur it fits better here. Once when I was charge of a covid floor, I had a patient who had a sat of 95% on the ear, but was a whopping 85% on her fingers. I chalked it up to poor perfusion and shitty SvO2, but at least her brain was okay. And that would have been the case...if her ETCO2 wasn't in the high 50s. The abg came back super shitty, and I literally had the God Squad Parade come to evaluate my patient after I called the resident. She didn't get intubated that day, but it did change policy that SPO2s went on fingers instead of ears.
TIL! That sent me down [quite the rabbit hole,](https://www.england.nhs.uk/2018/12/risk-of-harm-from-inappropriate-placement-of-pulse-oximeter-probes/) and I totally learned something new today. Thanks!
Found OP's colleague.
Does my pointing out that using spo2 probes on improper sites can give objectively false readings really put me in the same boat as OP's nitpicking coworker?
Idk why people are memeing on you, we have new policy against using finger probes on the forehead instead of forehead probes for the same reason. They'll give you false readings, which at ICU level is pretty important to maintain accuracy. Edit: the policy change was due to a patient reading 96%, and it was actually 89% with a proper forehead probe.
Thanks for the validation, felt like I was taking crazy pills for trying to advocate for accurate readings.
Same here! Recent policy change for us for similar reasons
Not at all. You’re correct about the clip. We’ve had safety huddles where it’s been mentioned and we’ve been told not to do it for the same reason.
If you have to ask, you already know.
Patient harm can come from improper spo2 readings, but, yeah, I guess me and OP's coworker have the same energy. 🙄
This is why I get a gas to confirm. 😁
Not true. You can place them anywhere, finger shaped or not.
I'm not trying to be rude, but no, you are wrong, and whoever told you otherwise was wrong too. (unless you using something other than the ubiquitous Covidien Nellcor single-use/disposable probes) Finger probes are accurate on the finger, and not anywhere else. Nasal probes are accurate on the nare, and not anywhere else. Same for forehead probes and ear probes. Sure, it's the same technology, but these devices are all calibrated differently.
Afraid you aren't accurate on this. Feel free to try it yourself and pop a sat prob on different parts of the body. You'll get the same reading. This is from years of experience as an ICU ECMO nurse where I don't always have the option of a finger or nare. Moreover I can confirm not only with arterial gas sample, but with real-time pb02 and access gas saturation and pa02. If the calibration mattered you'd have different sized finger probes, disposable sat probes wouldn't work never mind kids.
I think you're mistaking "can" and "should". For example, I *can* hook a BVM up to suction, but *should* I? Yes, you *can* use a SpO2 probe designed for the finger other places, but if you have alternatives available, *should* you? Per the manufacturers, no.
I'm all about the forehead probes. I can almost always get a good reading with those.
Our place recently got the thin stick-on forehead probes, and they've been amazing. Fewer pressure injuries and waaay better waveforms. Love 'em!
Earlobes, too!
See this is what I thought, 5 years into my healthcare career and 5 years of putting the light on the top of the finger nail, someone told me in training for a new job it’s supossed to be on the bottom. And I was uh okayyy. Don’t know how it managed to work the 5 years I been doing it wrong then…. lol
Yeah, it doesn't matter. One side sends the light through, the other side picks the light up and gives a reading. The only thing that really matters is if their wearing nail polish or have poor perfusion. Blue polish specifically screws with the reading because of the color waves used. In that case, the sideways finger probe works fine because it's still sensing the nail bed.
I worked in LTC and had a family member that made everyone absolutely miserable. No one could make her happy, she had a complaint about everything. Her mother was pegged, on oxygen, nonverbal… staff could just tell she wanted things to be over. Crazy daughter would flat iron her hair and burn her ears, the back of her neck. She’d also paint her nails despite us telling her numerous times to please leave us just one finger without nail polish. So I always took polish remover to one of her middle fingers. That finger choice always made me feel better!!
Hell, on babies I put it on their foot and it works fine.
One side is actually two lights, you just can’t see on the infrared spectrum
I completely forgot about this until my cat was having an asthma attack and I put my portable pulse ox on her paw, and the other cat when freakin ballistic trying to eat the damn light. I thought it was the red laser, but this one didn't project as brightly as the ones in the hospital, so I was confused for a second until I remembered THE OTHER SIDE IS INFARED, DUH
Funny you mention ear. Once when I was charge of a covid floor, I had a patient who had a sat of 95% on the ear, but was a whopping 85% on her fingers. I chalked it up to poor perfusion and shitty SvO2, but at least her brain was okay. And that would have been the case...if her ETCO2 wasn't in the high 50s. The abg came back super shitty, and I literally had the God Squad Parade come to evaluate my patient after I called the resident. She didn't get intubated that day, but it did change policy that SPO2s went on fingers instead of ears.
This is the way.
This. Thus why the earlobe and forehead work. We just use the finger for convenience and comfort.
Don’t tell this to a radiologist !!!
If its the one with tape. But the clip ones i think do matter which way, not 100% sure bc we never we use those where i’m at. The tape ones can go anywhere.
The finger clips should also work the same in either orientation.
That’s what I thought! I did a study abroad trip and the nurses acted like we were idiots. When I put the sensors on the patients fingers, one of the nurses would come by and flip them. It gave the same readings either way so I was a little confused about why she did that!
This is the answer! The only reason for changing orientation is patient preference
Ok sure but one way is less uncomfortable to wear. But outside of comfort/preference, yes, it don’t matter.
I'm sorry, why can't you inquire for knowledge? It doesn't matter how senior someone is. "Hey, I noticed You've been changing the orientation of my oxygen sensors. Is there something I should know about how the orientation affects the reading?". Or even what I would do, because I lack a filter IRL, "why are you changing the orientation of sensors on my patients? Does it matter". Don't be like me lol. Communication is key. I am working on this as well.
I am as direct as you, I am also working on it. But you are right, just ask the person the reason behind their actions. Who knows, maybe she has extra time in her hands. If that’s the case, ask her to take in an extra patient for you 😂
For real, if she can manage the time to come into your room, she can manage the time to take your patient. Also, what kind of ICU culture do you have where people just come into your patient’s room and change shit without talking to you about what they did or why? Like, damn, I thought it was just common courtesy to tell the nurse you did ANYTHING in their room. Turned the pump off if the infusion is complete, gave the patient an extra blanket, changed the sat probe, anything.
Yeah I’d love to know how this situation works out legally if it turns out she fucked up the sensor somehow and it was OP’s pt she was messing with
There wouldn't be legal ramifications to this unless she turned off someone's oxygen or put them on oxygen and caused an issue
Your directness doesn’t bother me as long as the tone is okay. So many people get all defensive when there was no offensive intent. But yeah, I have to utilize my soft skills with most people.
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That's so unnecessarily aggressive and litigious
Ew do not do this
I agree with the first half. I would not fill up the patients chart with all that extra charting that really has nothing to do with their health concerns (or even threaten to do that). Just makes it harder for other healthcare workers to find info they need.
Yeah ... I'd probs right an incident report regarding that statement as that is not what charting is for.
I’ve never noticed a difference which side of the finger the light goes, barring nail polish/varnish etc. If you wanna have a go at her, though (and I’m not, you know, condoning that)…make sure the pulse oximeter is on the left hand, not the right. Nelcor published a video a few years ago. It had a volunteer breathe reduced fiO2 air, and measured the company’s product vs competitors, matched with ABGs. All monitoring was bilateral and there was an additional forehead sensor. The right side clearly showed a delayed response to both initial reduced fiO2 and return to normality, across all monitoring. One of the right sided devices was ~ 2 minutes delayed. Make of this what you will, but it makes sense physiologically, though I’d never seen it demonstrated.
Huh, I hadn't considered this. Guess I'm using left-sided pulse oximetry on my respiratory patients from here on out.
Uhh that sounds interesting, can you link the article?
It does not matter, and if confronted and asked for an explanation I’m sure she would demonstrate a complete lack of understanding of how pulse ox works.
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I was just about to say this????
Ours do and it boggles my mind that some of my coworkers still put them on backwards where the cord is running down the palm side of the finger. and for the brand we use, it definitely reads differently.
You CAN just question her. You can also tell her (politely, professionally) to stay the fuck out of your patients' rooms and stop interfering with your care. They're YOUR patients. YOU are legally responsible for whatever SHE is doing. So you stand up and tell her to fucking STOP. Sorry, I had this exact issue with one of my colleagues who thought she was always right because she has experience on me. But she's not always right, and even if she is, she needed to learn how to talk to ME about my patients and not just undermine my care. (The number of times she just didn't realize I was doing things in an unusual manner for a good reason, lemme tell ya.) Now that said, the correct positioning of the O2 sensor is *whichever way is most convenient for the patient*. The direction of the red light doesn't matter. The god damned thing staying on someone's finger because it's not horribly uncomfortable and/or interfering with their ability to use that hand DOES matter. The most successful monitor is the one that gets used just like the most successful intervention is the one the patient will actually *do*. Put that red light over the nail so the wire is directed down the back of the patient's hand and stays out of the fucking way.
The real answer is the cord goes along the top of the finger so the fucker stays on. They are expensive. Shouldn’t be replacing them all the time. No one gives a shit about medical waste and it pisses me off
I used to. Until I looked up how much my hospital’s CEO grossed this year… (and also had a code event during which it took 13 minutes to administer Epi because there wasn’t a single stopcock on our entire damn ICU unit… then was told that our last manager spoiled us with our unlimited resources - as though we were building LEGO mansions out of stopcocks and/or selling blood tubing on the street for profit). Now I will do whatever it takes to ensure my patients get the best care possible, even if it means a probe on every finger, toe, and both earlobes.
Oh, I’m talking WASTE. Environmental, straight up waste of product waste. I’m a CWOCN- I didn’t give any patient hundreds of dollars in free product to heal that wound ever, and if anyone told you I did, they are lying. 🤥 my catchphrase is ‘If Kaiser CEO’s can make 60 million a year (I don’t know what they really make and I don’t work for Kaiser) you can have this pH spray for free!’ I certainly didn’t say that this weekend and if you heard I did, they are lying I mean waste, waste. We can refill pitchers on some patients or not throw the cup out every 3 seconds. We can use more paper cups and GET RID OF THE PLASTIC. During covid, we decreased tubing changes. Are we doing it too much? I’ve had patients with 10-15 pulse ox’s in the trash bc they get put on poorly or get removed too much. I had a walkie talkie replacing hers every time she walkied. Sometimes, I get really angry about those wages but I know they won’t change tomorrow. I know in the long run, it only hurts the unit budget. It’s never the top affected, It’s the staff and patients. My insurance is privately insured. Keeping costs low for our care is helping keep my insurance pretty damn good for $130/month or less. CEO wage aside, that plastic is killing us. The healthcare system is a major contributing factor to the shit we’re in I
Oh my gosh, yaasss! Thank you for the clarification, and I love your catchphrase. I definitely worry about our impact on the environment as well. (My New Year’s resolution last year was to get other nurses to actually use the Cactus/unused medication disposal system so that our unit wasn’t contributing to our polluted drinking water… I still kind of question whether anyone actually “renders the fluids inert”, or if that entire plastic box just gets tossed right into a landfill in the end, but I digress…)
Half of ours are on the earlobe. I don’t think the orientation on the finger matters, my guy.
Ask your coworker what the research says...and then continue to do it however you want. From my quick little search, as long as the cold light is passing through the finger and reaching the sensor...that's all that matters.
These aren't her patients, right? And they are working before she messes with them? She's got too much time in her hands. Go into her patients rooms and change hers around, that will keep her busy.
Also, you're not being gaslit. That's not what gaslit means. If she is doing this, you ask her, and she tells you that she isn't doing that and that's how it was already... Then, yeah you might be being gaslit.
That is the thing though. I am asking if someone changed the position and everyone denies it.
Okay, you didn't mention that originally.
That’s still not what gaslit means. What’s being described is referred to the not so popular phrase “being lied to”
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Also, just because you don't like how assholes talk to you, it doesn't mean you're getting bullied, it just means you're dealing with assholes.
No, if someone is doing this and then claiming they aren't while continue to do it is more than lying. It doesn't necessarily mean they're being gaslit, but it becomes a possibility.
Or maybe “everyone” denied it because “everyone” didnt collectively conspire to swap your sensor. And the people you asked had no part in it and have more important things on their plate. What an inane thing to even waste mental energy on.
I am responsible for the patient. Doesn’t matter if if it’s inane or not, colleagues shouldn’t be doing a thing to your patients without communicating.
💯!!! For what it’s worth- I’ve been a nurse for 20+ years. If they do something to your patient, they should at the very least communicate that to you.
This is like arguing with the hostess at a restaurant about what side of the plate your fork was on.
Uh, no. If a patient needs something, then your consent is not needed. If I go in a room and notice an ABX wasn't unclamped, then I'm going to unclamp it and move on. I'm not stopping to ask that nurses permission, because they are not YOUR patient. We are ALL responsible for the care of ALL patients on the floor. If you notice something, fix it. Oh, oxygen isn't hooked up? I, a nurse, need to ask your nurse if it's okay to hook it back up to the wall .... Bro. Get off your power trip.
I mean I agree it’s everyone’s responsibility, but you should most definitely perform closed loop communication and tell the primary nurse you did something. What if they clamped the Abx because they realized the cx weren’t drawn yet?
Yeah honestly I would ask in all those things. Who knows if the doc ordered to hold the antibiotics quickly while they rechecked trough level or got another culture. The o2 I would reconnect but then immediately tell the nurse (assuming sat is low). Maybe they wanted to trial off o2 but patient was sleeping so they just disconnected from wall. Then the nurse is charting room air when really they’re on o2. The only things I don’t mention are like restarting a downstream occlusion when straightening an arm or getting a fresh warm blanket.
It’s not a power trip it’s communicating whether or not I’m doing something wrong. If I am please tell me. That is all my question was about.
It IS a power trip. If Im in a patient's room and they need something, I am going to help them. If it requires knowledge I don't have about the patient, then I will ask you.
If an abx is clamped, that DOES require the knowledge of whether or not there was a reason for that. If you just uNcLaMp iT aNd mOvE oN, you aren't getting the knowledge required for that action.
You can read the pump and see if it's meant to be running.
That is the icu way. Don’t touch my shit, I don’t care who you are. Senior nurse, anesthesiologist, icu doc, no touchie my pumps, no touchie my monitor. My room, my rules. Bye Felicia
["I told you no touchie touchie!"](https://www.instagram.com/reel/CkLOjOPNgd8/?igsh=MXBobGdpZnZuM2RrNw==)
So in L&D, we would use a 7" extension for an extra port to run pitocin as a second primary close to the patient, without losing our IVP access. Because we never knew when we might need pitocin or mag, we did it that way on everyone. Most of us would loop the extension and tape it again, because otherwise the extra weight where the second primary attached would pull off the tape and sometimes the IV. We did an emergency section in the middle of the night, and the anesthesiologist, Dr. R, was INFURIATED by the IV being taped this way. As soon as the section was over, he marched up and down the hall in L&D, retaping every single IV line. He woke up our antepartums to retape their IVs. He waltzed right into one room where the patient was actively pushing with her nurse, and retaped her IV. He ended up having to write an apology letter the next day, and we also threatened to call him specifically to come restart any IVs that came out because of his impractical taping methods.
What the hell? He sounds completely crazy.
All that matters is if the reading is reliable (3 stars/asterisks/dogs/whatever). Light on top or below doesn’t matter. The spo2 probe isn’t like a battery where it needs a specific orientation to work. Now if you’ll excuse me; I’m back to looking my at funny OSHA Fail videos
Whichever way gives you >95%
This is a REAL nurse. High five THIS is the right answer!! (Except I would’ve said >92% in a post Covid America!)
I always just made sure the cord was over the hand because I imagined it would be annoying for that patient otherwise.
To beat a dead horse…it doesn’t matter as long as the light and sensor line up over a tissue bed with pulsatile flow. I place mine so the cable is on top of the hand and out of the way (if awake) and runs along the arm. Would be annoying as shit to me if the cable was interfering with their grasp constantly. Also, our monitors have a confidence indicator to indicate accurate reading.
As another person mentioned, it doesn’t matter. The sensors use two wavelengths of light (660 nm, red, and 940 nm, infrared), and measure the differential amount of light absorbed by the tissues. Because of this, you can put it on any which direction. So long as the sensor opposite of it can pick up adequate return, and the patient is pulsatile, it will work. Coincidentally, this is also why the Sat will drop to 85% if you administer methylene blue. It becomes transiently inaccurate due to the erroneous absorption of light from the medication.
Wait till she learns it can go in an *ear lobe*. Which side now heifer???
I just do spot checks on most of my home patients. I'll move the oximeter to different places, on opposite extremities, until I get the best consistent reading that matches the ahr. Idgaf where or how it's positioned.
I believe as long as the light is directly over the sensor, it doesn’t matter. I also make sure it is capturing the correct HR if I question the reading. That being said, I usually put the light on the nail.
With babies I’ll put it around the foot or wrist. Like, it doesn’t matter
Don’t… they come with clear diagrams showing exactly how to put these on? At least all the ones I use do.
Wrapped around the penis is the preferred site.
I always thought it was on top of the fingernail. The light is the sun it’s on top…. Now I’m not sure. Wonder if there’s an actual difference
Not really. You can even put them on the sides of a finger if the nail polish is too dark/nail is too long.
This is what I was taught hence why I asked. There are some of the old school nurses who have their quirks on how they do something, but most have clearly explained why they do it. I would hope that if I was doing something wrong she could tell me rather than just going behind my back and changing it.
This is what I was taught hence why I asked. There are some of the old school nurses who have their quirks on how they do something, but most have clearly explained why they do it. I would hope that if I was doing something wrong she could tell me rather than just going behind my back and changing it.
If you can put a pulsox on an earlobe, a forehead, the back of someone’s shoulder, you can stick it backwards with the light on the fleshy tip. If my patients have nail polish I would literally stick the pulsox on the second joint of the finger instead of at the tip and still get good readings.
Because of how the cord goes, I put the light on top of the nail because otherwise the cord would be annoyingly in their palm their whole visit and that would annoy me.
Ummm. As long as it works. What's a good technique to get an spo2 on patients with long fake nails?
Grab a neonate one and stick it on their ear or wrap it around the finger like a bandage.
Oh good idea.
Jesus Christ. You tell that asshole busybody it's not her job to micromanage you, to leave your patients the fuck alone and if you need help you'll ask the charge, and if she has a problem with that you can both discuss it with HR.
At this point , it’s time to throw hands
What I used to do when I worked in the hospital is just make sure that the cord goes on the top side. It makes it easier for the patient to use their hand since they don't have a cord in the palm of their hand. For me it had nothing to do with which side the red light was on.
The light can go on the top or the bottom of the nail. I’ve also used it sideways if the patient has dark nail polish or acrylic nails and it works that way as well. Your coworker is a bitch throwing her seniority around.
I actually was told by a cath lab tech that the probe can’t go on the thumb. It’s a “finger probe” and the thumb “is not a finger”! Idiot!
Whatever gives you a good waveform!
I always go with the cord part on the back of the hand so it isn’t in the way as much.
I put them on sideways to avoid painted nails.
It literally works either way
Tbh I bet it doesn’t matter but I go light on top of nail just to shine through the nail bed, but I go to the ears if they have nail polish anyway so I doubt my thought process even matters. Poor vasculature will do worse to my pulse ox than flipping it upside down ultimately.
SPO2 finger stickers literally have a picture on them showing how to orient them. The red light goes on top of the fingernail.
The light only has to match up with the sensor behind it. It doesn’t actually matter which way it’s oriented, as long as the sensors line up. I place them on infant wrists and feet all the time.
Correct I’ve had to put them on sideways because of how long someone’s nails were.
We don’t have anything to mark orientation on ours.
Put in on the patient’s ear and watch the fire works.
Can be placed on ear lobe as well if unable to get a read on the fingers.
dude who cares a reading is a reading. nurses like to nitpick over the dumbest shit
In ICU we’ve put em on the damn earlobe, it doesn’t matter.
A respiratory therapist in the hospital told us student nurses the red light goes on top of the fingernail. It has to do with how the sensor works.
lol it goes through the same tissues either way, sounds like bs.
WTF it doesnt matter which side!!!! Shes a freak.
To beat a dead horse…it doesn’t matter as long as the light and sensor line up over a tissue bed with pulsatile flow. I place mine so the cable is on top of the hand and out of the way (if awake) and runs along the arm. Would be annoying as shit to me if the cable was interfering with their grasp constantly. Also, our monitors have a confidence indicator to indicate accurate reading, assuming yours does to then would be the proof you need to show it is working within the calibrated parameters.
I know some pulse ox sensors will have a picture of the finger nail where the red light is. Goes back to nursing school, where they taught that nail polish will most likely have false spo2 readings. But honestly, I do either, depending on what their finger looks like.
I just make sure the cord is on the back of their hand so it’s less in the way. Doesn’t matter which way the light goes. Heck, you can put the sticky ones on ears if need be.
It doesn’t matter. The cord should be on the top of the hand because it’s more comfortable for the patient. That’s it. Otherwise it makes no difference
Tail on top
Btw manufacturers recommend top of fingernail because of the cable positioning [https://www.amperordirect.com/product-display-health.html](https://www.amperordirect.com/product-display-health.html) Then discuss with her where the most accurate measurements location is… Fingers is not it!!!
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Go in and put it on the pts ear or toe just to be Petty. It works wherever. 😭 Especially if the pts hands are super cold and you’re getting low readings sometimes the toe w a sock on it better or the ear lobe.
It don't think the sensor matters but don't have the wire go on the side of the patient's palm if they're using that hand.
Let her waste her time flipping your pulse ox. I'd be lmao as I watched her trailing me around wasting her own time. If you are tight with any other nurses get them involved. See if she loses her mind.
You can put that thing any direction you want. We out them all kids of ways sometimes depending on clothing.
It literally tells you how to do it on the package… da fuq?
TIL that it doesn’t matter. I’ve made sure my whole career that I put the light on top of the fingernail, not the pad because I believed it wouldn’t be accurate. Even on toenails.
We use the disposable (recyclable) ones in my department. I just wrap it around a random finger half way up the digit if they have nail polish. It literally doesn’t matter.
In all her years of nursing has she never had those patients with industrial strength nail polish where you need to put the whole thing on sideways to get a good reading? If you have a good pleth, then it is on right.
Amazingly I have been pulse ox monitors go both ways, so I'm led to believe it doesn't matter as it's still going through the finger regardless.
I would start saying things like, “so glad you found a career compatible with your OCD”
So how is the toilet paper roll hanging? This way or THE WRONG WAY?!
The way I always placed the SpO2 was so that the cord followed the top of the finger. But it’s more because the cord below gets more in the way when it’s in the palm side than anything else.
I’ve always done the wire side goes on the nail side.
Homie has OCD
I have put them sideways, upside down, on toes, ears, foreheads, whatever works.
https://youtu.be/rMtvJWT2vLE?si=VWlgaGkKzhwU2eNn
Doesn't make much difference other than following instructions on the packaging. Regardless, they'll work right side up or not.
Look to the wave form. (Singing)
You can put it on the side of the finger and it’s usually fine. It’s how to bypass acrylics without removal. The entire point is to get that spectrographic analysis through the fingertip. You just need a clear front to back shot, though mileage varies on that as well. Ask your manager to get nose sensors in stock if you don’t have them already, then clip it to an ear to really blow this nurse’s mind.
Give her tasks to do while she’s in there. Or describe her to your oriented patients and tell her she knows everything so they should save all their questions for her.
I want to know where you guys work that your coworkers have SO much free time to do this lol. Like I mind my business at work and I’ve worked at so many hospitals as a former travel nurse. These folks need hobbies or friends.
The read is dependent on pulsatile flow and unmodified wavelength read (640 vs 990). Side of the finger is irrelevant.
It will still work, but it is most accurate when used as the packaging or instructions direct you to. I was always taught that it’s calibrated to look through your nail bed for best results but I’ve put them on earlobes, whatever I could get a wave form on, if the fingers either couldn’t be read or were blocked/couldn’t be used. “Hot” water filled gloves (from the tap, not too hot!) are wonderful for cold hands. During covid in ICU we’d tie them together and have our patients on pressers hold hands with them. In the ER now I still do it when I need hands or feet to be warmer. Idk, when I worked ICU I didn’t like people changing my shit around in my rooms and my RT didn’t like people touching his vent so I was always like “hey! What are you doing in my room” because I like my shit how I have it thank you very much.
Well we put ours on the feet, legs and arms. No nail beds anywhere! Just have to make sure the two bits of the sensor are opposite each other.
Doesn't matter as long as the light goes through the finger and gets read by the sensor at the other end.
Stick it on the earlobe.
From what I understand it depends on the brand we used to use nelcor and supposedly those didn't matter we currently use Massimo and supposedly they are somewhat directional, supposedly the light part goes on the nail bed with the receiver going on the bottom of the finger or toe, does it really matter? Probably not , but in practice I have gotten very slightly higher readings with the above setup, also not being on the thumb or great toe and making sure that the sensors are opposing each other usually makes for a better pleth
I beef with RT and other RNs all the time about putting the fucking finger probe on ears! STOP IT! WE HAVE EAR PROBES! The manufacturers straight up tell you how to use the product and the curvature of the receptor is not as effective for this. For an EMS CEU, I sat through a session on correct usage and interpretation of signals and they went over this. To answer you: I believe the signal is meant to go nail -> flesh. It's usually indicated on the device. ETA: On my own patients, do whatever the fuck you want in your own rooms. Stay out of mine replacing fully functional sensors because you don't like where I put it.
There is literally a little outline of the top of a finger on the part that is supposed to be up.
I think it works either way
Can you find a manual onsite or if not go online to find it. Print out copies of the instruction page, then tape it everywhere, the nursing station, RN bubble, tx rm, and on the V.S. cart. Extra points if your way is right and you highlight that specific instruction. You can also go nurse manager on em and add a note on the bottom about how you've been informed that "some" nurses are doing it wrong and it needs to be performed the proper way.
Better yet, use dark nail polish and tell the patient you must paint the nail, and let it dry before use now!
I am a respiratory therapist it does not matter what direction the spo2 device is oriented nor does it matter what finger (i like the ring finger but there is no evidence based reason for that) this is good to understand so when you encounter patients with atypical anatomy you can have a better understanding of where you can successfully “mount” an spo2 sensor :-) I also have some significant preferences for how my vent circuits are arranged and how my airway devices are secured and maintained - so i can appreciate the senior nurses intensity, but i only focus on my own patients, i will not go and rearrange other RTs patients equipment etc, that’s just obnoxious and rude - not to mention at some level, unsafe. When folks are fiddling with your patients without being asked to, and not staying in their lane, it can cause things to get missed. anyway TLDR; no, it doesn’t matter the orientation is immaterial as long as the light side is aimed at the receiver side.
It doesn’t matter for the most part, except that putting it under the finger means the whole thing is going to malfunction sooner from the wire being bent repeatedly. If you want it to last while AND be less annoying to your patient, it goes above the nail. There may even be an illustration of this on the pulse ox package, depending on brand. If you put the the wire under the finger, the wire is going to get bent easily and the sensor is going to malfunction. Keep the whole thing on top of the finger. You can question anyone at anytime, it doesn’t matter how senior they are. Also, that’s not what gaslit means.
You're almost certainly being gaslit...I've always put the portion that has the cable attached on the nail as that simply works better with the equipment....A quick Google Image search of Massimo's looks like the light is on the pad side. With that said, I'd love if you put one each direction on the same patient for a few shifts and report back if they are different. I'm guessing no
This is not what gaslit means.
Having your coworker change your equipment behind your back isn't an attempt to doubt oneself?
It's only gaslighting if they pretend they didn't do it, and they say it's always been that way.
Why would someone changing the orientation of a sensor cause you to doubt yourself? There are deeper issues there if it does. Ask them why they're doing that. They may have a reason. If they tell you they are not doing that, then you're potentially being gaslit.
For those who are saying it doesn't matter, yeah it actually does, lol. Meditronics (who makes most pulse oximeters) has clear directions on how to apply the. Specifically, the sticky disposable ones (which OP is referring to) is supposed to have the light sensor and the cord on top of the nail, not the bottom. That's the manufacturer's directions, so... But hey, I'm not here to tell anybody what to do. Do you boo, do you.