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Annotated Bibliography on Technology in Nursing
Learners Name
Capella University
NURSFPX4040: Managing Health Information and Technology
Instructor Name
August 1, 2019
Copyright 2019 Capella University. Copy and distribution of this document are prohibited.
2
Technology in Nursing
Pulse oximetry is one of the most common methods of measuring the percentage of
oxygen saturation in blood (Narayen et al., 2016). Pulse oximeters play a crucial role in critical
care settings by detecting low levels of oxygen saturation. Pulse oximeters are also adopted by
anesthesiologists in recovery, emergency, and pediatric wards; operation theatres; and neonatal
units (Hendaus, et al., 2015). This annotated bibliography provides insight into how pulse
oximeters are used, their limitations and accuracy, and patient outcomes.
Annotated Bibliography
Hendaus, M. A., Jomha, F. A., & Alhammadi, A. H. (2015). Pulse oximetry in bronchiolitis: Is it
needed? Therapeutics and Clinical Risk Management, 11, 15731578.
https://doi.org/10.2147%2FTCRM.S93176
This article discusses the use of pulse oximetry in pediatric wards. The authors state that
hospitals in the United States admit a significant number of children every year with
bronchiolitis and other respiratory problems. These problems are usually monitored with
the help of a pulse oximeter, an instrument used to measure the saturation of oxygen in
the blood. Oxygen saturation levels are used by health care providers to evaluate a
patients respiratory status and are one of the deciding factors for a patients discharge.
Pulse oximetry is frequently used in pediatrics (in pediatric intensive care units and
pediatric wards) and in emergency departments. Pulse oximeters are used to monitor
oxygen saturation during resuscitations, while estimating perfusion, while detecting
pulsus paradoxus, and while screening infants for . Though the
source does not fully explain why the limitations occur, it identifies several cases in
which pulse oximeters are likely to be inaccurate. Pulse oximeters have certain
Commented [A1]: Comprehensive information regarding the
types of pulse oximetry devices, selection criteria, decision makers,
and associated costs is not available in the selected papers. The two
types of pulse oximeters and their advantages over the others is
provided; however, information on the various types of pulse
oximeters is not available and the associated costs are not provided.
This paper does mention that this technique is cost-effective which
can fulfill the required criteria.
Copyright 2019 Capella University. Copy and distribution of this document are prohibited.
3
limitations due to inadequate signals. Inadequate signals occur in cases of anemia, bright
external light, dark skin, nail polish, low perfusion, and intravenous dye. Pulse oximeters
show low readings in cases of venous pulsations such as severe right heart failure,
tricuspid regurgitation, and blood pressure cuffs or tourniquets above the site of the pulse
oximeter. Pulse oximeters might not detect hypoxemia in patients with elevated arterial
oxygen tension levels because of the sigmoidal shape of the oxyhemoglobin dissociation
curve. Also, pulse oximeters provide unreliable readings in cases of methemoglobinemia.
The source highlights several limitations, which will help readers exercise caution when
using pulse oximeters. However, despite these limitations, the use of pulse oximeters in
pediatrics is recommended because they are handy and allow for noninvasive measuring
of arterial oxygen saturation.
Jubran, A. (2015). Pulse oximetry. Critical Care, 19(1), 272.
https://doi.org/10.1186%2Fs13054-015-0984-8
This into the principles, accuracy, functioning, and outcome of
pulse oximeters. It discusses the potential advantages of multiwavelength pulse oximeters
over conventional pulse oximeters. Multiwavelength pulse oximeters are capable of
estimating the blood levels of carboxyhemoglobin and methemoglobin, whereas
conventional pulse oximeters assume that dyshemoglobins such as carboxyhemoglobin
and methemoglobin are absent because they can only distinguish between hemoglobin
and oxyhemoglobin. Hence, physicians prefer to use multiwavelength pulse oximeters for
more accurate results. In hospital settings, the transfer rate from a postsurgical care floor
to the intensive care unit (ICU) is an important factor that influences the use of pulse
oximeters. The resource reviews a study by Ochroch et al. in which patients were Commented [A3]: Deals with criterion 3: Organizational factors
that influence the selection of a technology in health care setting.
Commented [A2]: Meets criterion 3 as it deals with
organizational factors that influence the selection of a technology in
health care setting.
Copyright 2019 Capella University. Copy and distribution of this document are prohibited.
4
monitored by pulse oximeters either continuously (oximeter group) or intermittently
based on clinical needs as judged by a physician or a nurse (control group). The rate of
ICU transfers for pulmonary complications was lower in the oximeter group than in the
control group. Additionally, for patients who did require ICU transfers, the estimated cost
of treatment from enrollment to the completion of the study was lower for the oximeter
group ($15,481) than for the control group ($18,713) despite the patients in the oximeter
group being older and having higher comorbidity. The reduction in pulmonary transfers
to the ICU in the oximeter group was speculated to be the result of early recognition and
treatment of postoperative pulmonary complications. As cited in Jubran, another study by
Moller et al. indicates that anesthesiologists considered pulse oximetry to be of immense
value as it guides clinical management.
oximeters because they believe that maintaining oxygenation within limits might help
prevent irreversible injury. Pulse oximetry is, therefore, a key part of the standard
protocol for monitoring critically ill patients.
Narayen, I. C., Blom, N. A., Ewer, A. K., Vento, M., Manzoni, P., & te Pas A. B. (2016).
Aspects of pulse oximetry screening for critical congenital heart defects: When, how
and why? Archives of Disease in Childhood Fetal and Neonatal Edition, 101(2),
F162F167. http://doi.org/10.1136/archdischild-2015-309205
This article describes how pulse oximetry is being implemented worldwide for the
screening of critical congenital heart defects (CCHD). The use of pulse oximetry to
screen for CCHD is highly recommended because it is effective, quick, simple, and costeffective. The authors state that training parents and caregivers and using tools that are
computer based can improve pulse oximetry screening. Pulse oximetry helps detect
significant pathology and is reliable for keeping track of CCHD, which requires constant
Anesthesiologists recommend the use of pulse Commented [A4]: Deals with criterion 3: Organizational factors
that influence the selection of a technology in health care setting.
Commented [A5]: Fulfills the rubric criteria: Justify the
implementation and use of a selected technology in a health
care setting.
And also fulfills: Describes organizational factors influencing
the selection of a technology in the health care setting.
Copyright 2019 Capella University. Copy and distribution of this document are prohibited.
5
diagnosis and immediate medical intervention. In almost every infant with CCHD,
clinically undetectable hypoxemia is identified by pulse oximeters. Early studies of
neonatal pulse oximetry screening for CCHD showed accurate details. As a result, the
U.S. Secretary of Health and Human Services advised adding CCHD screening to the
recommended uniform screening panel. According to a meta-analysis of 13 screening
studies, pulse oximetry screening reported a specificity of 99.9 percent, a sensitivity of
76.5 percent, and a false positive rate of 0.14 percent. Therefore, the authors concluded
that the universal screening criteria were met by pulse oximetry screening. Pulse
oximetry screening shows no difference in accuracy when pre-ductal and post-ductal
pulse oximetry measurements are performed. The authors also observed that pulse
oximetry screening done 24 hours after birth increases the risk of late detection of CCHD
in infants but decreases the false positive rate. Therefore, the use of pulse oximeters can
be crucial for the early detection of CCHD and helps reduce mortality and improve
postoperative outcomes.
Nitzan, M., Romem, A., & Koppel, R. (2014). Pulse oximetry: Fundamentals and technology
update. Medical Devices: Evidence and Research, 7, 231239.
https://doi.org/10.2147/MDER.S47319
This article offers comprehensive insight into how pulse oximetry works; particularly, it
looks at the techniques involved in measurement, the limitations of using the techniques,
and the accuracy that can be expected while determining oxygen saturation. Oxygen
saturation (SaO2) is the measurement of the percentage of oxygen in hemoglobin. Pulse
oximeters detect the significant decline of oxygen in the respiratory function of patients.
Measurements of oxygen saturation in pulse oximeters (SpO2) are often inaccurate when
Commented [A6]: Fulfills the rubric criteria: Justify the
implementation and use of a selected technology in a health
care setting.
Copyright 2019 Capella University. Copy and distribution of this document are prohibited.
6
critically ill patients receive supplemental oxygen. The difference between SpO2 and
SaO2 determines the accuracy of a pulse oximeter. Though the outcome of pulse oximetry
in measuring SaO2 in sick patients is 34 percent inaccurate, pulse oximeters quickly
detect the abrupt drop of SpO2 in anesthetized patients and in patients in intensive care
units. Despite the limitations of pulse oximetry, SpO2 values obtained from the pulse
oximeter are considered reliable for the detection of deterioration in respiratory function.
Further, pulse oximetry has the advantage of being a noninvasive technique to measure
oxygen saturation. Studies suggest that pulse oximetry should not be the only method to
monitor SaO2 in the neonatal intensive care unit because of infants vulnerability to
retinopathy of prematurity, which is induced by the high partial pressure of oxygen in
arterial blood. The authors conclude that technological advancements in pulse oximeters
over the years have enabled them to diagnose and monitor patients better.
Conclusion
Despite their limitations, pulse oximeters are recommended for monitoring oxygen
saturation levels in patients with respiratory problems. The use of pulse oximeters helps reduce
the rate of pulmonary transfers of patients from a postsurgical floor to the ICU. They play a
crucial role in screening infants for CCHD, and therefore, the use of pulse oximeters in pediatric
wards is highly recommended. Pulse oximetry helps in the early detection of certain diseases,
thereby to organs and reducing the rate of mortality. Pulse
oximeters are a cost-effective resource in hospitals. They can easily detect a significant decline
of oxygen in the respiratory function of patients. The rate of transfers to the intensive care unit
due to pulmonary complications was significantly lower in patients who were continuously
monitored using pulse oximeters than in patients who were intermittently monitored using pulse
Commented [A8]: Fulfills criteria 3: Describes organizational
factors influencing the selection of a technology in the health
care setting.
Commented [A7]: Fulfills the criteria: Justifies the
implementation and use of a selected technology in a health
care setting. Provides an in-depth and well-researched
analysis of the impact of the technology on quality care and
patient safety.
Copyright 2019 Capella University. Copy and distribution of this document are prohibited.
7
oximeters. The readings obtained from pulse oximeters are reliable and help make immediate
adjustments to a patients oxygen supply, which can help prevent irreversible damage or death.
The limitations of conventional pulse oximeters are overcome by multiwavelength pulse
oximeters, which can estimate the levels of carboxyhemoglobin and methemoglobin in blood.
Medical practitioners in interdisciplinary teams, such as pediatricians, pulmonologists, and
anesthesiologists, can collectively use the readings obtained from pulse oximetry to assess the
condition of a patient before administering treatment. Hence, pulse oximetry is valuable in
hospital settings, helping medical practitioners decide the correct course of treatment and provide
immediate and effective care to patients.
Copyright 2019 Capella University. Copy and distribution of this document are prohibited.
8
References
Hendaus, M. A., Jomha, F. A., & Alhammadi, A. H. (2015). Pulse oximetry in bronchiolitis: Is it
needed? Therapeutics and Clinical Risk Management, 11, 15731578.
https://doi.org/10.2147%2FTCRM.S93176
Jubran, A. (2015). Pulse oximetry. Critical Care, 19(1), 272.
https://doi.org/10.1186%2Fs13054-015-0984-8
Narayen, I. C., Blom, N. A., Ewer, A. K., Vento, M., Manzoni, P., & te Pas, A. B. (2016).
Aspects of pulse oximetry screening for critical congenital heart defects: When, how and
why? Archives of Disease in Childhood Fetal and Neonatal Edition, 101(2), F162
F167. http://doi.org/10.1136/archdischild-2015-309205
Nitzan, M., Romem, A., & Koppel, R. (2014). Pulse oximetry: Fundamentals and technology
update. Medical Devices: Evidence and Research, 7, 231239.
https://doi.org/10.2147/MDER.S47319
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