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Lit Review: A comprehensive literature search using Children’s Health Library, Medline, and Scopus databases was conducted using key terms including pulse oximetry, pediatric, hypoxia, arterial, and accuracy. The search yielded 24 articles including systematic reviews and randomized controlled trial. Literature suggests that overestimation of oxygen saturation by pulse oximeters, particularly in hypoxic states, is higher in darker pigmented skin tone or states of lower perfusion. Readings may also be influenced by factors such as the method of oxygen saturation measurement (e.g., venous versus capillary). On the inpatient pediatric pulmonary unit, 76% of the patient population during 2025–2026 is Hispanic or African American which correlates with darker pigmented skin, making this an important consideration when interpreting pulse oximetry measurements. PICO: Literature shows that earlier detection of low oxygen saturation in the pediatric population allows for quicker interventions, improving overall patient safety and outcomes. On an inpatient pediatric pulmonary unit, there have been multiple instances of staff concern for inaccurate pulse oximetry readings. In one year, there were 3 code/MET events, in which uncertainty of device accuracy delayed response time and interventions. To address this problem, an evidence-based practice project was implemented using the PICOT question: In respiratory technology dependent pediatric patients (P), how does alternative oximetry monitoring (I) compared to current oximetry monitoring (C) affect early notification of decreased oxygen saturation (O)? A different type of pulse oximetry device was evaluated to determine if pulsatile signal tracking technology would improve early detection of decreased oxygen saturation. Results: Side by side comparison included recording minute by minute oxygen saturation and heart rate from both devices. Both nurses and respiratory therapists were surveyed during pilot with 45 total responses. Respondents had 89% confidence that piloted pulse oximeter correlated with other clinical signs/symptoms, 60% had confidence of piloted pulse oximeter accuracy, with an overall 53% product preference. The bedside staff recorded and/or time stamped desaturation event details, that allowed review of minute-by-minute data. These results indicated that the piloted pulse oximeter picked up desaturations and responded to clinical interventions quicker than current pulse oximeter. In addition, the heart rate detected by the piloted pulse oximeter correlated consistently with heart rate detected by electrocardiogram (ECG) leads and two occasions with exact correlation to blood gas O2 saturation value. Next steps include expanded pilot and evaluation of piloted pulse oximeter for system use.

Publication Date

11-9-2026

Keywords

Pediatric nursing

Disciplines

Pediatric Nursing

Pulse (Ox) Check! Smarter Monitoring, Stronger Outcomes

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