Sophia Delgado
Pulse oximeters are devices that can be used to measure the oxygen saturation in an individual's blood. They are considered a game-changer in the medical industry, especially during the COVID-19 pandemic, as they can be used to detect oxygen requirements in patients. However, the accuracy of these devices can be influenced by various factors, including long fingernails, fake nails, nail polish, and even ambient lighting. This paragraph will discuss the impact of long nails and nail treatments on pulse oximeter readings and explore whether they can affect the accuracy of these important medical measurements.
| Characteristics | Values |
|---|---|
| Long nails | Artificial acrylic nails |
| Fake nails | |
| Nail polish | Thick nail polish |
| Dark nail polish colours | |
| Impact on pulse oximeter readings | Inconsistent readings |
| Inaccurate readings | |
| No impact on readings | |
| Factors affecting pulse oximeter readings | Ambient lighting |
| Skin pigmentation | |
| Poor peripheral perfusion | |
| Anemia | |
| Hypotension | |
| Cold extremities |
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What You'll Learn
Nail polish colour may affect readings
Pulse oximeters are devices used to determine the oxygen saturation in patients' blood. They are widely used, especially for patients undergoing surgical procedures or suffering from respiratory ailments. The device is clipped onto a person's fingertip and emits a low infrared light that penetrates the skin and counts the number of oxygenated blood cells flowing through the veins.
Nail polish and artificial nails have been thought to affect pulse oximeter readings. This is because the light emitted by the device may be reflected by the nail polish or artificial nails, preventing it from fully penetrating the finger. This can result in inaccurate readings. However, recent studies have shown that nail treatments such as nail polish and artificial nails do not significantly affect pulse oximeter readings. These studies found that nail treatments did not cause a difference in blood oxygen readings greater than 1%, which is within the standard margin of error for pulse oximeters.
While nail treatments may not significantly affect pulse oximeter readings, the colour of nail polish may have some influence. A study found that a patient with different colours of nail polish on each fingernail had inconsistent oxygen saturation readings. The dark forest green colour consistently gave significantly lower readings compared to the control, while orange and purple colours gave readings similar to the control. Another study found that black, blue, and green colours significantly reduced saturation readings, while brown had an effect as well.
Based on these findings, it can be concluded that while nail polish colour may affect pulse oximeter readings to some extent, it does not have a clinically relevant impact. This is especially true when using modern devices with high-performance LED and sensor technology. Therefore, it is not necessary to remove nail polish during emergency situations to obtain valid oximetry measurements. However, it is still recommended to remove nail polish or artificial nails when using a pulse oximeter to ensure the most accurate readings.
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Nail treatments may not affect readings
The accuracy of pulse oximeters can be affected by a variety of factors, including skin pigmentation, ambient lighting, and the positioning of the probe. While nail treatments such as acrylic nails or nail polish have been thought to interfere with pulse oximetry readings by reflecting light back into the sensor, recent studies have found that these treatments do not significantly affect blood oxygen readings.
Researchers from University College Cork and South Infirmary Victoria University Hospital surveyed a small group of healthcare professionals and experimentally assessed the impact of nail treatments on blood oxygen saturation (SpO2) measurements under different physiological conditions. They found that none of the nail treatments examined caused more than a 1% variation in SpO2 readings compared to untreated nails, which is within the standard margin of error for pulse oximeters.
Additionally, a systematic review by Sendoa Ballesteros and colleagues analysed data from 440 individuals who participated in 12 clinical trials and concluded that while nail varnish may slightly alter blood oxygen saturation readings, this alteration is not clinically relevant, especially when using modern devices with high-performance LED and sensor technology. Therefore, it is not necessary to remove nail polish during an emergency situation to obtain valid oximetry measurements.
Furthermore, Hinkelbein et al. found that nail polish colour did not exert a clinically significant effect on pulse oximetry readings, with a mean error of measurement within ±2%. These findings suggest that nail treatments may not significantly impact the accuracy of pulse oximetry readings and that hospitals may not need to require the removal of nail treatments prior to using DPO equipment.
However, it is important to note that there are conflicting findings regarding the impact of nail treatments on pulse oximetry readings. Some studies have reported that certain colours of nail polish, such as dark colours like black, blue, and green, can reduce saturation readings. Additionally, almost half of the respondents in a survey of clinical staff at four university hospitals stated that nail treatments affected their clinical practice. Therefore, while nail treatments may not significantly affect pulse oximetry readings in most cases, there may be specific situations or contexts where they can interfere with the accuracy of the measurements.
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Bright ambient lighting may affect readings
Bright ambient lighting may affect pulse oximeter readings. The pulse oximeter probe emits a low infrared light that penetrates the skin and counts the number of oxygenated blood cells flowing through the veins. However, bright ambient lighting can dilute these infrared rays, leading to a higher likelihood of incorrect readings. This issue can be mitigated by avoiding the use of pulse oximeters near highly saturated lighting sources.
The accuracy of pulse oximeter readings can be influenced by certain environmental and physiological conditions. While nail treatments such as acrylic nails or nail polishes may not significantly impact readings, it is important to consider the potential impact of light reflection from these treatments. Bright ambient lighting can interact with the infrared light emitted by the pulse oximeter, affecting the accuracy of the sensor's measurements.
In a study conducted by researchers from University College Cork and South Infirmary Victoria University Hospital, the impact of nail treatments on blood oxygen saturation (SpO2) measurements was assessed under different physiological conditions. The results indicated that nail treatments did not cause a significant difference in blood oxygen readings, and it was recommended that hospitals should not require the removal of nail treatments prior to using DPO equipment.
However, it is important to note that the colour of nail polish or acrylic nails might affect oxygen saturation readings. A Nigerian study found that dark forest green nail polish consistently resulted in significantly lower oxygen saturation readings compared to control measurements. Other colours, such as orange and purple, had less impact on the readings.
To ensure accurate pulse oximeter readings, it is recommended to avoid bright ambient lighting and pay attention to the positioning of the probe. Additionally, the presence of accessories on the fingers, such as fake fingernails or thick nail polish, may reflect light back into the sensor, interfering with the device's functionality. Therefore, removing these products is advised for optimal sensor performance.
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Skin pigmentation may affect readings
Skin pigmentation may affect pulse oximeter readings. Pulse oximeters work by shining light through the skin and measuring how much is absorbed. Melanin, the pigment that determines skin colour, also absorbs light. Higher levels of melanin, found in darker skin, can interfere with the device's readings. This is a systemic issue that puts patients with darker skin at risk.
A 2022 study from Harvard Medical School and Brigham and Women's Hospital found that Black, Hispanic, and Asian patients in intensive care units were more likely to have falsely elevated oxygen readings than White patients. As a result, they received less supplemental oxygen. This reveals a direct link between device inaccuracy and unequal treatment. The study's corresponding author, Eric Gottlieb, stated:
> "It's important to keep in mind that pulse oximeters give us an estimate, but it's more than just a number. We use that estimate to make clinical decisions, such as how much supplemental oxygen to give a patient."
Another study of 1,760 paired measurements of blood oxygen levels from 631 critically ill patients at Zuckerberg San Francisco General Hospital found that pulse oximeters underestimated blood oxygen levels overall. However, for patients with darker skin, the margin of error often flipped in the opposite, more dangerous direction—overestimating oxygen levels and potentially delaying care.
The FDA has recognized the limitations of pulse oximeters, particularly in different populations. Studies have shown that individuals with darker skin tones may receive less accurate readings due to the technology's initial design, which does not always account for variations in skin pigmentation. The FDA is actively revisiting the evaluation processes for pulse oximeters, focusing on how factors such as race and skin pigmentation impact readings. Efforts are underway to create devices that provide accurate readings across varying skin colours.
To maximize the reliability of pulse oximeters, users should be mindful of the various factors that can influence readings, including skin pigmentation, poor circulation, skin temperature, fingernail polish, bright light exposure, and smoking tendencies. Following the manufacturer's instructions is also essential.
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Intravenous dyes may affect readings
Intravenous dyes used in diagnostic and haemodynamic testing may affect pulse oximeter readings by causing inaccurate, usually lower, estimates of oxygen saturation. The dyes interfere with the amount of specific infrared or red wavelength detected by the device.
Indocyanine green (ICG), for example, absorbs light with a wavelength of 805 nm, which falsely decreases the amount of 805 nm light detected by the cerebral oximeter. This light is displaced as an increased SctO2 reading. Intravenous ICG administration has also been shown to cause a false decrease in SaO2 readings.
Similarly, indigo carmine, commonly used during urologic surgical procedures, causes a false decrease in SaO2 readings by decreasing the amount of red light (660 nm) detected by the pulse oximeter.
Methylene blue, used to treat vasoplegic syndrome, has an absorption peak at 668 nm and shows a dose-dependent effect on plasma light absorbance, resulting in falsely low values on pulse oximeters and cerebral oximeters.
Therefore, clinicians should be aware of the effects of intravenously administered dyes on pulse oximetry readings and interpret the values shown on optical technology-based patient monitors with caution.
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Frequently asked questions
Long nails themselves do not affect pulse oximeter readings. However, nail treatments such as nail polish or acrylic nails can affect readings.
Nail treatments can reflect light back into the sensor, preventing it from fully penetrating the finger. This can cause inaccurate readings.
Dark colours such as black, blue, and green have been found to reduce saturation readings. However, some studies suggest that nail polish colour does not have a clinically relevant effect on pulse oximetry readings.
It is generally recommended to remove nail treatments before using a pulse oximeter to ensure accurate readings. However, some studies suggest that hospitals should establish policies that do not require the removal of nail treatments before using DPO equipment.
In addition to nail treatments, factors such as skin pigmentation, ambient lighting, and positioning of the probe can also affect pulse oximeter readings. Pulse oximeters are under scrutiny for their accuracy with patients with darker skin tones.
