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Fake nails do not appear to affect digital pulse oximetry readings

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Nail treatments do not affect readings of patients’ oxygen levels, despite widespread concern, according to researchers from Ireland.

They found that, contrary to previous thinking, nail treatments such as acrylic nails or nail polishes did not affect readings from digital pulse oximetry (DPO) devices used in hospitals.

“Knowledge of, and approach to potential complications of nail treatments on DPO varies among healthcare staff”

Study authors

The researchers noted that the DPO device fits around the fingertip including the nail, and the side facing the nail is emitting light which is detected by a sensor on the far side of the fingertip.

Researchers, from University College Cork and South Infirmary Victoria University Hospital, surveyed attitudes and approaches to the issue among a small group of healthcare professionals.

They also experimentally assessed the effect of nail treatments on blood oxygen saturation (SpO2) measurements under different physiological conditions.

The nail treatments the team studied were acrylic nails and differing colours of nail polish or varnish.

They issued a questionnaire to clinical staff at four university hospitals to assess their knowledge and opinions on how nail treatments impact clinical decisions pertaining to DPO.

They also conducted an experiment on 12 volunteers to analyse the effects of nail polish of different colours and acrylic nails from popular brands on SpO2 under varying physiological conditions – healthy, venous congestion, and venous constriction.

“It would be reasonable to establish hospital policies that do not require prior removal of nail treatments”

Study authors

Congestion was modelled by applying a blood pressure cuff to restrict blood flow, while constriction was modelled by immersing the subject’s hand in cold water at 10 degrees for 10 minutes.

There were 86 responses to the survey – 55 doctors and 21 nurses – with 45% of respondents saying that nail treatments affected the way they conducted their clinical practice. More than 30% of those surveyed had intervened to remove nail treatments to prevent them affecting DPO readings.

The experimental part of the study found none of the treatments examined caused more than a 1% variation in SpO2 readings under any of the conditions tested, compared to untreated nails.

Furthermore, none of the treatments resulted in an SpO2 of less than 95%, at which intervention with oxygen therapy is recommended.

The study authors said: “Knowledge of, and approach to potential complications of nail treatments on DPO varies amongst healthcare staff, with poor knowledge or understanding of effects.”

They suggested that hospitals should establish policies that do not require the removal of any of the nail treatments examined in their study prior to the use of DPO equipment.

“Our survey data suggest it would be reasonable to establish hospital policies that do not require prior removal of nail treatments examined in this study,” they said.

They added: “Experimental data indicate the nail treatments specified do not contribute significantly to a difference in blood oxygen readings, therefore have no clinical impact on patient care.”

The research was presented at this year’s Euroanaesthesia congress in Copenhagen in Denmark.

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Readers' comments (1)

  • It might sound silly, but I have noted that the biggest (external, not talking about 'shocked' patients) problem are silver blinds at the window. These can strangely refract the light and somehow make the assessment very difficult and unreliable. I always cover the pulse oximeter with the sheet or blanket and it appears to do the trick.

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