White Paper • May 2010 Pulse Oximetry at Home Patricia B. Koff, MEd, RRT, Affiliate Faculty Member, University of Colorado, Denver, Colorado Introduction The use of pulse oximetry at home has expanded over the past twenty years and is expected to be one of the major growth areas in home monitoring during the next decade.1 Initial use at home in the early 1990s focused on continuous monitoring with home mechanical ventilation and sleep studies.2-6 Intermittent spot-check use at home has become more common in recent years with conditions such as Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure (CHF) and others requiring longterm oxygen therapy. Self-monitoring enables patients to become more active participants in their health care. As the population ages and the incidence of pulmonary and cardiac diseases continue, home pulse oximetry can provide objective data for determining health status and the possible need for medical consultation or interventions. The use of spot-check devices can eliminate the “nuisance alarm” situations sometimes encountered with continuous use and are easy for a patient to use. If spot checks are sufficient, proven fingertip pulse oximeters such as Nonin’s Onyx® 9500, Onyx® II 9550 and GO2™ are useful in providing assurance and peace of mind to the patient and family. The first fingertip oximeter, Onyx 9500, was introduced in 1995 by Nonin Medical which revolutionized the portability and availability of pulse oximetry to both caregivers and individual patients. Fingertip pulse oximeters are portable, battery operated, and user friendly. However, other factors to consider when choosing a personal device are durability and accuracy. Quality fingertip pulse oximeters can yield solid results and provide an assessment of oxygen status and health stability in the homecare setting. With fingertip pulse oximeters being introduced to the market, patients and caregivers alike will have added questions on how to choose and use a fingertip pulse oximeter in the home environment. Throughout this paper, we will describe our experience in using fingertip pulse oximeters in the home environment, as well as the key features and functions to consider when choosing a quality fingertip pulse oximeter for home health use. The type of patient being monitored along with the complexity of the medical situation can help drive the decision to use a continuous, alarmed device or a simpler spot-check device. A patient in a more severe state, such as dependence on a ventilator or life-support system, is more likely to require continuous monitoring, while others will be sufficiently served with a spot-check device. Patricia Koff is an affiliate faculty member of the Division of Pulmonary Sciences and Critical Care Medicine at the University of Colorado. She has a Masters in Education from the University of Florida in Gainesville and is a registered respiratory therapist. She has been actively involved in COPD care for the past eight years— primarily in eHealth programs focused on remote monitoring and integrated care. She first became involved in the technology related area for healthcare in 2002 while working with the University of Barcelona pulmonologists. Since then, she has presented abstracts related to the topic at numerous pulmonary meetings and currently is developing papers related to the COPD eHealth Program and the 600 plus participants in both urban and rural settings in Colorado for potential publication.

White Paper • May 2010 The University of Colorado Hospital – Integrated eHealth Home Program At the University of Colorado Hospital, we incorporated the use of home pulse oximetry spot-checks into the, “Integrated eHealth for COPD” remote home monitoring program from 2004 to 2009.7-11 Three formal studies were conducted with over 650 patients enrolled. At the enrollment clinic visit, patients were assessed at rest and during a six minute walk test (defined as “exercise” for this group). Patients enrolled in the “treatment” group received a personal fingertip pulse oximeter, a Health Buddy® telecommunication...

Pulse Oximetry at Home The use of a personal oximeter enabled patients to note oxygen saturation levels and better control the oxygen delivery to achieve appropriate oxygenation levels both at rest and during exercise. As it can be extremely difficult for some people to face the need for supplemental oxygen, patients were able to recognize their desaturation episodes and, in many cases, realize that their doctor’s advice to wear oxygen was indeed appropriate. (The fact that they could see the actual oxygen saturation levels during different activities of daily living opened a window of understanding...

Pulse Oximetry at Home need for some to change batteries. For those units that did require battery changes, the changes were easily accomplished at home by the patient. At the completion of the program, mean oxygen saturation with exercise was improved. Patients’ ability to walk a greater distance in six minutes was also improved and dyspnea levels were reduced. All of these factors most likely contributed to the improved quality of life scores that were also obtained with the treatment group participants in the program. In addition, health care expenses were projected to be reduced.7 Cautions...