Summary:

Oxygen saturation is one of the important vital signs to be measured and monitored for
critically ill patients. One of the important factors is nursing practices such as suctioning, positioning,
turning, and bathing can lead to oxygen desaturation. This study was conducted to determine the
relationship between nursing practices and oxygen desaturation in critically ill patients, with the goal
of optimizing tissue perfusion and maintaining adequate oxygen delivery, nurses play an important
role in monitoring oxygenation and ventilation. Nursing practices may affect oxygen saturation in
critically ill patients.

Tracheal suctioning is an invasive and blind procedure with many adverse effects including
decreased oxygen saturation, therefore, patients need to be hyper oxygenated before, during and
after suctioning. But, nurses sometimes do not adhere to the best practice recommendations when
performing suctioning like hyper oxygenation and infection control practices which can cause other
complications specifically oxygen desaturation. Body positions affect oxygenation especially in
critically ill patients as positioning and mobilization of patients contribute to improved oxygenation,
secretion removal, and airway patency. Sitting patients on the bed resulted in oxygen desaturation
(SpO2<80%). In another study, desaturation of more than 5% occurred in 6% of patients when
performing patients‘ positioning and turning. Bathing can bring about different effects: on thermal
regulation, microbiology, boxy hemodynamic balance, hospital costs, and client satisfaction.
Temperature should be ranging from 37°C to 40°C. bathing. It is an important therapeutic procedure
and despite it is little appreciated and discussed in many clinical areas.

A descriptive research design was used in this study. The present study was conducted in the
Critical Care Units (CCUs) of two selected Hospitals at Makah Al- Mukaramah. A convenience sample
of 100 newly admitted critical patients was recruited for the study but A pilot study was conducted
on (10%) of patients first before proceeding, necessary modifications of the tool were done
according to pilot results. The tool of data collection was the relationship between nursing practices
and oxygen desaturation in critically ill patients’ tool. It consists of two parts: Part 1 which is nursing
practices observation checklists and part 2 which is oxygen saturation monitoring record.

There were significant relationships between oxygen desaturation and the procedures
performed as oxygen saturation decreased during and after procedures performed especially with
suctioning, bathing and CVP measurement. In addition, there were significant correlation between
oxygen saturation during, and after bathing oxygen saturation and during measuring CVP. It can be
concluded that the nursing practice mainly suctioning, positioning and bathing may lead to oxygen
desaturation of critically ill patients. Significant relationships between oxygen desaturation and the
procedures performed as oxygen saturation decreased during and after certain performed
procedures especially suctioning.

The researcher recommends that protocols should be developed regarding oxygen

desaturation in critically ill patients. Adequate supervision should be provided on nurses during their
practice.
Reaction:

I choose this journal because as a student nurse, we should be capable of promoting our
patient’s health and preventing further complications on their condition. As a nurse, we should know
how to deal with our patient’s condition and should also know how to manage it properly.

I learned that proper assessment on oxygenation is a must, thereby we should make

accurate and precise nursing intervention specifically on patient who has respiratory problems. In
the area, patient with low O2 saturation should be given full course of nursing care and shouldn’t be
disregard because oxygen desaturation is a life threatening condition. So as a nurse, I should be able
to monitor O2 saturation frequently or as ordered specially when suctioning for secretions. I should
be also performing all nursing interventions carefully specifically those interventions that involves
moving the patient, because this might cause lowering of O2 saturation. I should also hyperventilate
my patient first before suctioning.

This journal has a wide implication on the knowledge and skills that I should be performing to
the patients who has respiratory problem and low oxygen saturation level. However, we should also
consider those patients who have high risk of having low oxygen saturation level.

This journal can also be use on nursing education by emphasizing the importance of low
oxygen saturation and determining factors that can affect it, like suctioning. Particularly, in the RD,
this journal wants to reminds us that hyper oxygenation should be emphasized well before
suctioning.

This journal also alarms us that oxygen desaturation is a life threatening condition, thereby
topics related to it should be emphasize well in order for the student nurses not to commit error that
may lead to complications, or worse, death of the patient. It also contributed that suctioning,
positioning and bathing can affect oxygen desaturation.

This can also be use in nursing research to serve as a baseline for other research. Primarily it
could be used for research that aims to know other factors or nursing practices that can affect
oxygen desaturation. It can be used as a source for making hospital protocols that can develop
oxygen desaturation in critically ill patients.

RELATED LEARNING LITERATURES:

1. Low oxygen saturation and mortality in an adult cohort: the Tromso study
Background:
Oxygen saturation has been shown in risk score models to predict mortality in emergency medicine.
The aim of this study was to determine whether low oxygen saturation measured by a single-point
measurement by pulse oximetry (SpO2) is associated with increased mortality in the general adult
population. Results
 The mean age was 65.8 years, and 56% were women. During the follow-up, 1,046
(20.3%) participants died. The age- and sex-adjusted hazard ratios (HRs) (95% confidence intervals)
for all-cause mortality were 1.99 (1.33–2.96) for SpO2 ≤ 92% and 1.36 (1.15–1.60) for SpO2 93–95%,
compared with SpO2 ≥ 96%. In the multivariable Cox proportional-hazards regression models that
included selfreported diseases, respiratory symptoms, smoking history, BMI, and CRP levels as the
explanatory variables, SpO2 remained a significant predictor of all-cause mortality. However, after
including forced expiratory volume in 1 s percent predicted (FEV1% predicted), this association was no
longer significant. Mortality caused by pulmonary diseases was significantly associated with SpO2
even when FEV1% predicted was included in the model. Conclusions
 Low oxygen saturation was
independently associated with increased all-cause mortality and mortality caused by pulmonary
diseases. When FEV1% predicted was included in the analysis, the strength of the association
weakened but was still statistically significant for mortality caused by pulmonary diseases.
2. Effect of hyperoxygenation for one and two minutes on PH, Pao2, Paco2, O2sat during
endetracheal suctioning in patient under mechanical ventilation in ICU in Zanjan Vali-e-Asr hospital
2011
Background and objective: Endotracheal suctioning (ETS) is a inevitable procedure in patient under
mechanical ventilation. The most important complication of this procedure is hypoxemia. The aim of
this study is effect of hyperoxygenation for one and two minutes on hypoxemia during ETS. This
study is a clinical trial on 30 patients under mechanical ventilation in ICU of Vali-e-Asr hospital in
Zanjan. The samples are selected based on study criteria. Finding show that in comparison two long
of time hyperoxygenation for one and two minute during ETS has not meaningful effect on O2sat
and Pao2 but it sause meaningful effect on PH and Paco2. This recommended for best use of time
and cost and to prevent hyperoxygenation complication. For saving money and time and also for
preventing from side effects caused by HO, we need to know the most effective period of time for
UTS Results of current study shows that the duration of HO hasn’t any effect on PaO2 and O2 sat but
it can affect PH and PaCo2.

References:

Asfour, H. (2016). Oxygen Desaturation and Nursing Practices in Critically Ill Patients. Retrieved
October 03, 2016, from http://www.iosrjournals.org/iosr-jnhs/ papers/ vol5-issue2/Version-
1/L05218594.pdf

Vold et al. (2015). Low oxygen saturation and mortality in an adult cohort: The Tromsø study.
Retrieved October 03, 2016, from http:// bmcpulmmed.biomedcentral.com/ articles/10.1186/s12890-
015-0003-5

Moraveji. (2012). International Research Journal of Applied and Basic Sciences. Effect of
Hyperoxygenation for One and Two Minutes on PH, Pao2, Paco2, O2sat during Endetracheal
Suctioning in Patient under Mechanical Ventilation in ICU in Zanjan Vali-e-Asr Hospital 2011.
Oxygen Desaturation and Nursing Practices in Critically Ill Patients

A Journal Report Presented to

The Faculty of the School of Nursing

Saint Louis University

In Partial Fulfillment

Of the Requirements for NCM 108

Submitted by:

Trisha Fae B. Loyola

BSN IV- C4

Submitted to:

Engelbert C. Manuel, RN, MM-IR

Department Head, Level IV

The Impact of Evidenced-Based Practices on Postoperative Pain in Patients undergoing
Gastrointestinal Surgery in Amiralmomenin Hospital in Zabol During 2014-2015

A Journal Report Presented to

The Faculty of the School of Nursing

Saint Louis University

In Partial Fulfillment

Of the Requirements for NCM 108

Submitted by:

Rachelle E. Javier

BSN IV- C4

Submitted to:

Engelbert C. Manuel, RN, MM-IR

Department Head, Level IV