Işıl İrem BUDAKOĞLU, Tuğba Şişmanlar EYÜBOĞLU, Elif KELEŞ, Okşan Derinöz GÜLERYÜZ

What do Intern Doctors Know about the Use of Pulse Oximetry in Pediatric Patients?

Amaç: Birinci basamakta sağlık hizmeti verecek olan intörn doktorların, çocuk hastalarda nabız oksimetre kullanımı ile ilgili bilgi düzeyleri hakkında çalışma bulunmamaktadır. Bu çalışmanın amacı, intörn doktorların özellikle çocuk hastalarda nabız oksimetre kullanımı ile ilgili bilgi düzeylerinin değerlendirilmesi ve bilgilerini etkileyen faktörlerin belirlenmesidir. Yöntem: Nabız oksimetre cihazı kullanımı ve çalışma prensipleri ile ilgili hazırlanmış on soruluk anket bir üniversite hastanesinde çalışan intörn doktorlar tarafından cevaplandırıldı. Her sorunun altında verilen olası yanıtlardan uygun olanların işaretlenmesi istendi. Bulgular: İki yüz dört anket değerlendirildi. Nabız oksimetrenin hipoksiyi ölçtüğü katılımcıların yalnızca üçte biri tarafından doğru bilindi. Cihazın komplikasyonlarının bilinme oranı çok düşüktü . Diyabet ve venöz konjesyonda kan gazı ile doğrulamanın gerekliliği ile ilgili bilginin düşük olduğu saptandı. Olgu örneklerinde uygunsuz prob yerleşiminde katılımcıların % 33'ü ve yoğun aydınlıkta katılımcıların % 26'sı uygun çözüm bulabildi. Ankette doğru yanıtların toplam puanı 22 iken katılımcıların ortalama puanı 12,9 ± 0,17'idi. Yaş ve çalışılan bölümler ile anket puanı arasında ilişki saptanmadı. Sonuç: Nabız oksimetre kullanımının önemi vurgulanmalıdır. Çocuk hastalarda nabız oksimetre kullanımı ile ilgili eğitimler yapılmalı özellikle nabız oksimetre cihazlarının kullanım kısıtlılıkları ve komplikasyonları ile ilgili eğitimler mezuniyet öncesinde arttırılmalıdır

İntörn Doktorlar Çocuk Hastalarda Nabız Oksimetre Kullanımı ile İlgili Neler Biliyor?

Objective: There is no information on how the knowledge of intern doctors that will work as primary health care providers use pulse oximetry in pediatric patients. The aim of this study was to assess and compare knowledge of intern doctors on the use of pulse oximetry especially in pediatric population and factors that affect their knowledge. Methods: A questionnaire consisting of ten questions on the use and principles of pulse oximetry were answered by intern doctors in a university hospital. A uniform answer box including possible response choices was given below each question, and subjects were asked to check the answers that they thought appropriate. Results: A total of 204 questionnaires were analyzed. Only one of third of subjects correctly answered that pulse oximetry measures hypoxia. The known complications of the procedure were not very well known (4-21%). Knowledge about the need for blood gases confirmation in diabetes (19%) and venous congestion (23%) were very low. The correct solutions were answered by 33% of subjects about inappropriate probe position and 26% about intense external light energy. The maximum score of correct answers was 22 in the questionnaire, and mean score of subjects was 12.9 ± 0.17. There was no correlation between age and number of departments with questionnaire scores. Conclusions: The importance of using pulse oximetry should be emphasized. In addition, training about pulse oximetry usage in pediatric patients especially in terms of complications and limitations of devices should be increased in the undergraduate training process

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1. Neff TA. Routine oximetry. A fifth vital sign?. Chest 1988;94:227.
2. Sarnaik AP, Clark JA, Sarnaik AA. Chapter 71: Respiratory Distress and Failure. In: Kliegman RM, Stanton BF, ST Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. Philadelphia, PA: Elsevier 2016:528-45.
3. Ortega R, Hansen CJ, Elterman K, Woo A. Videos in clinical medicine. Pulse Oxymetry. N Engl J Med 2011;364:33.
4. Fouzas S, Priftis KN, Anthracopoulos MB. Pulse oximetry in pediatric practice. Pediatrics 2011;128:740-52.
5. Dieckmann RA. Chapter 1: Pediatric Assessment. In Fuchs S., Yamamoto L. APLS: The Pediatric Emergency Medicine Resource/American Academy of Pediatrics, American College of Emergency Physicians. Sudbury, United States; Jones&Bartlett Publishers2012:2-37.
6. Seeley MC, McKenna L, Hood K. Graduate nurses' knowledge of the functions and limitations of pulse oximetry. J Clin Nurs 2015;24:3538-49.
7. Milutinović D, Repić G, Aranđelović B. Clinical nurses' knowledge level on pulse oximetry: A descriptive multicentre study. Intensive Crit Care Nurs 2016;37:19-26.
8. Kiekkas P, Alimoutsi A, Tseko F, Bakalis N, Stefanopoulos N, Fotis T, et al. Knowledge of pulse oximetry: comparison among intensive care, anesthesiology and emergency nurses. J Clin Nurs 2013;22:828-37.
9. Elliott M, Tate R, Page K. Do clinicians know how to use pulse oximetry? A literature review and clinical implications. Aust Crit Care 2006;19:139-44.
10. Gülpınar MA, Gürpınar E, Songur A, Vitrinel A. Ulusal Çekirdek Eğitim Programı, 2014. Available at: http://tip.baskent.edu.tr/kw/upload/600/dosyalar/egitim/Ulusal_ CEP.pdf. Accessed November 10, 2017.
11. Association of American Medical Colleges. Recommendations for Clinical Skills Curricula for Undergraduate Medical Education 2005: Available at: https://www.aamc.org/download/130608/data/clinicalskills_oct0 9.qxd.pdf.pdf.Accessed November 10, 2017.
12. Faculty Clinical Skills Working Party, University of Otago, Faculty of Medicine. Clinical Skills in the Undergraduate Medical Curriculum 2013: Available at: http://www.otago.ac.nz/christchurch/otago040817.pdf. Accessed November 10, 2017.
13. Mehem CC. Pulse oximetry in adults. In Uptodate web site. Available at: www.uptodate.com/contents/pulse-oximetry-inadults?source=search_result&search= pulse%20oximetry&selectedTitle=2~150. Accessed November 8, 2017.
14. Bozeman WP, Myers RA, Barish RA. Confirmation of the pulse oximetry gap in carbon monoxide poisoning. Ann Emerg Med 1997;30:608-11.
15. Tremper KK, Barker SJ. Pulse oximetry. Anesthesiology 1989; 70:98-108.
16. Van de Louw A, Cracco C, Cerf C, Harf A, Duvaldestin P, Lemaire F, et al. Accuracy of pulse oximetry in the intensive care unit. Intensive Care Med 2001; 27:1606-13.
17. Talke P, Stapelfeldt C. Effect of peripheral vasoconstriction on pulse oximetry. J Clin Monit Comput 2006; 20:305-9.
18. Haymond S, Cariappa R, Eby CS, Scott MG. Laboratory assessment of oxygenation in methemoglobinemia. Clin Chem 2005;51:434-44.
19. Pu LJ, Shen Y, Lu L, Zhang RY, Zhang Q, Shen WF. Increased blood glycohemoglobinA1c levels lead to overestimation of arterial oxygen saturation by pulse oximetry in patients with type 2 diabetes. Cardiovasc Diabetol 2012;11:110.
20. Huicho L, Pawson IG, León-Velarde F, Rivera-Chira M, Pacheco A, Muro M, et al. Oxygen saturation and heart rate in healthy school children and adolescents living at high altitude. Am J Hum Biol 2001;13:761–770.
21. Weitz CA, Garrutto RM. A comparative analysis of arterial oxygen saturation among Tibetans and Han born and raised at high altitude. High Alt Med Biol 2007;8:13–26.
22. Mau MK, Yamasato KS, Yamamoto LG. Normal oxygen saturation values in pediatric patients. Hawaii Med J 2005;64:42,44-5.
23. Balasubramanian S, Suresh N, Ravichandran C, DineshChand GH. Reference values for oxygen saturation by pulse oximetry in healthy children at sea level in Chennai. Ann Trop Paediatr 2006;26:95–9.
24. Laman M, Ripa P, Vince JD, Tefuarani N. Reference values for pulse oximetry in healthy children in coastal Papua New Guinea. P N G Med J 2009;52:8–12.
25. Stoneham MD, Saville GM, Wilson IH. Knowledge about pulse oximetry among medical and nursing staff. Lancet 1994;344:1339– 42.
26. Popovich DM, Richiuso N, Danek G. Pediatric health care providers’ knowledge of pulse oximetry. Pediatr Nurs 20014;30:14-20.
27. Bilgin H, Kutlay O, Cevheroglu D, Korfali G. Knowledge about pulse oximetry among residents and nurses. Eur J Anaesthesiol 2000;17:650-1.
28. Davies G, Gibson A, Swanney M, Murray D, Beckert L. Understanding of pulse oximetry among hospital staff. N Z Med J 2003;116:1–9.
29. Walters TP. Pulse oximetry knowledge and its effects on clinical practice. Br J Nurs 2007;16:1332-1340.