Forehead spo2 monitoring

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Is anyone familiar with how this device works, as it obviously does not function the same as a conventional finger probe.

A quick Google search will reveal several abstracts claiming that not only does the forehead peripheral oxygen saturation monitoring actually work, the studies also lead to the conclusion that it is more accurate than the finger pulse oximeter.

I am unable to find any literature detailing how this form of spo2 monitoring works, can anyone provide any insight and or links?

Thank you
 
I've seen this used with the normal sticker finger probe. Just instead of sticking it on the finger they stick it on the forehead. Local ER does this typically with elderly patients.
 
I am unable to find any literature detailing how this form of spo2 monitoring works, can anyone provide any insight and or links?

It's basically a "bootleg" play... the earlobe is another "wildcat" option.
 
I've seen this used with the normal sticker finger probe. Just instead of sticking it on the finger they stick it on the forehead. Local ER does this typically with elderly patients.

DO NOT do this!

That also goes for placing the finger probe on the ear.

The reps from Nellcor and Masimo (leading in pulse ox technology), if they are doing their jobs correctly, will emphasize this in the product training since liability from improper use which may give false highs that can have dire consequences due to the delay in lack of appropriate treatment.

The signal strength and wavelength are specifically designed for certain body parts which is why a weight recommendation is listed on each probe with a specific shape.

Both Masimo and Nellcor have literature from their testing on their products which was required to meet FDA approval for use.

http://www.nellcor.com/prod/product.aspx?S1=POX&S2=SEN&id=246

http://www.masimo.com/pdf/cpub/SETBiblio/LAB1942T_68.pdf

http://www.masimo.com/cpub/clinicals.htm

http://www.masimo.com/pdf/cpub/SETBiblio/Lab1942T_09.pdf

http://www.masimo.co.jp/images/cpub/b42.pdf

http://www.anestech.org/media/Publications/Annual_2004/Redford.pdf

http://www.masimo.co.jp/IMAGES/HOME/NellcorBiblio.pdf
 
Unless I'm thinking of something different, the technology involved is essentially the same; near-infrared spectroscopy.

Bring on StO2!
 
Unless I'm thinking of something different, the technology involved is essentially the same; near-infrared spectroscopy.

Did you read any of the links I posted? They explain the variations for how each sensor determines SpO2 and the factors involved.

Bring on StO2!

If some in EMS do not understand the fundamentals of SpO2, what are they going to do with StO2? That sensor is also not good for all body parts either.

As least with the SpO2 parameter EMT-Bs can provide treatment but would be very limited in correcting the StO2 value.
 
Aside from different wavelengths of light, different types of probes function differently. Probes designed to have an LED emit light on one side, and a recessed photod ecector on the other detect it. The light tends to be red (680 nm) and/or Infared (940nm), and when placed over a vascular bed, the light is absorbed differently by Arterial and Venous blood, in addition to different tissues.
The light that passes through is measured.

Vent, I have grown to learn that few people read links posted, while continuing to argue their moot (or incorrect) point, so have included color pictures to entertain the readers.

Take a look at the pictures below... see if they help. They came from a presentation that I attended a few months ago, author unknown.
LED.pox.jpg


forehead%20probe.jpg


diagram.jpg
 
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DO NOT do this!

That also goes for placing the finger probe on the ear.

The reps from Nellcor and Masimo (leading in pulse ox technology), if they are doing their jobs correctly, will emphasize this in the product training since liability from improper use which may give false highs that can have dire consequences due to the delay in lack of appropriate treatment.

The signal strength and wavelength are specifically designed for certain body parts which is why a weight recommendation is listed on each probe with a specific shape.

Both Masimo and Nellcor have literature from their testing on their products which was required to meet FDA approval for use.

http://www.nellcor.com/prod/product.aspx?S1=POX&S2=SEN&id=246

http://www.masimo.com/pdf/cpub/SETBiblio/LAB1942T_68.pdf

http://www.masimo.com/cpub/clinicals.htm

http://www.masimo.com/pdf/cpub/SETBiblio/Lab1942T_09.pdf

http://www.masimo.co.jp/images/cpub/b42.pdf

http://www.anestech.org/media/Publications/Annual_2004/Redford.pdf

http://www.masimo.co.jp/IMAGES/HOME/NellcorBiblio.pdf

I have read the links and several other pieces of literature detailing comparisons, but have yet to find anything that describes why it works?

Without a recessed photo detector opposing the light emitting diode, how are the projected waveforms measured and quantified? If a single electrode is placed on the patients forehead, and it emits a light, and there is no light sensitive detector opposite to receive the light, then how is this piece of equipment functional?
 
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I have read the links and several other pieces of literature detailing comparisons, but have yet to find anything that describes why it works?

Without a recessed photo detector opposing the light emitting diode, how are the projected waveforms measured and quantified? If a single electrode is placed on the patients forehead, and it emits a light, and there is no light sensitive detector opposite to receive the light, then how is this piece of equipment functional?

Look at the photos EMT.DAN posted. Do you see the photo detectors and note the shape of the device? It utilizes similar technology but the light emissions and photo detectors are specifically positioned and programmed for the forehead. Each different pulse oximeter works on an algorithm designed for a specific part of the body and its characteristics.

If you combine what you read with the pictures, it should make sense to you.

If you still want a technical manual, call your local representative for either Nellcor or Masimo. Your BioMed department will also have a manual available.
 
Look at the photos EMT.DAN posted. Do you see the photo detectors and note the shape of the device? It utilizes similar technology but the light emissions and photo detectors are specifically positioned and programmed for the forehead. Each different pulse oximeter works on an algorithm designed for a specific part of the body and its characteristics.

If you combine what you read with the pictures, it should make sense to you.

If you still want a technical manual, call your local representative for either Nellcor or Masimo. Your BioMed department will also have a manual available.

I see how the unit in your first post would work. I have no experience with theese, and they were explained to me by several students as a single adhesive electrode placed on the forehead, with no opposing photo detector, much like the one pictured below.
index.php


http://www.lifemedicalsupplier.com/index.php?main_page=popup_image&pID=2509
 
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I think there is a bit of a misunderstanding. There are some disposable SpO2 that are designed for the finger, others designed for the forehead.
Those designed for the finger have the LED and detector aligned to measure through the fingernail, the forehead sensors are designed differently.
I think Vent is saying that it is inappropriate (and problematic) if you use a finger probe on the forehead.
Here are some pictures of different disposable fingertip, forehead and earlobe probes.
All pictures are from allmed.net
0-315-1.jpg


0-295-1.jpg


0-296-1.jpg


0-297-1.jpg


0-299-1.jpg


-.jpg


-%20%281%29.jpg


02901.jpg
 
I think there is a bit of a misunderstanding. There are some disposable SpO2 that are designed for the finger, others designed for the forehead.
Those designed for the finger have the LED and detector aligned to measure through the fingernail, the forehead sensors are designed differently.
I think Vent is saying that it is inappropriate (and problematic) if you use a finger probe on the forehead.



0-295-1.jpg


0-296-1.jpg


]

Right and that is understood. As you can see in these pictures, there appears to be no alignment of a LED and any sort of receptor. In absence of an aligned LED and a receptor, how is spo2 measured?
 
I see how the unit in your first post would work. I have no experience with theese, and they were explained to me by several students as a single adhesive electrode placed on the forehead, with no opposing photo detector, much like the one pictured below.
index.php


http://www.lifemedicalsupplier.com/index.php?main_page=popup_image&pID=2509

If you look at the second picture posted by EMT.Dan, you will see how the photo detectors are placed. There are both light emitters and photo detectors in that single probe and its design allows for the detector to pick up the light emitted.

Now look at the difference in the placement of the light emitters and detectors on the finger probe.

The distance between the emitters and the detectors is very important for the algorithm to work as is the design of the probe. If you put a standard finger probe on the forehead, the distance and shape of the emitters and detectors are very different and the algorithm will not be correct. The calculations will be skewed and the chances of picking of other light sources increased.
 
Here is the Nellcor manual.

Read section 2.

http://www.nbngroup.com/manuals/machine/V-CliniciansSensorGuide.pdf

BTW, you agencies should have the manuals for the equipment you use at easy access for quick reference. Don't assume you know everything about something which is why some are placing finger probes on the forehead and ears.

Duhhh:blush:

Thank you EMT.DAN and Vent.

I now see that the forehead unit utilizes reflectance oximetry, while the more conventional probes are transmission oximeters.

The present invention performs its operation by the combination of the following features. First and second beams of a wavelength subjected to a change in absorbance due to a change in oxygen saturation of hemoglobin in blood of tissue of aliving body, third and fourth beams of another wavelength not subjected to any change in absorbance, and fifth and sixth beams of a further wavelength subjected to a relatively small change in absorbance due to changes in a quantity of hemoglobin andoxygen saturation, are applied to the tissue of the body, and light receiving means receives the first to sixth beams reflected from the tissue of the body. Intensities of the respective outputs of the light receiving means are evaluated and, based on apredetermined function, the quantity of hemoglobin in the tissue is calculated and the result of the calculation is outputted.

Consequently, the present invention makes it possible to avoid various problems encountered in the conventional non-invasive type oximeters, such as the ability of measuring in a body part where a pulsation component does not exist, measurementslimited only to oxygen saturation in an artery, noise due to sway or vibration of a sensor, and the ability of measuring without an optical cuvette because of an optical transmission method. Accordingly, the oximeter of the present invention is capableof evaluating lung functions, heart functions, the state of oxygen supplied to tissue, and other data in examinations of anesthesiology, dermatology, pediatrics etc., and is also capable of continuously monitoring conditions of a patient for a longperiod.
In a preferred embodiment of the present invention, a calibration mode and a measurement mode can be selected and when the calibration mode is selected, a voltage to be applied to light source means is set so that the intensity of light emittedfrom the light source means is within a predetermined range.

According to the above-mentioned preferred embodiment of the present invention, the intensity of light emitted from the light source means is calibrated prior to measurement and a quantity of hemoglobin in the tissue of the body can be measuredmore accurately.

In another preferred embodiment of the present invention, assuming that intensities of the first, second, third, fourth, fifth and sixth beams reflected from the tissue are P1, P2, P3, P4, P5 and P6, the quantity of hemoglobin in the tissue iscalculated by:

where C1, C2 and C3 are correction values.

In addition, in a further preferred embodiment of the present invention, the light source means is formed by first to sixth light sources emitting the first to sixth beams, respectively, and the first, third and fifth light sources are located atpositions distant from the center of the light receiving means by a predetermined distance d1, while the second, fourth and sixth light sources are located at positions distant from the center of the light receiving means by a predetermined distance d2,with a relation of d1<d2 being maintained.

In another aspect of the present invention, first and second beams of a wavelength subjected to a change in absorbance due to a change in oxygen saturation of hemoglobin in the blood of the tissue of a living body, third and fourth beams ofanother wavelength not subjected to any change in absorbance, and fifth and sixth beams of a further wavelength subjected to a relatively small change in absorbance due to a change in oxygen saturation are applied to the tissue of the body and the firstto sixth beams relected therefrom are detected, whereby intensities of the respective beams are evaluated and the oxygen saturation of the tissue is evaluated based on a predetermined function.

Consequently, according to this aspect of the invention, it becomes possible to measure the oxygen saturation in a body part not containing a pulsation component, which could not be measured in a conventional apparatus.

These objects and other objects, features, aspects and advantages of the present invention will become more apparent from the following detailed description of the present invention when taken in conjunction with the accompanying drawings.
Oximetry can be implemented either in a transmission mode or in a reflectance mode. In transmission mode oximetry, a tissue sample is transilluminated and the intensity of specific wavelengths of light transmitted through the tissue sample is measured to determine the percentage of oxygenated hemoglobin. In reflectance mode oximetry, the tissue sample is illuminated and the intensity of specific wavelengths of backscattered light is measured to determine the percentage of oxygenated hemoglobin.

The invention concerns an apparatus for indicating the oxygenation of a tissue sample. The apparatus comprises a means for producing light of an intensity capable of penetrating material adjacent the tissue sample, such that the light is reflected by the tissue sample back through the material. The apparatus also comprises a means for responding to the reflected light and for producing an output signal related to the oxygenation of the tissue sample.
http://www.patentstorm.us/patents/4867557/description.html
http://www.patentstorm.us/patents/5069214/description.html
 
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DO NOT do this!

That also goes for placing the finger probe on the ear.

I was aware that probes placed in places 'non-typical' tend to be less accurate, but not to such an extent. I will take a look at the links you have posted. I have not done that in the field (as of yet) but I have seen other medics do it. As well the ER where I do my clinical time will sometimes do the forehead probe, mostly on elderly patients that get extremely inaccurate readings from the fingers.

Thanks for the heads up and links :)
 
I was aware that probes placed in places 'non-typical' tend to be less accurate, but not to such an extent. I will take a look at the links you have posted. I have not done that in the field (as of yet) but I have seen other medics do it. As well the ER where I do my clinical time will sometimes do the forehead probe, mostly on elderly patients that get extremely inaccurate readings from the fingers.

Thanks for the heads up and links :)

Good article with references:

http://www.clinicalwindow.net/cw_issue_19_article3.htm

Another one that discusses proper positioning.
http://www.ncbi.nlm.nih.gov/sites/entrez/19843792?dopt=Abstract&holding=f1000,f1000m,isrctn
 
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