The effect of venous pulsation on the forehead pulse oximeter wave form as a possible source of error in Spo2 calculation
Abstract
Reflective forehead pulse oximeter sensors have recently been introduced into clinical practice. They reportedly have the advantage of faster response times and immunity to the effects of vasoconstriction. Of concern are reports of signal instability and erroneously low Spo(2) values with some of these new sensors. During a study of the plethysmographic wave forms from various sites (finger, ear, and forehead) it was noted that in some cases the forehead wave form became unexpectedly complex in configuration. The plethysmographic signals from 25 general anesthetic cases were obtained, which revealed the complex forehead wave form during 5 cases. We hypothesized that the complex wave form was attributable to an underlying venous signal. It was determined that the use of a pressure dressing over the sensor resulted in a return of a normal plethysmographic wave form. Further examination of the complex forehead wave form reveal a morphology consistent with a central venous trace with atrial, cuspidal, and venous waves. It is speculated that the presence of the venous signal is the source of the problems reported with the forehead sensors. It is believed that the venous wave form is a result of the method of attachment rather than the use of reflective plethysmographic sensors.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Pulse oximetry values were both lower in cases where CVP contributed to the signal.
“The pulse oximetry values were both lower in cases where CVP contributed to the signal.”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [125]
Shelley et al. and Sami et al. both demonstrated the influence of the venous signal on SpO2, showing that forehead and earlobe pulse oximeters produced a significantly biased variable component of the PPG determined to originate from central venous pressure (CVP).
“Shelley et al. and Sami et al. both demonstrated the influence of the venous signal on SpO2, showing that forehead and earlobe pulse oximeters (respectively) produced a significantly biased variable component of the PPG determined to originate from central venous pressure (CVP) [125,127].”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [125]
The difference in compliance between the arterial and venous systems, as well as the lower-pressure gradient, translates to the relative amplitude of the AC venous component of the PPG being smaller than the AC arterial component.
“The difference in compliance between the arterial and venous systems, as well as the lower-pressure gradient, translates to the relative amplitude of the AC venous component of the PPG being smaller than the AC arterial component [125].”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [125]
Eliminating venous contributions to PPG by application of contact pressure may eliminate the arterial pulsation in hypotensive patients as well as increase pressure-induced injury risk to the measurement site.
“However, it is possible that this will eliminate the arterial pulsation in hypotensive patients as well as increase pressure-induced injury risk to the measurement site [125].”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [125]
The citation lists haven’t been fetched yet
References 7 · Cited by 91
- Authors
- Shelley, K. H., Tamai, D., Jablonka, D., Gesquiere, M., Stout, R. G., & Silverman, D. G.
- Affiliations
- Yale University (US)
- Corresponding author
- Shelley, Kirk H.
- Venue
- Anesthesia & Analgesia
- Published
- 2005-03
- Volume
- 100
- Issue
- 3
- Pages
- 743-747
- ISSN
- 0003-2999 (ISSN-L)
- OpenAlex
- W2035219544
- Cited by
- 91
- References
- 7
- Citations by year
- 2025: 2 · 2024: 4 · 2023: 2 · 2022: 7 · 2021: 9 · 2020: 2 · 2019: 3 · 2018: 5 · 2017: 7 · 2016: 3 · 2015: 5 · 2014: 4 · 2013: 3 · 2012: 3
- FWCI
- 5.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Anesthesia & Analgesia (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Optical Imaging and Spectroscopy Techniques
- Keywords
- venous pulsation, central venous pressure, pressure dressing
- MeSH terms
- Female, Forehead, Humans, Male, Oximetry, Oxygen, Plethysmography, Veins
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
