301
RLJBIN ET AL
J Oral Maxlllofac
Surg
49:301-302.1991
Digital Injury From a Pulse Oximeter Probe MITCHELL
Noninvasive tion via pulse
M. RUBIN, DMD,* HENRY C. FORD, DMD,t
monitoring oximetry
of hemoglobin
satura-
has become a popular method of assessment in various patient care settings. As with any device that comes into contact with patients, potential injury can occur. Particular concern should arise when prolonged contact occurs. ’ This is the second reported case of fingertip injury due to an oxygen saturation monitor probe following a lengthy orthognathic surgical
procedure .2 Report of a Case A 30-year-old man presented to the Nassau County Medical Center Oral and Maxillofacial Surgery Clinic for
Received from the Department of Oral and Maxillofacial Surgery, Nassau County Medical Center, East Meadow, NY. * Attending Oral and Maxillofacial Surgeon; in private practice, Rockville Centre. NY. t Resident. f Director of Advanced Training. Address reprint requests to Dr Rubin: South Shore Oral Surgery Associates, PC. 155 W Merrick Rd. Freeport, NY 11520. 0 1991 American geons
Association
of Oral and Maxillofacial Sur-
0278-2391/91/4903-0016$3.00/O
FIGURE 1.
AND RORY S. SADOFF, DDSS
consultation regarding orthognathic surgery. Following clinical, cephalometric, and model analysis, it was determined that the patient had a vertical maxillary excess and mandibular retrussion. A treatment plan was formulated consisting of Le Fort I and bilateral sagittal split ramus osteotomies. The patient’s past medical history was not significant. He had no known allergies and was taking no medication. Past surgery included a varicotomy in 1980 and lower lumbar disc surgery in 1987. Preoperative blood tests, including a complete blood count and differential count, prothrombin time/partial thromboplastin time and renal/hepatic profiles, were within normal limits. The physical examination was unremarkable. On the day of surgery, the patient’s oxygen saturation was monitored with a Space Labs (Hillsbury, OR) nondisposable oximeter probe placed on the thumb of the left hand without tape. His arms were tucked at his side in such a fashion that his hands were partially covered by his buttocks. The probe remained on the thumb continuously for 12 hours. Normotensive anesthesia was maintained throughout the procedure and the oxygen saturation never fell below 98%. On removal of the probe, a 2 x 3-cm, painful, blisterlike swelling was noted where the probe contacted the thumb (Fig 1). An orthopedic surgery consultation was obtained, and it was advised that moist sterile dressings be placed on the thumb. By the 6th postoperative week, the thumb had healed uneventfully, without any sign of permanent sensory, motor, or esthetic deficit (Fig 2).
Dorsal (A) and lateral (E) views of blister on thumb 4 days postoperatively.
302
DIGITAL INJURY FROM A PULSE OXIMETER PROBE
Discussion The suspected mechanism of injury in this case was external pressure on the probe and finger as a consequence of tucking the patient’s hand under his body when draping before surgery. Immediately on completion of the case it was noticed that his hand was being compressed by his body, and that the skin beneath the fingertip probe was purple and swollen. Unlike the case reported by Chemello et a1,2 in which the patient sustained finger injury following an 1l-hour orthognathic surgical procedure while in a reduced flow state (hypotensive anesthesia), our patient was normotensive throughout an equally lengthy procedure. In both cases, however,
the finger received an increased amount of pressure for an extended period because the arm and hand were tucked at the patient’s side, allowing some of the patient’s body weight to compress the hand. Either high pressure for short periods, or lower pressures for longer periods may cause tissue ischemia. The most important means of preventing tissue damage when pressure is unavoidable is by intermittent relief of the pressure.3 The manufacturer recommends routinely changing the probe to a different finger every 3 to 4 hours to decrease the chance of prolonged ischemia.” Pulse oximetry, unlike the use of transcutaneous oxygen electrodes,4 does not require the probe to be in tight contact with the skin so that pressure ischemia should be entirely avoidable. The treatment of the large blister that develops following prolonged pressure on the oximeter probe is to simply apply sterile dressings. The blister usually ruptures spontaneously and heals uneventfully. This was the course of recovery in both our case and that of Chemello et al.* Although the finger appeared to warrant surgical drainage, the hand surgeon recommended more conservative therapy, correctly advising that the finger would spontaneously drain and heal without surgical intervention. References
FIGURE 2. Involved finger 6 weeks postoperatively complete healing.
showing
1. Sloan TB: Finger injury by an oxygen saturation monitor probe. Anesthesiology 68:936, 1988 2. Chemello PD, Nelson SR, Wolford LM: Finger injury resulting from pulse oximeter probe during orthognathic surgery. Oral Surg 69: 161, 1990 3. Berge KH, Lanier WL, Scalon PD: Ischemic digital skin necrosis: A complication of the resuable Nellcor pulse oximeter probe. Anesth Analg 67:712, 1988 4. Miyasaka K, Ohata J: Bum, erosion, and “sun” tan with the use of pulse oximetry in infants. Anesthesiology 67: 1008, 1987
RLJBIN ET AL
J Oral Maxlllofac
Surg
49:301-302.1991
Digital Injury From a Pulse Oximeter Probe MITCHELL
Noninvasive tion via pulse
M. RUBIN, DMD,* HENRY C. FORD, DMD,t
monitoring oximetry
of hemoglobin
satura-
has become a popular method of assessment in various patient care settings. As with any device that comes into contact with patients, potential injury can occur. Particular concern should arise when prolonged contact occurs. ’ This is the second reported case of fingertip injury due to an oxygen saturation monitor probe following a lengthy orthognathic surgical
procedure .2 Report of a Case A 30-year-old man presented to the Nassau County Medical Center Oral and Maxillofacial Surgery Clinic for
Received from the Department of Oral and Maxillofacial Surgery, Nassau County Medical Center, East Meadow, NY. * Attending Oral and Maxillofacial Surgeon; in private practice, Rockville Centre. NY. t Resident. f Director of Advanced Training. Address reprint requests to Dr Rubin: South Shore Oral Surgery Associates, PC. 155 W Merrick Rd. Freeport, NY 11520. 0 1991 American geons
Association
of Oral and Maxillofacial Sur-
0278-2391/91/4903-0016$3.00/O
FIGURE 1.
AND RORY S. SADOFF, DDSS
consultation regarding orthognathic surgery. Following clinical, cephalometric, and model analysis, it was determined that the patient had a vertical maxillary excess and mandibular retrussion. A treatment plan was formulated consisting of Le Fort I and bilateral sagittal split ramus osteotomies. The patient’s past medical history was not significant. He had no known allergies and was taking no medication. Past surgery included a varicotomy in 1980 and lower lumbar disc surgery in 1987. Preoperative blood tests, including a complete blood count and differential count, prothrombin time/partial thromboplastin time and renal/hepatic profiles, were within normal limits. The physical examination was unremarkable. On the day of surgery, the patient’s oxygen saturation was monitored with a Space Labs (Hillsbury, OR) nondisposable oximeter probe placed on the thumb of the left hand without tape. His arms were tucked at his side in such a fashion that his hands were partially covered by his buttocks. The probe remained on the thumb continuously for 12 hours. Normotensive anesthesia was maintained throughout the procedure and the oxygen saturation never fell below 98%. On removal of the probe, a 2 x 3-cm, painful, blisterlike swelling was noted where the probe contacted the thumb (Fig 1). An orthopedic surgery consultation was obtained, and it was advised that moist sterile dressings be placed on the thumb. By the 6th postoperative week, the thumb had healed uneventfully, without any sign of permanent sensory, motor, or esthetic deficit (Fig 2).
Dorsal (A) and lateral (E) views of blister on thumb 4 days postoperatively.
302
DIGITAL INJURY FROM A PULSE OXIMETER PROBE
Discussion The suspected mechanism of injury in this case was external pressure on the probe and finger as a consequence of tucking the patient’s hand under his body when draping before surgery. Immediately on completion of the case it was noticed that his hand was being compressed by his body, and that the skin beneath the fingertip probe was purple and swollen. Unlike the case reported by Chemello et a1,2 in which the patient sustained finger injury following an 1l-hour orthognathic surgical procedure while in a reduced flow state (hypotensive anesthesia), our patient was normotensive throughout an equally lengthy procedure. In both cases, however,
the finger received an increased amount of pressure for an extended period because the arm and hand were tucked at the patient’s side, allowing some of the patient’s body weight to compress the hand. Either high pressure for short periods, or lower pressures for longer periods may cause tissue ischemia. The most important means of preventing tissue damage when pressure is unavoidable is by intermittent relief of the pressure.3 The manufacturer recommends routinely changing the probe to a different finger every 3 to 4 hours to decrease the chance of prolonged ischemia.” Pulse oximetry, unlike the use of transcutaneous oxygen electrodes,4 does not require the probe to be in tight contact with the skin so that pressure ischemia should be entirely avoidable. The treatment of the large blister that develops following prolonged pressure on the oximeter probe is to simply apply sterile dressings. The blister usually ruptures spontaneously and heals uneventfully. This was the course of recovery in both our case and that of Chemello et al.* Although the finger appeared to warrant surgical drainage, the hand surgeon recommended more conservative therapy, correctly advising that the finger would spontaneously drain and heal without surgical intervention. References
FIGURE 2. Involved finger 6 weeks postoperatively complete healing.
showing
1. Sloan TB: Finger injury by an oxygen saturation monitor probe. Anesthesiology 68:936, 1988 2. Chemello PD, Nelson SR, Wolford LM: Finger injury resulting from pulse oximeter probe during orthognathic surgery. Oral Surg 69: 161, 1990 3. Berge KH, Lanier WL, Scalon PD: Ischemic digital skin necrosis: A complication of the resuable Nellcor pulse oximeter probe. Anesth Analg 67:712, 1988 4. Miyasaka K, Ohata J: Bum, erosion, and “sun” tan with the use of pulse oximetry in infants. Anesthesiology 67: 1008, 1987
