Pulse Oximetry Inaccuracies in Cold Peripheries

Mechanism and Impact

Pulse oximeters rely on detecting arterial pulsations to distinguish arterial blood from venous blood and surrounding tissues, requiring pulsatile flow, which is compromised in cold peripheries 2, 3
The European Respiratory Society and American Thoracic Society acknowledge that pulse oximeters function by detecting variations in light transmission through pulsating arterial blood using two different wavelengths of light, which is affected by cold peripheries 1, 2

The American Thoracic Society notes that poor perfusion of the extremity due to cold can yield falsely low oxygen saturation readings 2, 3
Decreased pulsatility in cold peripheries makes it difficult for the device to detect adequate signals, as reported by the European Respiratory Society 1

The American College of Chest Physicians states that dark skin color can interfere with signal detection, which may be further exacerbated in cold conditions 4, 2
The American Heart Association recommends considering environmental factors, such as extreme temperatures and high humidity, which can affect device performance 5
The British Thoracic Society notes that patients with collagen vascular diseases causing severe Raynaud's phenomenon are particularly susceptible to inaccurate readings due to extreme vasoconstriction 6

The European Respiratory Society suggests actively warming the measurement site before and during measurement to improve accuracy 1
The American Thoracic Society recommends evaluating the quality of the plethysmographic waveform to help determine reliability of readings 6, 1
The American Academy of Pediatrics advises verifying readings by repositioning the probe and repeating the measurement, and never relying solely on pulse oximetry 7
The American Heart Association emphasizes the importance of understanding limitations of pulse oximetry, particularly in conditions of poor peripheral perfusion, and ensuring proper calibration and maintenance of pulse oximeters 6, 2