Training activity information
Details
Prepare and perform oximetry, to include two of the following:
- Pulse oximetry
- Invasive (svO2)
- Oxygen uptake (VO2)
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- Limitations of techniques
- Standard Operating Procedures
- Local and national guidance
- Interpretation and validation of waveform
- Interpretation of the waveform for diagnostic value
- Patient centred care and support
- Communication with patients, relatives and the clinical team
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
What does success look like?
- Identify what is expected of you in relation to preparing and performing different types of oximetry.
- Consider how the learning outcomes apply, specifically in relation to applying techniques to monitor respiratory function and practicing safely.
- Discuss with your training officer to gain clarity of what is expected of you in relation to criteria defining successful application and performance for pulse oximetry, invasive svO2, and VO2 measurement.
What is your prior experience of this activity?
- Think about what you already know about the principles of oxygen saturation measurement and oxygen uptake.
- Consider possible challenges you might face during the activity, such as obtaining a reliable signal, troubleshooting sensor application, or interpreting results in specific patient conditions (e.g., poor perfusion, anaemia, CO poisoning for pulse oximetry).
- Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if you struggle to obtain a reliable signal due to patient factors or encounter a discrepancy between expected and measured values.
- Acknowledge how you feel about preparing and performing oximetry in the full context of the training activity.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as setting up and performing measurements using different oximetry devices.
- Identify the specific insights you hope to gain into factors affecting pulse oximetry accuracy or the clinical application of svO2 or VO2 monitoring.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of this activity or similar tasks.
- Identify important information you need to consider before embarking on the activity, such as device-specific instructions, sensor placement, calibration procedures, or factors affecting accuracy (e.g., poor perfusion, anaemia, CO poisoning for pulse oximetry).
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst preparing and performing oximetry (pulse oximetry, invasive (svO2), oxygen uptake (VO2))?
- Are you encountering situations such as:
- You get unexpected oximetry readings (e.g., very low/high SpO2, unusual svO2 or VO2 values)?
- You face technical issues with the sensor placement, monitor connection, or data display?
- This monitoring process compares differently to previous times you’ve performed oximetry?
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to troubleshooting the signal by checking probe position, patient circulation, or connections if readings were surprising or equipment faulty? Did unexpected readings or issues affect your confidence in obtaining valid oximetry data?
- Consider the steps you are taking in the moment, such as checking probe position, patient circulation, or connections if readings were surprising or equipment faulty.
- How are you feeling in that moment? For instance, are you finding it difficult to interpret unexpected oximetry results or deal with equipment issues? Is it affecting your confidence in obtaining valid oximetry data?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you able to obtain reliable oximetry measurements, following correct procedures and working within your scope of practice? Or are you needing support because the technical fault with the svO₂ catheter or VO₂ system cannot be resolved by routine troubleshooting and requires specialist intervention?
- What are you learning as a result of the unexpected development? For example, are you mastering a technique for troubleshooting oximetry signals or specific measurement techniques (SpO2, svO2, VO2) from the unexpected event?
On action
What happened?
- Begin by summarising the key steps you took when preparing and performing the specified oximetry type(s).
- Consider specific events, actions, or interactions which felt important, such as successfully calibrating the invasive svO₂ catheter or obtaining a stable VO₂
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately repositioning the pulse oximetry sensor when movement artifact obscured the waveform.
- How did you feel during this experience, e.g., did you feel challenged by the setup complexity of oxygen uptake (VO2) monitoring or confident in troubleshooting application of monitoring electrodes/sensors?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding preparing and performing oximetry. What strengths did you demonstrate, e.g., technical accuracy in sensor application for pulse oximetry, even with poor perfusion?
- What skills and/or knowledge gaps were evident, e.g., uncertainty about the clinical interpretation of svO₂ values or the measurement principles underpinning VO₂?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in understanding the advantages and disadvantages of measuring resting energy expenditure (VO2) as opposed to calculated estimations?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding troubleshooting application of monitoring electrodes/sensors that consistently failed to provide a reliable reading, and how you reacted to this.
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to reviewing the measurement principles underpinning oximetry and oxygen uptake.
- What will you do differently next time you approach oximetry, for instance, by proactively checking patient-specific factors (e.g., anaemia or carbon monoxide exposure) that might compromise pulse oximetry accuracy?
- Do you need to practise any aspect of the activity further, such as the calibration procedure for invasive svO₂ or key learning outcomes related to applying techniques to monitor respiratory function?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of interpreting metabolic data (VO₂/VCO₂) or tissue oxygenation data (svO₂) in complex patients since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, encountering difficulty correlating low SvO₂ with patient clinical status forced you to re-evaluate the assumption of sensor accuracy during your first attempt at this training activity.
- Considering what you understand about oxygen saturation measurement, principles of VO₂ monitoring, and monitoring respiratory function now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your performance of oximetry measurements and interpretation of metabolic data based on further learning and experiences? For example, how you proactively integrated a more systematic check for patient factors (e.g., poor perfusion, anaemia) that compromise pulse oximetry accuracy based on further learning.
- Has discussing unexpectedly low pulse oximetry readings or the impact of svO₂ or VO₂ data on patient nutrition decisions with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior specialist about a case where inaccurate pulse oximetry due to CO poisoning refined your understanding of the critical need to consider technical limitations.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent respiratory and metabolic monitoring experiences, contributed to your overall confidence and ability in technical data acquisition and interpreting oxygenation or metabolic status, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated technical proficiency, data acquisition skills, and understanding of factors affecting oximetry accuracy now enables you to confidently acquire and interpret oxygenation or metabolic data during relevant case discussions or assessments.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to oximetry performance and result interpretation? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice from the Training Officer or Specialist Clinician immediately when unresolvable technical faults (e.g., with an invasive svO₂ catheter) or significant discrepancies between expected and measured values occur, recognising this requires specialist intervention or clinical correlation.
- Looking holistically at your training journey, how has this initial oximetry performance experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to applying techniques to monitor respiratory function? For example, how this foundational experience has supported your development in developing practical skills with medical devices and interpreting physiological processes related to critical care monitoring.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 5 |
Outcome
Apply techniques to monitor respiratory function in critically ill patients. |
| # 6 |
Outcome
Apply techniques to monitor temperature in critically ill patients. |
| # 8 |
Outcome
Practice safely in accordance with guidance and legislation to minimise risk in all elements of patient care. |