Fingertip Pulse Oximeter thumbnail 1
Fingertip Pulse Oximeter thumbnail 2
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Image of Gallery in South Kensington
On display at V&A South Kensington
Design 1900 to Now, Room 76

Fingertip Pulse Oximeter

Pulse Oximeter
2021
Artist/Maker
Place of origin

A pulse oximeter is a device which clips onto the finger and uses light to measure a patient’s pulse and blood oxygen level. First invented in 1974 by Dr Takuo Aoygi, it is an important tool for reducing deaths of patients under anaesthesia.

The device took on a new significance during the first peak of the COVID-19 pandemic in March 2020. At this time of crisis, it was used to identify ‘silent hypoxia’ – a state where blood oxygen levels become dangerously low, sometimes without outward symptoms. Early diagnosis helped save lives and as a result, the COVID Oximetry @home pathway was set up by the National Health Service (NHS) to provide home pulse oximeters for at-risk people who had tested positive for the virus.

Over the course of 2021, media attention and public awareness of evidence that suggested pulse oximeters were less effective on darker skin grew. Although this fact was known already in the early 2000s, in academic papers, such as ‘Effects of skin pigmentation on pulse oximeter accuracy at low saturation’ (1), and ‘Dark skin decreases the accuracy of pulse oximeters at low oxygen saturation: the effects of oximeter probe type and gender’ (2), a study published in December 2020 in The New England Journal of Medicine found similar results specifically linked to the COVID-19 pandemic (3). As a result of this study, the US Food and Drug Administration (FDA) issued a warning highlighting the limitations of pulse oximeters – identifying skin pigmentation, as well as other factors that may reduce efficacy – and updated recommendations on monitoring blood oxygen levels (4). In the UK, a government ordered survey, published on 2 June 2020 found that existing health inequalities – across socioeconomic, gender, and racial lines – were replicated and in some cases increased in COVID-19 health outcomes. This included the finding that: ‘people of Chinese, Indian, Pakistani, other Asian, Black Caribbean and other Black ethnicity had between 10 and 50% higher risk of death when compared to White British individuals’ (5). These findings, alongside others, contributed to growing concerns about the racial disparities in COVID-19 health outcomes.

Systemic racism within medical technologies as evidenced by the pulse oximeter was acknowledged by the UK Health Secretary Sajid Javid in November 2021 when, along with his American counterpart Xavier Becerra Secretary of Health and Human Services, he launched a review of international standards of medical devices. The review included new standards that devices must be tested on people of diverse backgrounds. He said in an interview to the Sunday Times: ‘It is easy to look at a machine and assume that everyone’s getting the same experience. But technologies are created and developed by people, and so bias, however inadvertent, can be an issue here too. So questions like who is writing the code, how a product is tested and who is sitting round the boardroom table are critical – especially when it comes to our health' (6). As an inexpensive device that is accessible on the open market and one that was distributed by health services, the pulse oximeter played an important role in triggering this broader awareness and investigation into racial bias in medical devices.

The pulse oximeter also featured as part of the V&A Pandemic Objects blog in June 2020 (7).


(1) Bickler PE, Feiner JR, Severinghaus JW. Effects of skin pigmentation on pulse oximeter accuracy at low saturation. Anesthesiology. 2005 Apr;102(4):715-9. doi: 10.1097/00000542-200504000-00004. PMID: 15791098.

(2) Feiner JR, Severinghaus JW, Bickler PE. Dark skin decreases the accuracy of pulse oximeters at low oxygen saturation: the effects of oximeter probe type and gender. Anesth Analg. 2007 Dec;105(6 Suppl):S18-S23. doi: 10.1213/01.ane.0000285988.35174.d9. PMID: 18048893.

(3) Sjoding, M., Dickson, R., Iwashyna, T., Gay, S. and Valley, T., 2022. Racial Bias in Pulse Oximetry Measurement | NEJM. [online] New England Journal of Medicine. Available at: <https://www.nejm.org/doi/full/10.1056/nejmc2029240> [Accessed 23 February 2022].

(4) U.S. Food and Drug Administration. 2022. Pulse Oximeter Accuracy and Limitations. [online] Available at: <https://www.fda.gov/medical-devices/safety-communications/pulse-oximeter-accuracy-and-limitations-fda-safety-communication?utm_medium=email&utm_source=govdelivery> [Accessed 23 February 2022].

(5) GOV.UK. 2022. COVID-19: review of disparities in risks and outcomes. [online] Available at: <https://www.gov.uk/government/publications/covid-19-review-of-disparities-in-risks-and-outcomes?utm_source=2e046dd4-5550-4042-b5a7-372873716a2a&utm_medium=email&utm_campaign=govuk-notifications&utm_content=immediate> [Accessed 23 February 2022].

(6) Thetimes.co.uk. 2022. Sajid Javid orders racial bias review after Covid deaths. [online] Available at: <https://www.thetimes.co.uk/article/sajid-javid-orders-racial-bias-review-after-covid-deaths-wxtsbsxdc> [Accessed 23 February 2022].

(7) Debenedetti, A., 2022. Pandemic Objects: Finger Oximeter • V&A Blog. [online] V&A Blog. Available at: <https://www.vam.ac.uk/blog/projects/pandemic-objects-finger-oximeter> [Accessed 23 February 2022].



Object details
Categories
Object type
Materials and techniques
Brief description
Fingertip Pulse Oximeter, designed to measure oxygen saturation using light, manufactured by aCurio, 2021.
Physical description
Medical device, hinged at one side to open and lip onto the finger. It is dark blue at the top and bottom, with a light grey middle section. On the top there is a screen, which when used can will display two numbers: one representing heartrate in BPM (beats per minute), and the other representing % of oxygen saturation in the blood.
Dimensions
  • Length: 58mm
  • Width: 35mm
  • Height: 32mm
  • Weight: 50g (Including batteries)
Production typeMass produced
Marks and inscriptions
Model: AS-302-L (The packaging, and paper insert that come with this Pulse Oximeter claim: "This product is easy to use, small in volume, light in weight, convenient in carrying, and adopted the low consumption design, with strong resistance to ambient light interference ability. The product is suitable for use in home healthcare, hospital (including internal medicine, surgery, anesthetic, intensive, care etc), oxygen bar, community medical centre, sports healthcare etc.")
Gallery label
02.02.2022 Device to measure blood oxygen levels Pulse oximeters clip onto the finger and use light to measure the level of oxygen in the blood. Demand for these devices rose sharply during the Covid-19 pandemic as blood oxygen levels could indicate a possible infection and its severity. From March 2020, the NHS started to supply pulse oximeters to the clinically vulnerable infected with Covid-19 so they could act if their blood oxygen became dangerously low. Due to their use of light to take a measurement, pulse oximeters are less accurate on individuals with darker skin pigmentation. Public awareness of this surfaced during the pandemic as it became clear that people from Black and Asian groups had worse health outcomes than their white counterparts. In November 2021, UK Health Secretary Sajid Javid launched a review of international standards for medical device testing to reduce racial bias. Pulse Oximeter 2021 Manufactured by aCurio, China Plastic and electronic parts Museum no. CD.2-2022
Summary
A pulse oximeter is a device which clips onto the finger and uses light to measure a patient’s pulse and blood oxygen level. First invented in 1974 by Dr Takuo Aoygi, it is an important tool for reducing deaths of patients under anaesthesia.



The device took on a new significance during the first peak of the COVID-19 pandemic in March 2020. At this time of crisis, it was used to identify ‘silent hypoxia’ – a state where blood oxygen levels become dangerously low, sometimes without outward symptoms. Early diagnosis helped save lives and as a result, the COVID Oximetry @home pathway was set up by the National Health Service (NHS) to provide home pulse oximeters for at-risk people who had tested positive for the virus.



Over the course of 2021, media attention and public awareness of evidence that suggested pulse oximeters were less effective on darker skin grew. Although this fact was known already in the early 2000s, in academic papers, such as ‘Effects of skin pigmentation on pulse oximeter accuracy at low saturation’ (1), and ‘Dark skin decreases the accuracy of pulse oximeters at low oxygen saturation: the effects of oximeter probe type and gender’ (2), a study published in December 2020 in The New England Journal of Medicine found similar results specifically linked to the COVID-19 pandemic (3). As a result of this study, the US Food and Drug Administration (FDA) issued a warning highlighting the limitations of pulse oximeters – identifying skin pigmentation, as well as other factors that may reduce efficacy – and updated recommendations on monitoring blood oxygen levels (4). In the UK, a government ordered survey, published on 2 June 2020 found that existing health inequalities – across socioeconomic, gender, and racial lines – were replicated and in some cases increased in COVID-19 health outcomes. This included the finding that: ‘people of Chinese, Indian, Pakistani, other Asian, Black Caribbean and other Black ethnicity had between 10 and 50% higher risk of death when compared to White British individuals’ (5). These findings, alongside others, contributed to growing concerns about the racial disparities in COVID-19 health outcomes.



Systemic racism within medical technologies as evidenced by the pulse oximeter was acknowledged by the UK Health Secretary Sajid Javid in November 2021 when, along with his American counterpart Xavier Becerra Secretary of Health and Human Services, he launched a review of international standards of medical devices. The review included new standards that devices must be tested on people of diverse backgrounds. He said in an interview to the Sunday Times: ‘It is easy to look at a machine and assume that everyone’s getting the same experience. But technologies are created and developed by people, and so bias, however inadvertent, can be an issue here too. So questions like who is writing the code, how a product is tested and who is sitting round the boardroom table are critical – especially when it comes to our health' (6). As an inexpensive device that is accessible on the open market and one that was distributed by health services, the pulse oximeter played an important role in triggering this broader awareness and investigation into racial bias in medical devices.



The pulse oximeter also featured as part of the V&A Pandemic Objects blog in June 2020 (7).





(1) Bickler PE, Feiner JR, Severinghaus JW. Effects of skin pigmentation on pulse oximeter accuracy at low saturation. Anesthesiology. 2005 Apr;102(4):715-9. doi: 10.1097/00000542-200504000-00004. PMID: 15791098.



(2) Feiner JR, Severinghaus JW, Bickler PE. Dark skin decreases the accuracy of pulse oximeters at low oxygen saturation: the effects of oximeter probe type and gender. Anesth Analg. 2007 Dec;105(6 Suppl):S18-S23. doi: 10.1213/01.ane.0000285988.35174.d9. PMID: 18048893.



(3) Sjoding, M., Dickson, R., Iwashyna, T., Gay, S. and Valley, T., 2022. Racial Bias in Pulse Oximetry Measurement | NEJM. [online] New England Journal of Medicine. Available at: <https://www.nejm.org/doi/full/10.1056/nejmc2029240> [Accessed 23 February 2022].



(4) U.S. Food and Drug Administration. 2022. Pulse Oximeter Accuracy and Limitations. [online] Available at: <https://www.fda.gov/medical-devices/safety-communications/pulse-oximeter-accuracy-and-limitations-fda-safety-communication?utm_medium=email&utm_source=govdelivery> [Accessed 23 February 2022].



(5) GOV.UK. 2022. COVID-19: review of disparities in risks and outcomes. [online] Available at: <https://www.gov.uk/government/publications/covid-19-review-of-disparities-in-risks-and-outcomes?utm_source=2e046dd4-5550-4042-b5a7-372873716a2a&utm_medium=email&utm_campaign=govuk-notifications&utm_content=immediate> [Accessed 23 February 2022].



(6) Thetimes.co.uk. 2022. Sajid Javid orders racial bias review after Covid deaths. [online] Available at: <https://www.thetimes.co.uk/article/sajid-javid-orders-racial-bias-review-after-covid-deaths-wxtsbsxdc> [Accessed 23 February 2022].



(7) Debenedetti, A., 2022. Pandemic Objects: Finger Oximeter • V&A Blog. [online] V&A Blog. Available at: <https://www.vam.ac.uk/blog/projects/pandemic-objects-finger-oximeter> [Accessed 23 February 2022].



Collection
Accession number
CD.2-2022

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Record createdFebruary 3, 2022
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