Abstract

Background: Hospitalized patients frequently have their SpO2 levels monitored using fingertip pulse oximetry. Although it is a practical, non-invasive tool, things like nail polish can compromise its accuracy. It is unclear whether and to what degree changing nail paint colors alter readings. Objective: Using a fingertip pulse oximeter, determine how nine dark nail polish colors—black, yellow, brown, red, orange, pink, green, blue, and purple—affect SpO2 values. Methods: A total of one hundred hospitalized women, with an average age of forty-two, were included. Each fingernail received one of nine different nail paint colors; the tenth nail was kept naked as a control. A BPL OXYlite oximeter was used to measure SpO2. Dunnett’s multiple comparisons test (p < 0.01) and one-way ANOVA were used to analyze the data. Results: The largest decrease in SpO2 was caused by black nail polish (mean reduction 2.00 ± 0.93; p < 0.0001). Second place went to Red (1.81 ± 1.02; p <0.0001). They were both statistically significant. The remaining colors showed no discernible changes: pink (0.17 ± 0.59), yellow (0.20 ± 0.57), orange (0.23 ± 0.58), purple (0.45 ± 0.59), brown (0.47 ± 0.73), blue (0.56 ± 0.69), and green (0.70 ± 0.94). Conclusion: SpO2 measurements were considerably lowered by black and red nail paint. To avoid erroneous readings and potential mistakes in clinical care, nail polish—especially deeper shades—should be removed before to pulse oximetry.

• 1.   American Association for Respiratory Care (AARC). AARC Clinical Practice Guideline: Pulse Oximetry. Respir Care. 1991; 36(12): 1406–1409.
• 2.   Aggarwal A.N., et al. Impact of Fingernail Polish on Pulse Oximetry Measurements: A Systematic Review. Respir Care. 2023; 68(9): 1271.
• 3.   Fluck R.R., Schroeder C., Frani G., Kropf B., Engbretson B. Does Ambient Light Affect the Accuracy of Pulse Oximetry? Respir Care. 2003; 48(7).
• 4.   Kyriacou P.A. Optical crosstalk and other forms of light interference in pulse oximeter comparison studies. J Clin Monit Comput. 2023; 37: 1481–1488.
• 5.   Giuliano K.K., Bilkovski R.N., Beard J., Lamminmäki S. Signal accuracy of three SpO2 onitors during motion and low perfusion. J Clin Monit Comput. 2023; 37: 1451–1461.
• 6.   Gudelunas M.K., et al. Low Perfusion and Missed Diagnosis of Hypoxemia by Pulse Oximetry in Darkly Pigmented Skin. Anesth Analg. 2024; 138: 552–561.
• 7.   Bickler P.E., Feiner J.R., Severinghaus J.W. Effects of skin pigmentation on pulse oximeter accuracy at low saturation. Anesthesiology. 2005; 102: 715–719.
• 8.   Sjoding M.W., Dickson R.P., Iwashyna T.J., Gay S.E., Valley T.S. Racial Bias in Pulse Oximetry Measurement. N Engl J Med. 2020; 383: 2477–2478.
• 9.   Seeker C., Spiers P. Accuracy of pulse oximetry in patients with low systemic vascular resistance. Anaesthesia. 1997; 52: 127–130.
• 10.   Nilles K., Subramanian R. Crit Care Med. 2012; 40: 1–328.
• 11.   Ralston A.C., Webb R.K., Runciman W.B. Potential errors in pulse oximetry III: Effects of interference, dyes, dyshaemoglobins and other pigments. Anaesthesia. 1991; 46: 291–295.
• 12.   Nitzan M., Romem A., Koppel R. Pulse oximetry: Fundamentals and technology update. Med Devices (Auckl). 2014; 7: 231–239.
• 13.   Cote C.J., Goldstein E.A., Fuchsman W.H., Hoaglin DC. The effect of nail polish on pulse oximetry. Anesth Analg. 1988; 67: 683–686.
• 14.   Desalu I., Diakparomre O.I., Salami A.O., Abiola A.O.. The effect of nail polish and acrylic nails on pulse oximetry reading using the Lifebox oximeter in Nigeria. Niger Postgrad Med J. 2013; 20: 331–335.
• 15.   Sazzad Hossain M., et al. Effect of Red Nail Polish on Pulse Oximetry Reading. KYAMC Journal. 2021; 11: 181–183.
• 16.   Miyake M.H., Diccini S., Bettencourt ARdC. Interference of nail polish colors and time on pulse oximetry in healthy volunteers. J Pneumol. 2003; 29: 386–390.
• 17.   Chan MM, Chan M.M., Chan E.D. What is the effect of fingernail polish on pulse oximetry? Chest. 2003; 123: 2163–2165.
• 18.   Yamamoto L.G., Yamamoto J.A., Yamamoto J.B., Yamamoto B.E., Yamamoto P.P. Nail Polish Does Not Significantly Affect Pulse Oximetry Measurements in Mildly Hypoxic Subjects. Respir Care. 2008; 53: 1470–1474.
• 19.   Yeganehkhah M., et al. Effect of Glittered Nail Polish on Pulse Oximetry Measurements in Healthy Subjects. Iran J Nurs Midwifery Res. 2019; 24.
• 20.   Sutcu Cicek H., et al. Effect of nail polish and henna on oxygen saturation by pulse oximetry in healthy young adult females. Emerg Med J. 2011; 28: 783.
• 21.   Brand T.M., Brand M.E., Jay G.D. Enamel Nail Polish Does Not Interfere With Pulse Oximetry Among Normoxic Volunteers. J Clin Monit Comput. 2002; 17: 93–96.
• 22.   Rodden A.M., Spicer L., Diaz V.A., Steyer T.E. Does fingernail polish affect pulse oximeter readings? Intensive Crit Care Nurs. 2007; 23: 51–55.
• 23.   Hakverdioglu Yont G., Akin Korhan E., Dizer B. The effect of nail polish on pulse oximetry readings. Intensive Crit Care Nurs. 2014; 30: 111–115.
• 24.   Hinkelbein J., Genzwuerker H.V., Sogl R., Fiedler F. Effect of nail polish on oxygen saturation by pulse oximetry in critically ill patients. Resuscitation. 2007; 72: 82–91.
• 25.   Shimoya-Bittencourt W., et al. Interference of nail polish on peripheral oxygen saturation in patients with lung problems during exercise. Rev Lat Am Enfermagem. 2012; 20: 1169–1175.
• 26.   Singh V.P., Ayub S. Effect of different colours of nail polish on pulse oximeter readings in ventilated patients. Int Res J Eng Technol. 2016.
• 27.   Zhu S., Mao Y., Tang Y., Zhou L., Liu Y. False pulse oximetry readings due to nail polish affecting blood transfusion decisions during thyroidectomy. Int J Clin Exp Med. 2016; 9: 14875–14879.

Data Sharing Statement

Funding