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EMJ Online First, published on November 14, 2014 as 10.1136/emermed-2013-203178
Short report
Does henna impact pulse oximetry results?
Mitra Zolfaghari,1 Parisa Moradi Majd,2 Fatemeh Behesht Aeen,3 Ali Reza Mohseni,4
Khadijeh Azimi Ahangari,5 Hamid Haghani6
1
Nursing & Midwifery Care
Research Center, Virtual
School, Tehran University of
Medical Science, Tehran, Iran
2
Paramedical Faculty,
Department of Anesthesia, Iran
University of Medical Science,
Tehran, Iran
3
School of Nursing and
Midwifery, Tehran University of
Medical Sciences, Tehran, Iran
4
Paramedical Faculty,
Department of Laboratory
Sciences, Mazandaran
University of Medical Sciences,
Sari, Iran
5
School of Nursing and
Midwifery, Tehran University of
Medical Sciences, Tehran, Iran
6
Department of Statistic
Faculty, School of Public
Health, Iran University of
Medical Science, Tehran, Iran
Correspondence to
Parisa Moradi Majd,
Paramedical Faculty,
Department of Anesthesia, Iran
University of Medical Science,
Tehran 2166904252, Iran;
[email protected]
Received 12 September 2013
Revised 7 October 2014
Accepted 25 October 2014
To cite: Zolfaghari M,
Moradi Majd P, Behesht
Aeen F, et al. Emerg Med J
Published Online First:
[please include Day Month
Year] doi:10.1136/emermed2013-203178
ABSTRACT
Objective To evaluate the effects of henna on the
results of pulse oximetry in healthy women.
Methods 100 young women (20–60 years of age) were
recruited. The Iranian original red henna was used to
colour the index finger of THE non-dominant hand; the
middle finger of the same hand was the control. Blood
oxygen saturation was simultaneously measured by two
calibrated pulse oximeters.
Result Henna did not affect pulse oximetry
measurement of oxygen saturation. There was no
statistically significant difference between the control and
the henna dyed fingers.
Conclusions Henna is not likely to change the accuracy
of oxygen saturation measured by pulse oximeter.
Clinical trial registration 20120906159N20.
INTRODUCTION
Pulse oximetry is a non-invasive and standard
device used to measure ad patients’ blood oxygen
saturation.1–4 It is especially used for patients at risk
of hypoxia.5 A pulse oximeter constantly evaluates
an ill patient’s respiratory function.6 Since its invention (in 1980) pulse oximetry has gone through
enormous changes to improve its function and
reduce errors in measuring blood oxygen saturation,
and hence has become reliable.6–8 Previous studies
have reported complete and precise harmony of
oxygen saturation between arterial blood samples
and pulse oximetry.8 Monitoring oxygen saturation
in clinical settings is recognised as an advanced
and important approach for ongoing patient
assessment.9
Recently, it has been suggested that nutrition,
smoking, spirometry and pulse oximetry should be
added to the four conventional vital signs of temperature, RR, BP and pulse rate. The most common
added parameter is pulse oximetery.10Although this
tool provides precise measurements of blood
oxygen saturation, the result could be affected by
various conditions such as low perfusion,11–13
hypoxia,14 15 carboxyhaemoglobinaemia,16 methaemoglobinaemia, acute anaemia,5 17 nail polish,
dark skin, high bilirubin in patients with hepatitis,
hypothermia, chills, hypotension, use of vasoconstrictors and cardiac dysrhythmia.6 It has been
shown that an increase in skin pigments and blood
bilirubin can cause changes in skin colour. This
change can effect oxygen saturation read by a pulse
oximeter.18
Henna is a popular make-up and is used commonly by the people of the East, Saudi Arabia and
India to dye hands, feet and hair.18 In Iran, henna
is commonly used by a variety of ethnicities. This
study aimed to evaluate the effects of henna dye on
pulse oximetry results in women.
MATERIALS AND METHODS
This clinical trial was conducted on a sample of
100 women, aged 20–60 years, recruited in 2011.
The inclusion criteria were: never diagnosed with
anaemia, haemoglobin level between 12 and
15 g/dL, body temperature between 36.8 and
37.4°C (axillary), and baseline blood oxygen saturation between 90% and 99%. Data were collected
using a one-page, multiple-section, researcher made
questionnaire (demographic information, medical
and medication history) and an information form
(measurement of haemoglobin, body temperature,
and blood oxygen of both control finger’s blood
oxygen saturation level and also that of the test
finger). The questionnaire was designed after
review of textbooks and the literature, and 10
faculty members confirmed its reliability.
After obtaining approval of the university ethics
committee, we explained the objectives and the
method of the study to the potential participants
who signed an informed consent. Prior to intervention, serum haemoglobin was measured using a
calibrated cell counter. Axillary temperature was
measured. Individuals with haemoglobin between
12 and 15 g/dL and temperature between 36.8 and
37.4°C were included in the study. First, data were
collected using the questionnaire. A calibrated pulse
oximeter was employed to the eligible individuals’
blood oxygen saturations at room temperature. If
the reading was within the designated range
(90–99%), the Iranian original red henna was
placed on the index finger of the non-dominant
hand. The henna which was used for all individuals
had the same composition (all natural and without
additives and dyes). The middle finger of the same
hand (without henna) was used as control. To
measure blood oxygen saturation, two calibrated
pulse oximeters were used. Blood oxygen saturation was simultaneously measured by examining
the two fingers: one henna dyed, and the other the
control. All samplings were performed at room
temperature, and after 10 min, two observers
recorded the numbers displayed by both devices.
Descriptive and inferential statistics were employed
for data analysis (SPSS V.16).
RESULTS
Mean±SD for age, haemoglobin level and body
temperature of the 100 women were 32.63
±12.36 years, 13.21±0.83 g/dL and 37.35±0.9°C,
respectively. At room temperature, the median (and
25th and 75th quartiles) of the oxygen saturations
readings by the pulse oximeter was 95.29% (94%
and 97%). To compare oxygen saturation of the
control and henna dyed fingers, the paired t-test
was used. It was shown that the use of henna in
comparison with the control did not cause changes
Zolfaghari M, et al. Emerg Med J 2014;0:1–2. doi:10.1136/emermed-2013-203178
Copyright Article author (or their employer) 2014. Produced by BMJ Publishing Group Ltd under licence.
1
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Short report
Table 1 Henna-dyed fingers; results of paired t test
SpO2
Mean
SD
N
Paired samples test
Henna
95.32
3.21
100
Control
95.29
3.14
100
t=0.15
df=99
p Value=0.87
in oxygen saturation reading by pulse oximetry ( p=0.87).
Table 1 displays the means for the blood oxygen saturations of
the control and henna dyed fingers and results of the comparison between them.
DISCUSSION AND CONCLUSION
Today, pulse oximetry is a standard monitoring technique used
in anaesthesia, and healthcare in critical care units and emergency rooms.10 19 20 Pulse oximetry utilises a sensor (a probe)
and a monitor (where the data are analysed). The sensor guides
the light along two red and infrared wavelengths through a pulsatile capillary bed such as fingers, forehead and ears.21 In this
study, the potential effects of henna on pulse oximetry results
were studied among 100 young women. The results showed
that henna has no effects on pulse oximetry measurement of
oxygen saturation. There was not a statistically significant difference between the control and the henna-dyed fingers ( p=0.87).
Feiner et al. (2007) showed that pulse oximetry measures arterial oxygen saturation in dark skinned people higher than its real
value;19 this finding contradicts our findings. Samman et al18
studied 104 healthy individuals with a mean age of 32.93 years
(16 men and 84 women) and 14 hypoxic patients, to evaluate
the effect of henna on pulse oximetry results. This study
showed no significant effect of henna on pulse oximetry results
in healthy people and that there was no statistically significant
difference between the control and experimental groups and the
group of healthy individuals ( p>0.05). However, in hypoxic
patients, henna increased oxygen saturation readings by pulse
oximetry ( p<0.01).18 Al-Majed and Harakati22 showed that red
henna was not a constraint on measurement of oxygen saturation by pulse oximetry and that it caused no significant difference; however, black henna caused a decrease in oxygen
saturation measured by pulse oximetry.22
According to the findings of this study, henna is not likely to
affect oxygen saturation measured by pulse oximetry and it
cannot cause errors in monitoring patients. The results could
have essential clinical application in the Middle Eastern and
African countries where henna is used for dying fingers.
Acknowledgements This article was extracted from the research “Effects of
henna on pulse oximetry results” registered as 91-02-99-17980 at Tehran University
of Medical Sciences in 2011 (the Iranian Registry of Clinical Trials code:
201209061599N20). We thank all the people who helped us conduct this research.
2
We also thank the students of Tehran University of Medical Sciences and the
patients who participated wholeheartedly in this research.
Contributors MZ: methodological support throughout; assessment of
methodological quality and perspective; interpretation of data, appraising the review,
write-up. PMM: design of this study; monitored data collection for the whole trial;
analysis and interpretation of data; and drafted and revised the paper. FBA:
literature search and screening the search results; monitored data collection for the
whole trial; and drafted and revised the paper. ARM: enter data into SPSS; analysis,
interpretation of data, writing up the review. KA: designed data collection tools and
drafted and revised the paper. HH: expert in statistics; wrote the statistical analysis
plan, monitored data collection for the whole trial, and revised the draft paper.
Provenance and peer review Not commissioned; externally peer reviewed.
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Zolfaghari M, et al. Emerg Med J 2014;0:1–2. doi:10.1136/emermed-2013-203178
Downloaded from http://emj.bmj.com/ on November 21, 2014 - Published by group.bmj.com
Does henna impact pulse oximetry results?
Mitra Zolfaghari, Parisa Moradi Majd, Fatemeh Behesht Aeen, Ali Reza
Mohseni, Khadijeh Azimi Ahangari and Hamid Haghani
Emerg Med J published online November 14, 2014
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