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Christmas tree fir green is not the intensive care unit’s favourite colour
  1. Sultan Hatab,
  2. Manprit Waraich,
  3. Danyal Amin and
  4. Ciara Mahon
  1. Critical Care, National Hospital for Neurology and Neurosurgery, London, UK
  1. Correspondence to Dr Sultan Hatab; sultanhatab{at}


A patient in her 60s presented to a district general hospital with headache, loss of consciousness, and vomiting. She was diagnosed with a subarachnoid haemorrhage secondary to an anterior communicating artery aneurysm and was transferred to a tertiary unit for coiling of the aneurysm under the neurosurgical team. She was intubated and had close observational monitoring, where it was noted that her oxygen saturations, obtained using finger-pulse oximetry, varied between 94% and 100%. Each fingernail had a different acrylic nail polish colour which we believe resulted in these inconsistent readings. The dark forest green colour consistently gave a significantly lower oxygen saturation reading when compared with our control, which was the arterial blood gas oxygen saturation, whereas orange and purple were most like our control. We therefore found that the varied colours painted on acrylic nails affected oxygen saturation readings differently. This difference could affect treatment pathways for patients in theatre and the intensive care unit.

  • Adult intensive care
  • Mechanical ventilation
  • Neuroanaesthesia
  • Neuro ITU
  • Respiratory system

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: SH, DA, MW, CM. The following authors gave final approval of the manuscript: SH, DA, MW, CM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.