Transcript Bedside Glucose Testing

Bedside Glucose
Testing
Reviewed December 2013 by DRohrbaugh, RN
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Purpose – Patient Safety

To obtain accurate and timely blood
glucose results that are used in clinical
decision-making for effective patient care
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Competency

Bedside glucose monitoring may be performed by
nursing personnel following competency validation

Initial bedside glucose monitoring competency is to be
upon hire, repeated in six months and then facilitated
annually

Skill level : RN, LPN, technicians involved with direct
patient care

The laboratory shall direct the quality control activities,
including data collection to ensure adherence to
standards
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Controls: Procedural Policies
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Bottles of controls MUST be dated / initialed when opened and are
stable for 3 months after opening
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Lot # for controls must match number on monitor
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Quality Control must be performed from 4am – 4am unless prearranged / approved with lab management

1 emergency patient test can be performed if quality control is due
or has not been performed within the allotted time period

PPE must be worn when performing Quality Controls
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Test Strips: Procedural Policies

Test strips must be stored at room temperature

Test strips are stable until the manufacturer’s expiration date found on the
vial (keep cap tightly closed except when removing strips)

Ensure that the meter code key matches the code number on the vial of
test strips being used. Incorrect coding may result in inaccurate results
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Expired test strips are discarded

All test equipment is biohazardous and should be handled according to
standard precautions. PPE must be worn during handling / testing.

System measurement range is from 10 – 600mg/dL.
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Testing Technique

If alcohol is used to prepare the finger, ensure the finger is
completely dry before obtaining blood sample

Do not use excessive squeezing of the finger since this can dilute
the sample with tissue fluid

Obtain a free-flowing and well formed drop of blood

Warming the puncture site may increase blood flow to the site

Do not attempt to express blood from a previously punctured site,
even if an old puncture site appears to be bleeding freely. It is likely
that the clotting process has begun with the formation of fibrin
stands and micro clots
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Testing Technique

When samples are collected from venous or arterial lines, the lines
must be carefully cleared of any line solution prior to sample
collection

Touch and hold the blood drop to the side of the ACCU-CHEK
Comfort Curve test strip until the entire yellow window if filled

If the yellow window is not completely filled, a second drop can be
added within 15 seconds of the first drop. Improper dosing can
lead to erroneous results

If a large amount of blood appears on the top of the test strip,
discard the test strip and repeat the test
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Critical Values
Hospital Wide
Critical values (mg/dL)
0 – 7 days olds
Below 40 or above 200
> 7 days
Below 50 or above 400
Physician notification and treatment for hypoglycemia /
hyperglycemia will be initiated if the blood glucose value is
less than / greater than the value indicated in the table
above
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Limitations To Consider

If the patient is currently using drug therapies that
contain or are metabolized to maltose or galactose, do
NOT use the ACCU-CHEK Inform system to test
glucose

Consult drug package or pharmacy to determine
whether it contains or is metabolized to maltose or
galactose

In certain situations of decreased peripheral blood flow,
fingerstick blood testing may not be appropriate, as it
may not reflect true physiological state
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Specimen Samples

Capillary, venous, neonatal (including cord blood) and arterial
whole blood specimens may be used for testing on the
ACCU-CHEK Inform system
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Capillary sample must be tested immediately after collection

Blood glucose determinations using venous and arterial
blood specimens should be performed within 30 minutes of
specimen collection

Take caution to clear arterial lines before the blood sample is
drawn and applied to test strip
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Neonatal Blood Specimen
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Caution is advised in the interpretation of
neonate glucose values below 40mg/dL
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Glucose level in a relaxed neonate patient
may change quickly if the patient becomes
agitated. Meter tests are usually performed
on resting and unsuspecting infants.
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Documenting Results
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Date, time, ID of the operator, patient ID #, and
glucose value are recorded in the ACCU-CHEK
Inform system and patient’s EMR
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Glucometer needs to be docked periodically at
least every 24 hours in the docking station. It will
lock up if this is not performed.
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Troubleshooting
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The trouble shooting guide remains in the
box or case
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If additional assistance is needed, call the
lab at 1212
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Interactive educational program is on the
Intranet under Education Department.
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In Depth Look At Accu-Chek
Click on the picture of the AccuChek monitor to begin a short
DVD which provides detailed
information about the AccuChek monitoring system.
Click the “x” on the DVD screen to
exit.
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
Thank you for reviewing this course material and
performing the interactive exercise.

Please Take Test to complete this course.
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