POINT OF CARE GLUCOSE TESTING

Created by: Maria Monteiro CNE, 2011

Revised: Michelle Wong, CNE 2013

Maria Monteiro, CNE 2015

Jennifer Page, CNE, 2015

Certification Process

► Certification requirements: 1. Written test (must obtain at least 80%) 2. Proficiency with finger puncture &

knowledge of machine operation 3. Knowledge of quality control program

► Annual Re-Certification requirements: 1. Perform 1 set of controls 2. Perform 3 patient tests in a year

Whole blood glucose

To assess patient’s clinical condition

Help manage patient’s medication requirements

Determine in urgent situations if the patient is hypoglycemic or hyperglycemic

DOES NOT PROVIDE RESULTS AS ACCURATE AS THE LAB

What are we measuring & Why?

Blood Glucose Levels

Fasting approx. P.C.

4-7 5-11

(3.8—7.8) non-diabetic (reference)

Signs & Symptoms

Hypoglycemia

Hyperglycemia

Measuring Range

The FreeStyle Precision Pro device

captures ranges:

(<1.1 mmol/L) to (>27.8 mmol/L) Critical Values as per NYGH

<2.6 or >22 mmol/L

A blood sample must be sent to the lab unless Specified by MD

Equipment Required for Testing

►Glucometer

►Test strips--you can touch the test site

with clean/dry hands (use one strip each time--check expiry date)

►Disposable lancet device

►Kleenex

►Gloves

►Alcohol wipes--At home patient may wash hands with water and soap instead of alcohol wipe

Procedure for Patient testing 1. Explain procedure to

patient and obtain consent

2. The barcode on your ID badge is scanned for OPERATOR ID

3. The barcode on the patient’s armband is scanned for the MRN

4. Confirm by entering last 2 numbers of patient’s year of birth (i.e. 19(88))

Site Selection

Fleshy sides of the fingers ► Avoid finger pads, very tip of the

finger and previous punctures, swollen, inflamed fingers

► To assist with blood flow, gently milk the entire finger

► Clean the site with alcohol and let it dry thoroughly

► After puncturing site wipe off the first drop with a dry tissue

► Place the test strip at a angle on the surface of the blood drop, the strip will then pull in the blood into the strip

►The glucose meter has wireless capabilities in most areas

►However, remember to dock at least once Q 4 hrs, to UPDATE & download data into Powerchart

► If required, patient data may be recalled by selecting “Data Review” from the menu, then “Patient Test”

Scenario

Glucometer reads 2.1, your patient feels tired, weak, hungry, is shaking & has a headache.

What are your actions?

► Assess the patient’s clinical presentation

► Is presentation consistent with result?

Severity of hypoglycemia is defined by clinical manifestation (Canadian Diabetes Association Clinical Practice Guidelines, 2008)

Results that are not consistent with presentation:

1. Perform High & Low controls 2. Repeat the test on another finger/hand

NYGH Medical Directive “Management of Hypoglycemia in Adults” (XII-905) Mild to Moderate Hypoglycemia (blood glucose 2.8—3.9)

Administer one 16 grams of glucose:

► 4 glucose tabs (4gms each) (must be sucked)

► 3 packets of sugar dissolved in H2O

► 175 ml of Juice or regular soft drink

► 1 tablespoon of honey

► Repeat blood glucose in 15 minutes if BS <4 then repeat glucose administration

Severe Hypoglycemia ( BS< 2.8)

Administer 20 grams of glucose (6 tabs)

Repeat blood sugar in 15 minutes if blood sugar <4 give another 16 grams of glucose tabs

Unconscious

Without IV access you can administer 1mg glucagon S/C or IM

OR

With IV access 25grms of 50%Dextrose

IV push over 1-3 minutes (All RNs @ NYGH)

Repeat Bs in 15 minutes

Until BS is >4 you can follow with D5W 75ml hr or as per MD order

Quality Control Testing

1.Monitors: test strips equipment operator performance Overall Quality control Testing Ensures valid

patient results & Is a Mandatory process for

Quality Assurance

Quality Control Testing

High & Low Control Testing Must be done Q 24 hrs Opened Solutions expire in 90 days (3 months) or

according to manufacturer’s expiry date Label bottles – date of opening, store at room temp. Wipe the tips of bottles with a tissue and/or discard

the first 2 drops of the solution before applying a drop of the test strip.

(Glucose solutions forms crystals in the opened bottles which skews glucometer readings)

Do not tip machine when placing control solution on strip, avoid solution entering calibration PORT

False Results

►Alcohol not dry (low results) ►Extreme environmental temperatures can

affect the machine ►Hematocrits <.15= high results ►Hematocrits >.65= low results ►Dehydration, Severe hypotension, Shock= low ► Poor blood circulation at the puncture site ►Excessive squeezing of the puncture site ►Severe hyperglycemic state

Care and Maintenance of Meter

Clean the exterior with disinfecting wipes

The meter requires 2 AA batteries

In case of malfunction, notify the Lab, a replacement will be provided

References

Canadian Diabetes Association Practice Guidelines (2008)

NYGH Department of Laboratory Medicine: Point of Care Glucose Testing System Procedures (self learning package with test) (2015)

NYGH Medical Directive: Management of Hypoglycemia in Adults (2014)

Dextrose 50%, Intravenous Guidelines for Nurses, NYGH (2012)