Title: Fingerstick Glucose by Accu-Chek Inform

Transcription

1 Title: Fingerstick Glucose by Accu-Chek Inform Target Audience: This module is available to aid in assessing competency for all clinical staff who perform fingerstick glucose testing. Contents Instructions... 2 Learning Objectives... 2 Policy & Procedure Job Aid Posttest Page 1 of 17

2 The material in this module serves as an educational tool and an aid in assessing competency for those performing this test within your facility. Read this module which includes the policy and procedure pertinent to this testing. If you have any questions about the material, ask your supervisor or facility POC Coordinator. Complete the online post test for this module. The Job Aid on pages may be customized to fit your department and then used as a quick reference guide. Completion of this module will be recorded under My Learning in PeopleLink. Learning Objectives: When you finish this module, you will be able to: 1. Demonstrate the proper procedure for performing quality control, calibration and testing for fingerstick glucose testing. 2. Describe/Demonstrate the proper technique for obtaining specimens for fingerstick glucose testing. 3. Identify what to do in the case of obtaining critical value while performing fingerstick glucose(s). Page 2 of 17

3 Glucose by the Roche Accu-Chek Inform System I. PRINCIPLE The enzyme glucose dehydrogense converts the glucose in the blood sample to gluconolactone. This reaction liberates an electron that reacts with a coenzyme electron acceptor, the oxidized form of the mediator hexacyanoferrate (III), forming the reduced form of the mediator, hexacyanoferrate (II). The Accu-Chek Comfort Curve test strips employ the electrochemical principle of biamperometry. The meter applies a voltage between two identical electrodes, which causes the reduced mediator formed during the incubation period to be reconverted to an oxidized mediator. This generates a small current that is read by the system. II. PROCEDURE A. Specimen Information Collect specimen as outlined in the Routine Blood Specimen Collection Procedures provided by the Laboratory. Capillary (fingertip or heel stick for neonates), venous, neonatal cord blood, and arterial whole blood specimens may be used for testing on the Accu-Chek Inform System with Accu-Chek Comfort Curve Test Strips. If using capillary samples, testing must start immediately after collection from the patient. Blood glucose determinations using venous and arterial blood specimens should be performed within 30 minutes of specimen collection to avoid glycolysis. Mix samples thoroughly. Label tube with patient s first and last name, account number, date, time, and initials of person performing testing. For best results with arterial and venous blood, the following anticoagulants/preservatives are recommended: lithium heparin and EDTA. Serum separator tubes and red-topped tubes are acceptable if blood is used immediately before clotting process begins. Iodoacetate or fluoride/oxalate should not be used as a preservative. Caution should be taken to clear arterial lines before blood is drawn and dosed on the test strip. Sufficient sample size is required to ensure valid results. Page 3 of 17

4 B. Test Method Instructions Testing Procedure: 1. Universal precautions must be observed when performing the procedure. Gloves must be worn as personal protective equipment (PPE). 2. Press purple power ON button. The meter will go through a series of self tests. 3. Scan your ID badge barcode. If your ID badge will not scan, you may manually enter your operator ID. Your operator ID is your badge number (ex ). Press the forward arrow button. *Please, contact Security to replace unreadable badges. If you are a new employee, contact Point of Care Testing for entry into system. Only a certified operator may perform a blood glucose test on the Accu-Chek Inform System. 4. Select PATIENT TEST. 5. If Other Test Entry (OTE) is not activated, the meter will go straight to the patient ID screen. If OTE is activated, the meter will display the test selection screen. Select GLUCOSE. 6. At patient ID screen, scan barcode on patient armband. If at a site where armbands are not utilized, scan barcode on patient label on chart. If barcode will not scan, manually enter 10 digit Account number for the patient ID. If patient is unable to be registered, manually enter the patient s first and last name. If patient identification is unknown due to physical or mental state, manually enter E911 for patient ID and complete E911 Form and submit to lab. In the event of a downtime, manually enter patient s first and last name for those patient s unable to be registered and document on Downtime Log Form. Press the forward arrow button. 7. The meter will display the patient s name associated with the account number entered and ask if this name is correct yes or no. If correct, select YES. If not correct, select NO and re-enter account number. If the meter states the account number is not found in the patient list do you want to run a test for this ID yes or no, double check the account number and if correct select YES. If not correct, select NO and re-enter account number. 8. Scan the test strip vial barcode. If the strip lot does not match the code key currently installed in the Accu- Chek Inform, the Replace Code Key screen is displayed. See Coding Calibration Procedure below. Page 4 of 17

5 If the strip lot has not previously been entered into the meter, a message will appear asking if the strip lot should be added. Press YES and enter the expiration date. Press the forward arrow button. The next screen asks you to verify that the control ranges assigned to this lot are correct. Verify the control ranges listed on the meter to the control ranges listed on the strip bottle. If the ranges are correct, press Accept to verify the control ranges. Press YES to complete verifying the lot number. Press the Menu button to return to the main menu. Proceed to step 4 of the Quality Control Procedure Section. NOTE: Quality Control must be run when a new bottle of test strips are put into use. 9. Remove a strip from the vial. Immediately replace the cap on the vial. Strips exposed to high humidity for prolonged periods of time may give inaccurate results. 10. When flashing strip icon appears on the meter display, gently insert test strip. Insert the end with the silver bars into the opening at the top of the meter. The yellow target area of the test strip window should be facing up. NOTE: Insert test strip BEFORE dosing. 11. When the flashing drop icon appears on the meter display, obtain a blood sample. You may use a whole blood capillary, venous, arterial, or neonatal (including a heel stick or cord blood) blood sample. Follow manufacturer s instructions if using a lancet device. Capillary sample: If able, the patient should wash his/her hands with warm, soapy water and dry well prior to testing with capillary samples taken from the fingertip. If the patient is unable to wash their hands, cleanse the fingertip with an alcohol swab and allow it to thoroughly dry. For heel sticks cleanse heel with an alcohol swab and allow to thoroughly dry. Alcohol at the puncture site must dry or an error/inaccurate result may occur. It is extremely important to clean the finger prior to obtaining the sample for glucose testing. Any residual sugar from food the patient may have eaten, lotion, oils, soap, etc. that may be on the finger will cause a falsely elevated glucose level. Follow manufacturer s instructions if using a lancet device. Wipe away the first drop of blood. If needed, immediately after pricking, gently squeeze the finger from the base to encourage blood flow. Do not squeeze at the fingertip. Use second drop of blood to dose strip. Using a venous or arterial sample: Use a syringe to collect sample. Expel the first drop of blood from the syringe needle. Use second drop of blood to dose strip. Page 5 of 17

6 12. Touch and hold second drop of blood to the curved edge of the yellow target area of the Accu-Chek Comfort Curve Test Strip. The blood is drawn into the test strip automatically. NOTE: It is extremely important to make sure the yellow test strip window is completely filled with blood or control. If it is not filled completely, a false result will be obtained. If you see any yellow color in the target area of the test strip window after you have applied the initial drop of blood, a second drop of blood may be applied to the strip within 15 seconds of the first drop. If more than 15 seconds have passed, the test result may be erroneous. Discard the test strip and repeat the test. 13. An hourglass will appear on the display while waiting for the result. Once testing is completed, a numerical blood glucose value will appear on the meter. If patient result is <10 mg/dl the meter will display LO as the result. If patient result is >600 mg/dl the meter will display HI as the result. Accu- Chek Comfort Curve Test Strips have been calibrated to deliver plasma-like values. NOTE: If an error is displayed, follow instructions displayed on meter or call Accu-Chek Customer Care for assistance. If the meter must be replaced, contact the Point of Care office for replacement. 14. Enter up to three preprogrammed comment codes or one custom comment, if necessary. Then press the forward arrow button to record the test and return to the Main Menu screen in order to run the next test. 15. Remove the test strip from the meter and discard according to the infection control policy for disposal of blood-contaminated items. 16. Press the purple power OFF button to turn the Accu-Chek Inform System off. 17. Return meter to base to download patient s glucose result into Lab information system. If valid account number is entered, the Laboratory LIS will order a POC whole blood glucose and result the patient s result in Star as part of the patient s permanent medical record. C. Reagents and Equipment 1. Accu-Chek Inform System 2. Accu-Chek Comfort Curve test strips (Cat. No ) 3. Accu-Chek Comfort Curve Glucose Control Solutions (Level 1 and 2) (Cat. No ) Store Accu-Chek Inform System away from direct sunlight and extreme temperatures. Do not expose the meter to excessive sources of heat for more than 10 seconds while obtaining a blood glucose result. Potential sources of heat can be, but not limited to: Leaving the meter under a bilirubin light or photo therapy light during testing Leaving the meter on a bed warmer during testing Leaving the meter in an isolette during testing Page 6 of 17

7 If the meter is exposed to heat for more than 10 seconds, allow the meter to return to ambient temperature and repeat the test. Test strips must be stored at room temperature, less than 90 F or 32 C. Do not freeze. Do not refrigerate. Test strips are stored in the same tightly capped vial in which they are packaged. The test strips are sensitive to moisture so the vial cap must be immediately replaced after removal of a test strip. The test strips are stable until the expiration date on the vial. Outdated strips are discarded. The test strips must remain in the sealed container until ready to be used. Test strips are used at temperatures between 14 and 40 C (57 and 104 F) and <85% humidity. Quality control must be run also each time a new vial of test strips is opened. The new vial of test strips must be dated and labeled QC d on the vial to verify quality control was performed. Ex. QC - 1/1/08. Control solutions must be stored at room temperature (less than 90 F or 32 C). Do not freeze. Do not refrigerate. Once opened controls are only stable for 90 days. Discard 90 days after opening or on original expiration date, whichever comes first. Document open date and new 90 day expiration date on the vial label. D. Supplies 1. Single-use, disposable lancets 2. Alcohol swabs 3. Cotton ball, tissue, or gauze for wiping finger after stick. 4. Gloves as personal protection equipment as required for universal blood collection precautions. 5. Syringe, if collecting arterial or venous samples E. Equipment Coding (Calibration) When the test strip vial barcode is scanned, coding (or calibration) is verified by the meter by matching the code of the Code Key with the code number for the vial of test strips. The monitor is calibrated when the instrument is turned on with the Code Key inserted. Place the new Code Key in the meter and discard the old Code Key. The Code Key must be changed with each vial of test strips. Coding Calibration Procedure: 1. If meter is on, press the purple button to turn the meter off. 2. Remove the Code Key from the test strip box. 3. Compare the 3-digit number on the Code Key with the number on the test strip vial. 4. Turn the meter over so you are looking at the back. Remove the old Code Key from the Accu-Chek Inform meter if one is installed and discard. Page 7 of 17

8 5. Snap the new Code Key (slots facing towards the monitor) into the Code Key slot with the printed side facing up. 6. Leave the Code Key in the meter. 7. Press the purple button to turn the meter on. 8. Scan your ID badge barcode. 9. Proceed to step 4 of the Quality Control Procedure Section. NOTE: Quality Control must be run when a new bottle of test strips are put into use. F. Equipment Maintenance Cleaning the outside of the Accu-Chek Inform System: Wear gloves as PPE during the cleaning process. After each use clean the outside of the Accu-Chek Inform System with a soft cloth slightly dampened with warm, soapy water, a freshly mixed solution of 1:10 bleach in water (1 part bleach in 9 parts water), 70% isopropyl alcohol, full strength, or a Sani-Wipe. Never spray the instrument directly with the solution as this could cause the solution to enter the meter and damage the electronic components. If cleaning solution does get on the connectors or pools in the base unit, unplug the base unit and dry the components with a dry cloth or gauze before returning the meter to the base unit. Do not allow cleaning solution to get into the connector at the bottom of the meter. Severe damage can occur to the meter. Visually verify no solution is seen in the connector at the completion of cleaning. Battery will only be changed by Point of Care Department. Please call Point of Care Department for assistance. Only the battery pack available from Roche Diagnostics (Cat. No ) will be used in the meter. Using any other type of battery pack may damage the system. If the meter is to be stored for a long period of time, the battery is removed to avoid leakage or damage. For other technical problems, first call Accu-Chek Customer Care at for assistance. If a meter needs replacing, please contact Point of Care Office, who will arrange for a replacement meter. G. Quality Control Two levels of quality control must be performed once daily for patient testing. Accu-Chek Comfort Curve Glucose Control Solutions of 2 levels (Cat. No ) are to be used for quality control. Page 8 of 17

9 Additional quality control must be run each time: 1. a new vial of test strips is opened. The new vial of test strips must be dated and labeled QC d on the vial. Ex. QC - 1/1/ a vial of strips has been left opened 3. the test strips have been exposed to extreme heat, humidity, or cold 4. the Accu-Chek Inform meter has been dropped. 5. the meter has been recoded 6. the battery has been replaced 7. the test results contradict clinical symptoms Successful quality control must be achieved before patient testing can be performed. Quality Control Procedure: 1. Universal precautions must be observed when performing the procedure. Gloves must be worn as PPE. 2. Press purple power ON button. 3. Scan your ID badge barcode. If your ID badge will not scan, you may manually enter your operator ID. Your operator ID is your badge number ( ). Press the forward arrow button. *Please, contact Security to replace unreadable badges. If you are a new employee, contact Point of Care Testing for entry into system. 4. Select CONTROL TEST. 5. Scan the control solution vial barcode. NOTE: Both levels must be run once every 24 hours in order to proceed with patient testing. 6. If the control lot has not previously been entered into the meter, a message will appear asking if the control lot should be added. Press YES and enter the expiration date. Press the forward arrow button. 7. Scan the test strip vial barcode. If the code key does not match or this lot number has not been previously entered into meter, see above testing procedure for instructions. 8. Remove a strip from the vial. Immediately replace the cap on the vial. Strips exposed to high humidity for prolonged periods of time may give inaccurate results. 9. When flashing strip icon appears on the meter display, gently insert test strip. Insert the end with the silver bars into the opening at the top of the meter. The yellow target area of test strip window should be facing up. NOTE: Insert test strip BEFORE dosing. Page 9 of 17

10 10. Mix controls gently by inversion to assure homogeneity of the contents. When the flashing drop icon appears on the meter display, touch and hold drop of glucose control solution to the curved edge of the yellow target area of the Accu-Chek Comfort Curve Test Strip. The glucose control solution is drawn into the test strip automatically. NOTE: It is extremely important to make sure the yellow test strip window is completely filled with control. If it is not filled completely, a false result will be obtained. If you see any yellow color in the target area of the test strip window after you have applied the initial drop of control solution, a second drop of control solution may be applied to the strip within 15 seconds of the first drop. If more than 15 seconds have passed, the test result may be erroneous and you should discard the test strip and repeat the test. If this is a new bottle of control, record open date and new 90 day expiration date on the vial label. 11. An hourglass will appear on the display while waiting for the result. Once testing is completed, a result of pass or fail will appear on the meter. 12. Remove the test strip from the meter and discard it according to the infection control policy for disposal of blood-contaminated items. 13. If the control value is outside the acceptable range, fail will be displayed. Enter an appropriate comment and press the forward arrow button to record the result and return to the Main Menu. Repeat control testing from step 4. Patient testing is not allowed until the control solution receives a result of pass. 14. If the control value is within the acceptable range, pass will be displayed. Enter a comment code, if needed. Then, press the forward arrow button to record the result and return to the Main Menu screen to test the next level of control or to proceed to patient testing. To test next control level continue from step Press the purple power OFF button to turn the Accu-Chek Inform System off. 18. Return meter to base to download control glucose results into Lab information management system. 19. If this is a new vial of test strips, record the date and QC on the vial. Ex. QC - 1/1/08. NOTE: If you have problems with control accuracy, check expiration dates on test strips and control solutions. Repeat test with fresh bottle of control solution or test strips if applicable. If problems persist, please contact the Point of Care office. H. Expected Values The Accu-Chek Inform meter displays a numerical blood glucose result. Accu-Chek Inform reference ranges: mg/dl (18+ months) mg/dl (2days - 17months) mg/dl (0-1days) Page 10 of 17

11 I. Interpretation of Results Caution is advised in the interpretation of neonate glucose values below 50 mg/dl. Critical values are <40 mg/dl and >500 mg/dl. All critical values should be repeated to eliminate the possibility of technical or operator error. If repeat value is critical, notify physician per critical value department policy. Critical value is confirmed by laboratory according to departmental policy. Ensure that the following information is recorded in the patient s medical record: date, time, test result, and initials of person who performed test. J. Method Limitations Test strips give dependable test results if the following limitations are understood: Use only Accu-Chek Comfort Curve test strips (Cat. No ) for testing with the Accu-Chek Inform meter. Blood glucose determinations using venous and arterial blood specimens should be performed within 30 minutes of specimen collection to minimize the effects of glycolysis. Avoid air bubbles if dosing with pipettes. Air bubbles may cause erroneous results. For best results with arterial and venous blood, the following anticoagulants/preservatives are recommended: heparin and EDTA. Serum separator tubes and red top tubes are acceptable if blood is used immediately before the clotting process begins. Iodoacetate or fluoride/oxalate should not be used as a preservative. Caution should be taken to clear arterial lines before blood is drawn and dosed on the test strip. Caution is advised in the interpretation of neonate glucose values below 50 mg/dl. Do not use during xylose absorption testing. No effect was found at 20% to 65% hematocrit and glucose concentrations up to 200 mg/dl. At glucose concentrations above 200 mg/dl, low hematocrits (below 20%) may cause elevated results and high hematocrits (above 55%) may cause reduced results versus a whole blood reference. Page 11 of 17

12 Infusion therapy solutions that contain maltrose concentrations >16 mg/dl (such as some human immunoglobulin solutions and peritoneal dialysis solutions containing icodextrin or extraneal) cause falsely elevated glucose results. If the patient is receiving products containing the sugars xylose, galactose or maltose (Ex. the drug Orencia for RA), falsely elevated glucose results may be obtained. The following compounds, when determined to be in excess of their limitations, may produce elevated glucose results: Galactose (>10 mg/dl), Maltose (>16 mg/dl), Bilirubin (unconjugated) (>20 mg/dl), Lipemic samples (>5000 mg/dl), Acetaminophen (>8 mg/dl), Uric Acid: Hypoglycemic range (>10 mg/dl), Euglycemic range (>12 mg/dl), Hyperglycemic range (>16 mg/dl). In situations of decreased peripheral blood flow, fingerstick blood testing may not be appropriate as it may not reflect the true physiological state. Examples would include, but are not limited to: severe dehydration caused by diabetic ketoacidosis or the hyperglycemic hyperosmolar nonketotic state, hypotension, shock, or peripheral vascular disease. In such cases a tube must be drawn and sent to the lab for analysis. The system measurement range is mg/dl. False glucose results may be caused by the following: 1. Not cleaning the finger well - It is extremely important to clean the finger with alcohol prior to obtaining the sample for glucose testing. Any residual sugar from food the patient may have eaten, lotion, oils, soap, etc. that may be on the finger will cause a falsely elevated glucose level. 2. Not allowing the alcohol to dry completely - The alcohol used to clean the finger must be allowed to dry thoroughly before obtaining a sample. Residual alcohol will give erroneous results. 3. Not using the second drop of blood - The first drop of blood from the fingerstick should never be tested. Rather it should be wiped away and the second drop tested. The first drop contains tissue fluids and will give erroneous results. 4. Not completely filling the yellow sample area - The yellow sample area on the test strip must be filled completely with patient sample. Under or over filling will give erroneous results. 5. Squeezing the finger repeatedly at the fingertip to obtain more blood - If there is not enough blood flow, you may gently squeeze the finger at the base of the finger to encourage blood flow. Do not squeeze at the fingertip or excess tissue fluids may be introduced into the sample and give erroneous results. Page 12 of 17

13 6. Testing patients with decreased peripheral circulation - Patients who have decreased peripheral circulation due to dehydration, hypotension, shock, vascular disease, etc. will have fingerstick glucose results that are significantly different from specimens that are drawn by venipuncture and tested in the lab. These patients must have lab draws for accurate glucose readings. 7. Testing patients receiving products containing the sugars xylose, galactose or maltose - If the patient is receiving products containing the sugars xylose, galactose, or maltose (Ex. The drug Orencia for RA or sugars which are metabolized to maltose, such as peritoneal dialysis solutions containing icodextrin or extraneal), a falsely elevated result will be obtained. 8. Using strips that have not been kept in a tightly closed strip vial. Strips left out of the tightly closed vial can be affected by moisture or the chemical in the strip that causes the reaction may dry up causing inaccurate results. Page 13 of 17

14 JOB AID Accu-Chek Glucose Meter (Whole Blood Glucose) Code Key - The Code key supplied with the testing strips is used to calibrate the Accu- Chek instrument. The Code key should be changed when every new vial of testing strips is opened. Discard the old Code key. Controls - Two levels of liquid controls are required to be performed daily, every time a new vial of test strips is opened, and if the machine is dropped. Control solutions are stable for 3 months from the date they are opened, as long as it is within the original expiration date stated on the bottle. The open and new 3 month expiration date must be recorded on each bottle. Strips - The test strips are sensitive to moisture and must be kept tightly capped. The open date and QC d must be recorded on the test strip bottle to verify that quality control was performed on the strips upon opening. A valid patient and operator identification must be entered into the instrument prior to patient testing. A valid operator ID is obtained by scanning the employee s barcode on the back of the employee badge. A valid patient identification is the Account/Visit Number (The 11 number) obtained by scanning the patient s armband. If they have not yet been registered, ER patients may be identified using a first and last name or Social Security Number. False glucose results may be caused by the following: 1. Not cleaning the finger well - It is extremely important to clean the finger with alcohol prior to obtaining the sample for glucose testing. Any residual sugar from food the patient may have eaten, lotion, oils, soap, etc. that may be on the finger will cause a falsely elevated glucose level. 2. Not allowing the alcohol to dry completely - The alcohol used to clean the finger must be allowed to dry thoroughly before obtaining a sample. Residual alcohol will give erroneous results. 3. Not using the second drop of blood - The first drop of blood from the fingerstick should never be tested. Rather it should be wiped away and the second drop tested. The first drop contains tissue fluids and will give erroneous results. 4. Not completely filling the yellow sample area - The yellow sample area on the test strip must be filled completely with patient sample. Under or over filling will give erroneous results. Page 14 of 17

15 5. Squeezing the finger repeatedly at the fingertip to obtain more blood - If there is not enough blood flow, you may gently squeeze the finger at the base of the finger to encourage blood flow. Do not squeeze at the fingertip or excess tissue fluids may be introduced into the sample and give erroneous results. 6. Testing patients with decreased peripheral circulation - Patients who have decreased peripheral circulation due to dehydration, hypotension, shock, vascular disease, etc. will have fingerstick glucose results that are significantly different from specimens that are drawn by venipuncture and tested in the lab. These patients must have lab draws for accurate glucose readings. 7. Testing patients receiving products containing the sugars xylose, galactose or maltose - If the patient is receiving products containing the sugars xylose, galactose, or maltose (Ex. The drug Orencia for RA or sugars which are metabolized to maltose, such as peritoneal dialysis solutions containing icodextrin or extraneal), a falsely elevated result will be obtained. 8. Using strips that have not been kept in a tightly closed strip vial. Strips left out of the tightly closed vial can be affected by moisture or the chemical in the strip that causes the reaction may dry up causing inaccurate results. A normal fasting blood sugar for a non-diabetic adult is mg/dl. A critical glucose value is <40 mg/dl or >500 mg/dl. If a critical value is obtained, the test must first be repeated to eliminate the possibility of technical or operator error. If the result is still critical, verify the result by a lab draw. The system measurement range is mg/dl. Once the glucose meter is placed back in the base, the patient s results will download into the Laboratory Information System. A whole blood glucose test will automatically be ordered and the result automatically entered into the patient s permanent electronic medical record. In the labs computer for each glucose test, the date, time, operator s name, patient s account number, result, any comments added, and which instrument was used for testing is documented and stored for any needed future reference. Page 15 of 17

16 Posttest Name: Date: Acknowledgement of Module Content review (Check appropriate response): I have read the module contents: Fingerstick Glucose Using Accu-Chek Inform. Yes No 1. Alcohol used to clean the finger must dry completely prior to the fingerstick or inaccurate results may be obtained. a) True b) False 2. It is important to adequately clean the finger prior to obtaining the sample for glucose testing. a) True b) False 3. It is extremely important to completely fill the yellow test strip window or inaccurate results may be obtained. a) True b) False 4. Falsely elevated glucose results will be obtained on patients receiving products containing the sugars xylose, galactose, or maltose (Ex. Orencia, peritoneal dialysis solutions containing icodextrin or extraneal). a) True b) False 5. The first drop of blood from the fingerstick should always be used to perform the patient test. a) True b) False Page 16 of 17

17 6. Two levels of quality control must be run: a) Every day of patient testing b) Every time a new bottle of testing strips is opened c) If the instrument has been dropped d) All of the above 7. Glucose controls are stable for how long after they are opened? a) One month not to exceed the expiration date on the bottle b) Three (3) months not to exceed the expiration date on the bottle c) Until the expiration date on the bottle 8. What must be recorded on the glucose control bottles upon opening? a) Open date b) New expiration date c) Nothing d) Both a and b 9. What must be recorded on the glucose strip bottle upon opening? a) Open date b) QC d (for Quality Control performed) c) Nothing d) Both a and b 10. A result that is flagged with Lo or Hi means that a) The strip is defective b) The test result is outside the glucose meter s measurement range of mg/dl. c) Controls should be run d) None of the above 11. In which situations should the Inform glucose meter not be used for glucose testing: a) Patients with decreased peripheral blood flow b) Patients in shock c) Patients with hypotension d) Patients with peripheral vascular disease e) Patients with severe dehydration f) All of the above 12. A critical blood glucose level is <40 mg/dl and >500 mg/dl. What is the first thing that should be done? a) Immediately report to physician b) Repeat test to eliminate possibility of technical/operator error c) Do nothing Page 17 of 17