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
What are we measuring & Why? 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
Blood Glucose Levels Fasting approx. P.C. 4-7 5-11 (3.8 7.8) non-diabetic (reference)
Signs & Symptoms Hyperglycemia Hypoglycemia
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)