{"id":3621,"date":"2015-06-18T15:12:49","date_gmt":"2015-06-18T15:12:49","guid":{"rendered":"http:\/\/opentextbc.ca\/clinicalskills\/?post_type=chapter&p=3621"},"modified":"2021-05-20T22:08:04","modified_gmt":"2021-05-20T22:08:04","slug":"8-2-glucometer-use","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/clinicalskills\/chapter\/8-2-glucometer-use\/","title":{"raw":"9.2 Glucometer Use","rendered":"9.2 Glucometer Use"},"content":{"raw":"People\u00a0with\u00a0diabetes require regular monitoring of their blood\u00a0glucose to help them achieve as close to normal blood glucose levels as possible for as much of the time\u00a0as possible. The benefits of\u00a0maintaining a blood glucose level that is consistently\u00a0within the range of 4-7 mmol\/L will reduce the\u00a0short-term, potentially life-threatening complications of\u00a0hypoglycemia as well as the\u00a0occurrence rate and severity of the long-term\u00a0complications of hyperglycemia.\r\n\r\nPatients in the hospital setting are likely to have inconsistent blood glucose levels as they are affected by changes in diet and lifestyle,\u00a0surgical procedures, and the stress of being in a hospital. The physician will prescribe how regularly the blood glucose should be monitored. In acute situations, a sliding-scale treatment for insulin will be individually prescribed per patient. The medication administration record (MAR) or sliding scale will provide directions for the amount of medication to be given based on the blood glucose reading.\r\n\r\nIt is usually the responsibility of the nurse to perform blood glucose readings. As with any clinical procedure, ensure that you understand the patient's condition, the reason for the test, and the possible outcomes of the procedure. Prior to performing a blood glucose test, ensure that you have read and understood the manufacturer's instructions and your agency's policy for the blood glucose monitoring machines (see Figure 9.1) used in your clinical setting, as these vary. It is also important that you determine the patient's understanding of the procedure and the purpose for monitoring blood glucose level. Before you begin,\u00a0you should also determine if there are any conditions present that could affect\u00a0the reading. For example, is the patient\u00a0fasting? Has the patient\u00a0just had a meal? Is the patient on\u00a0any medications that could affect the reading (e.g.,\u00a0anticoagulants)? In these situations, draw on your knowledge and understanding of diabetes, the medication you are administering, the uniqueness of your patient, and the clinical context. Use your knowledge and critical thinking to make a clinical judgment.\r\n\r\n[caption id=\"attachment_5049\" align=\"aligncenter\" width=\"280\"]\"DSC_0718\"<\/a> Figure 9.1 A blood glucose monitoring machine with cotton balls, lancets, and reagent strips[\/caption]\r\n\r\nInspect the area of skin that will be used as the puncture site and ask the patient if they are in agreement with the site you have identified to use for the skin puncture. Your patient may have a preference for the puncture site.\u00a0For example, some patients prefer not to use a specific finger for the skin puncture. Or a particular\u00a0site may be contraindicated. For example, you shouldn't\u00a0use the hand on the same side as a mastectomy.\r\n\r\nPatients who\u00a0do their own\u00a0blood glucose testing at home may prefer to handle the skin-puncturing device themselves and continue self-testing while they are in the hospital.\u00a0<\/strong>\r\n\r\nChecklist 77 outlines the steps for taking a skin-puncture\u00a0blood sample and using a blood glucose monitor (glucometer) to measure a patient's blood glucose level.\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
<\/a>Checklist 77:\u00a0Blood Glucose Monitoring<\/caption>\r\n
\r\n
Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\r\n<\/td>\r\n<\/tr>\r\n
\r\n
Safety considerations:<\/h5>\r\n
    \r\n \t
  • Perform hand hygiene.<\/li>\r\n \t
  • Check room for additional precautions.<\/span><\/li>\r\n \t
  • Introduce yourself to patient.<\/span><\/li>\r\n \t
  • Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\r\n \t
  • Check allergy band for any allergies.<\/li>\r\n \t
  • Complete necessary focused assessments and\/or vital signs and document on MAR.<\/span><\/li>\r\n \t
  • Provide patient education as necessary.<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
\r\n

Steps<\/h4>\r\n<\/td>\r\n

\r\n

\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n

1. Review the patient's medical history for diabetes type, medications, and\/or anticoagulant therapy.<\/td>\r\nA thorough knowledge of the patient's\u00a0medical history is important even when the test performed is a relatively simple procedure.\r\n\r\nAnticoagulant therapy may result in prolonged bleeding at the skin-puncture site and require pressure to the site.<\/td>\r\n<\/tr>\r\n
2. Determine if the test requires special timing; for example, before or after meals. Blood glucose monitoring is usually done prior to meals and the administration of antidiabetic medications.<\/td>\r\nBlood glucose levels are affected by diet, and the test may be scheduled at very specific intervals.\r\n\r\nDiet and medication\u00a0orders are based on the assumption that the test results are accurate.<\/td>\r\n<\/tr>\r\n
3. Gather equipment\u00a0needed:\r\n
    \r\n \t
  • Disposable latex-free gloves<\/li>\r\n \t
  • Alcohol swab<\/li>\r\n \t
  • Lancet or automatic lancing device<\/li>\r\n \t
  • 2 x 2 gauze<\/li>\r\n \t
  • Reagent strips<\/li>\r\n \t
  • Blood glucose meter<\/li>\r\n<\/ul>\r\n<\/td>\r\n
Having equipment prepared and available promotes organization, safety, and timeliness.\r\n\r\n[caption id=\"attachment_5081\" align=\"aligncenter\" width=\"268\"]\"DSC_1101\"<\/a> Gloves, alcohol swab, lancet, gauze, reagent strips, glucometer[\/caption]<\/td>\r\n<\/tr>\r\n
4. Determine if blood glucose meter needs to be\u00a0calibrated.<\/td>\r\nCalibration should be done regularly according to agency policy to ensure accuracy of readings.<\/td>\r\n<\/tr>\r\n
5. Assess patient's\u00a0sites for skin puncture.<\/td>\r\nSkin integrity at the puncture site\u00a0minimizes the\u00a0risk of infection and promotes healing.<\/td>\r\n<\/tr>\r\n
6. Perform hand hygiene.<\/td>\r\nHand hygiene prevents the transfer of microorganisms.\r\n\r\n[caption id=\"attachment_5972\" align=\"aligncenter\" width=\"150\"]\"Hand<\/a> Hand hygiene with ABHR[\/caption]<\/td>\r\n<\/tr>\r\n
7. Have patient\u00a0wash hands with soap and warm water, and position the patient\u00a0comfortably in a semi-upright position in bed or upright in a chair. Encourage patient to keep hands warm.\r\n\r\nHospital policy may require use of an alcohol swab only, not water, to clean the puncture site.\r\n\r\nEnsure that puncture site is completely dry prior to skin puncture.<\/td>\r\nWashing reduces transmission of microorganisms and increases blood flow to the puncture site.\r\n\r\n[caption id=\"attachment_5083\" align=\"aligncenter\" width=\"150\"]\"DSC_1100\"<\/a> Have patient wash hands with warm water[\/caption]\r\n\r\n[caption id=\"attachment_5095\" align=\"aligncenter\" width=\"150\"]\"DSC_1118\"<\/a> Or clean with an alcohol swab if that is agency policy[\/caption]<\/td>\r\n<\/tr>\r\n
8. Remove a reagent strip from the container and reseal the container cap.\u00a0Do not touch the test pad portion of the reagent strip.<\/td>\r\nTight closure of the container keeps strips from damage due to\u00a0environmental factors.\r\n\r\n[caption id=\"attachment_5085\" align=\"aligncenter\" width=\"150\"]\"DSC_1108\"<\/a> Remove reagent strip from container and close container tightly[\/caption]<\/td>\r\n<\/tr>\r\n
9. Follow the manufacturer's instructions to prepare the meter for measurement.<\/td>\r\nThis prepares meter for accurate readings.\r\n\r\n[caption id=\"attachment_5086\" align=\"aligncenter\" width=\"150\"]\"Prepare<\/a> Prepare the glucometer[\/caption]<\/td>\r\n<\/tr>\r\n
10. Place the unused reagent strip in the\u00a0glucometer or on a clean, dry surface (e.g., paper towel) with the test pad facing up. This step is dependent on the manufacturer's\u00a0instructions.<\/td>\r\n\r\n\r\n[caption id=\"attachment_5088\" align=\"aligncenter\" width=\"150\"]\"DSC_1110\"<\/a> Prepare the reagent strip according to the manufacturer's instructions[\/caption]\r\n\r\nMoisture may alter the test results.<\/td>\r\n<\/tr>\r\n
11. Apply non-sterile gloves.<\/td>\r\n\r\n\r\n[caption id=\"attachment_5090\" align=\"aligncenter\" width=\"150\"]\"Apply<\/a> Apply non-sterile gloves[\/caption]\r\n\r\nGloves protect health care provider from contamination by blood.<\/td>\r\n<\/tr>\r\n
12. Keep area to be punctured\u00a0in a dependent position. Do not milk or massage finger site.<\/td>\r\nDependent position will increase blood flow to the area. Milking or massaging the finger may introduce excess tissue fluid and hemolyze the specimen.\r\n\r\nAvoid having\u00a0the patient\u00a0stand during the procedure to reduce the risk of\u00a0fainting.<\/td>\r\n<\/tr>\r\n
13. Select appropriate puncture site and perform skin puncture.<\/td>\r\nYour patient may have a preference of site used. For example, the patient\u00a0may prefer not to use a specific finger for the skin puncture. Or the site may be contraindicated. For example, do not use the hand on the same side as a mastectomy.\u00a0Avoid fingertip pads; use sides of finger.\r\n\r\n[caption id=\"attachment_5092\" align=\"aligncenter\" width=\"150\"]\"DSC_1130\"<\/a> Perform skin puncture using a lancet[\/caption]<\/td>\r\n<\/tr>\r\n
14. Gently squeeze above the site to produce a large droplet of blood.<\/td>\r\nDo not contaminate the site by touching it.\r\n\r\nThe droplet of blood needs to be large enough to cover the test pad on the reagent strip.\r\n\r\n[caption id=\"attachment_5093\" align=\"aligncenter\" width=\"150\"]\"Gently<\/a> Gently squeeze site to produce a large droplet of blood[\/caption]<\/td>\r\n<\/tr>\r\n
15. Transfer the first drop of blood (or second drop if indicated by agency policy or manufacturer's instructions) to the reagent strip and apply following the manufacturer's instructions.<\/td>\r\nThe test pad must absorb the droplet of blood for accurate results. Smearing the blood will alter results.\r\n\r\n[caption id=\"attachment_5096\" align=\"aligncenter\" width=\"150\"]\"DSC_1141\"<\/a> The test pad must absorb the droplet of blood for accurate results[\/caption]\r\n\r\nThe timing and specific instructions for measurement will vary between blood glucose meters. Be\u00a0sure to read the instructions carefully to ensure accurate readings.<\/td>\r\n<\/tr>\r\n
16. Immediately press the timer on the meter (unless it starts automatically with insertion of reagent strip).<\/td>\r\nTiming is critical to produce accurate results.\r\n\r\nAlways check the manufacturer's instructions because the technique varies between meters.<\/td>\r\n<\/tr>\r\n
17. Apply pressure, or ask patient to apply pressure, to the puncture site using a 2 x 2 gauze pad or clean tissue.<\/td>\r\n\r\n\r\n[caption id=\"attachment_5097\" align=\"aligncenter\" width=\"150\"]\"DSC_1146\"<\/a> Apply pressure to the puncture site[\/caption]\r\n\r\nThis will stop the bleeding at the site.<\/td>\r\n<\/tr>\r\n
18. Read the\u00a0results on the unit display.<\/td>\r\nEach meter has a specified time for the reading to occur.\r\n\r\n[caption id=\"attachment_5098\" align=\"aligncenter\" width=\"172\"]\"DSC_1152\"<\/a> Read the blood glucose results on the glucometer[\/caption]<\/td>\r\n<\/tr>\r\n
19. Turn off the meter and dispose of the test strip, 2 x 2 gauze, and lancet according\u00a0to\u00a0agency policy.<\/td>\r\nThis reduces contamination by blood to other individuals.<\/td>\r\n<\/tr>\r\n
20. Remove non-sterile\u00a0gloves and place them in the appropriate receptacle.<\/td>\r\nThis reduces transmission of microorganisms.\r\n\r\n[caption id=\"attachment_5969\" align=\"aligncenter\" width=\"150\"]\"Remove<\/a> Remove non-sterile gloves[\/caption]<\/td>\r\n<\/tr>\r\n
21. Perform hand hygiene.<\/td>\r\nThis reduces the transmission of microorganisms.\r\n\r\n[caption id=\"attachment_5972\" align=\"aligncenter\" width=\"150\"]\"Hand<\/a> Hand hygiene with ABHR[\/caption]<\/td>\r\n<\/tr>\r\n
22. Review test results with the patient.<\/td>\r\nThis promotes patient participation in health care.<\/td>\r\n<\/tr>\r\n
23. Document results according to\u00a0agency policy.<\/td>\r\nResults will be used to determine the patient's\u00a0treatment plan.<\/td>\r\n<\/tr>\r\n
Data source: BCIT, 2015; Hortensius et al., 2011; Pagana & Pagana, 2011; Perry, Potter, & Ostendorf, 2014; VCH & PHC Professional Practice, 2013; Weiss Behrend, Kelley, & Randoloph, 2004<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n

Converting to Canadian (SI) measurements<\/h2>\r\nMany nursing resources are from the\u00a0United States,\u00a0where glucose values are reported as mg\/dl. Canadian laboratories use the international system of units (SI), which are\u00a0mmol\/L. Therefore, it is important to convert your patient's\u00a0laboratory values to SI units.\u00a0For glucose, divide the mg\/dl by 18 to find the comparable SI unit (e.g., 65 mg\/dl = 3.61 mmol\/L). This conversion chart<\/a> shows specific conversions.\r\n<\/strong>\r\n

Blood Glucose Readings that Require Follow-up<\/h2>\r\nThe concerns listed in Table 9.1 must\u00a0<\/em>be attended to and reported immediately to the relevant health care provider.\u00a0Please consult hospital\/unit-specific recommendations for\u00a0exact values. The concerns and actions in Table 9.1 are guidelines only.\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
Table 9.1 Blood Glucose Readings that Require Follow-up<\/caption>\r\n
Concern<\/strong><\/td>\r\nAction<\/strong><\/td>\r\n<\/tr>\r\n
Blood sugar outside \"acceptable range\" (<2.2 mmol\/L or >20 mmol\/L)<\/td>\r\nRepeat capillary test to confirm, and report if reading remains out of range.<\/td>\r\n<\/tr>\r\n
Blood sugar <2.2 mmol\/L or >20 mmol\/L<\/td>\r\nOrder a stat blood glucose (venous sample) by laboratory staff and initiate\u00a0hypoglycemia or hyperglycemia protocol according to agency policy.<\/td>\r\n<\/tr>\r\n
Blood sugar <4 mmol\/L<\/td>\r\nInitiate hypoglycemia protocol according to agency policy.<\/td>\r\n<\/tr>\r\n
Preoperative blood sugar <4 mmol\/L or >20 mmol\/L<\/td>\r\nCall physician.<\/td>\r\n<\/tr>\r\n
Post-operative blood sugar >13.5 mmol\/L (acceptable post-operative range = 8-13 mmol\/L)<\/td>\r\nTest urine for ketones. If positive, monitor urine ketones\u00a0every 4 hours.<\/td>\r\n<\/tr>\r\n
Data source: BCIT, 2015<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n
\r\n

Critical Thinking Exercises<\/p>\r\n\r\n<\/header>\r\n

\r\n
    \r\n \t
  1. Describe two methods for increasing blood flow to a patient\u2019s finger prior to lancing the finger.<\/li>\r\n \t
  2. What is one thing that you must wait for before administering rapid-acting insulin to a patient on your ward?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>","rendered":"

    People\u00a0with\u00a0diabetes require regular monitoring of their blood\u00a0glucose to help them achieve as close to normal blood glucose levels as possible for as much of the time\u00a0as possible. The benefits of\u00a0maintaining a blood glucose level that is consistently\u00a0within the range of 4-7 mmol\/L will reduce the\u00a0short-term, potentially life-threatening complications of\u00a0hypoglycemia as well as the\u00a0occurrence rate and severity of the long-term\u00a0complications of hyperglycemia.<\/p>\n

    Patients in the hospital setting are likely to have inconsistent blood glucose levels as they are affected by changes in diet and lifestyle,\u00a0surgical procedures, and the stress of being in a hospital. The physician will prescribe how regularly the blood glucose should be monitored. In acute situations, a sliding-scale treatment for insulin will be individually prescribed per patient. The medication administration record (MAR) or sliding scale will provide directions for the amount of medication to be given based on the blood glucose reading.<\/p>\n

    It is usually the responsibility of the nurse to perform blood glucose readings. As with any clinical procedure, ensure that you understand the patient’s condition, the reason for the test, and the possible outcomes of the procedure. Prior to performing a blood glucose test, ensure that you have read and understood the manufacturer’s instructions and your agency’s policy for the blood glucose monitoring machines (see Figure 9.1) used in your clinical setting, as these vary. It is also important that you determine the patient’s understanding of the procedure and the purpose for monitoring blood glucose level. Before you begin,\u00a0you should also determine if there are any conditions present that could affect\u00a0the reading. For example, is the patient\u00a0fasting? Has the patient\u00a0just had a meal? Is the patient on\u00a0any medications that could affect the reading (e.g.,\u00a0anticoagulants)? In these situations, draw on your knowledge and understanding of diabetes, the medication you are administering, the uniqueness of your patient, and the clinical context. Use your knowledge and critical thinking to make a clinical judgment.<\/p>\n

    \"DSC_0718\"<\/a>
    Figure 9.1 A blood glucose monitoring machine with cotton balls, lancets, and reagent strips<\/figcaption><\/figure>\n

    Inspect the area of skin that will be used as the puncture site and ask the patient if they are in agreement with the site you have identified to use for the skin puncture. Your patient may have a preference for the puncture site.\u00a0For example, some patients prefer not to use a specific finger for the skin puncture. Or a particular\u00a0site may be contraindicated. For example, you shouldn’t\u00a0use the hand on the same side as a mastectomy.<\/p>\n

    Patients who\u00a0do their own\u00a0blood glucose testing at home may prefer to handle the skin-puncturing device themselves and continue self-testing while they are in the hospital.\u00a0<\/strong><\/p>\n

    Checklist 77 outlines the steps for taking a skin-puncture\u00a0blood sample and using a blood glucose monitor (glucometer) to measure a patient’s blood glucose level.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    <\/a>Checklist 77:\u00a0Blood Glucose Monitoring<\/caption>\n
    \n
    Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\n<\/td>\n<\/tr>\n
    \n
    Safety considerations:<\/h5>\n
      \n
    • Perform hand hygiene.<\/li>\n
    • Check room for additional precautions.<\/span><\/li>\n
    • Introduce yourself to patient.<\/span><\/li>\n
    • Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\n
    • Check allergy band for any allergies.<\/li>\n
    • Complete necessary focused assessments and\/or vital signs and document on MAR.<\/span><\/li>\n
    • Provide patient education as necessary.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    \n

    Steps<\/h4>\n<\/td>\n

    		\n

    \u00a0Additional Information<\/h4>\n<\/td>\n<\/tr>\n

    1. Review the patient’s medical history for diabetes type, medications, and\/or anticoagulant therapy.<\/td>\nA thorough knowledge of the patient’s\u00a0medical history is important even when the test performed is a relatively simple procedure.<\/p>\n

    Anticoagulant therapy may result in prolonged bleeding at the skin-puncture site and require pressure to the site.<\/td>\n<\/tr>\n

    2. Determine if the test requires special timing; for example, before or after meals. Blood glucose monitoring is usually done prior to meals and the administration of antidiabetic medications.<\/td>\nBlood glucose levels are affected by diet, and the test may be scheduled at very specific intervals.<\/p>\n

    Diet and medication\u00a0orders are based on the assumption that the test results are accurate.<\/td>\n<\/tr>\n

    3. Gather equipment\u00a0needed:<\/p>\n
      \n
    • Disposable latex-free gloves<\/li>\n
    • Alcohol swab<\/li>\n
    • Lancet or automatic lancing device<\/li>\n
    • 2 x 2 gauze<\/li>\n
    • Reagent strips<\/li>\n
    • Blood glucose meter<\/li>\n<\/ul>\n<\/td>\n
    		Having equipment prepared and available promotes organization, safety, and timeliness.<\/p>\n
    \"DSC_1101\"<\/a>
    Gloves, alcohol swab, lancet, gauze, reagent strips, glucometer<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    4. Determine if blood glucose meter needs to be\u00a0calibrated.<\/td>\nCalibration should be done regularly according to agency policy to ensure accuracy of readings.<\/td>\n<\/tr>\n
    5. Assess patient’s\u00a0sites for skin puncture.<\/td>\nSkin integrity at the puncture site\u00a0minimizes the\u00a0risk of infection and promotes healing.<\/td>\n<\/tr>\n
    6. Perform hand hygiene.<\/td>\nHand hygiene prevents the transfer of microorganisms.<\/p>\n
    \"Hand<\/a>
    Hand hygiene with ABHR<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    7. Have patient\u00a0wash hands with soap and warm water, and position the patient\u00a0comfortably in a semi-upright position in bed or upright in a chair. Encourage patient to keep hands warm.<\/p>\n

    Hospital policy may require use of an alcohol swab only, not water, to clean the puncture site.<\/p>\n

    Ensure that puncture site is completely dry prior to skin puncture.<\/td>\n

    		Washing reduces transmission of microorganisms and increases blood flow to the puncture site.<\/p>\n
    \"DSC_1100\"<\/a>
    Have patient wash hands with warm water<\/figcaption><\/figure>\n
    \"DSC_1118\"<\/a>
    Or clean with an alcohol swab if that is agency policy<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    8. Remove a reagent strip from the container and reseal the container cap.\u00a0Do not touch the test pad portion of the reagent strip.<\/td>\nTight closure of the container keeps strips from damage due to\u00a0environmental factors.<\/p>\n
    \"DSC_1108\"<\/a>
    Remove reagent strip from container and close container tightly<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    9. Follow the manufacturer’s instructions to prepare the meter for measurement.<\/td>\nThis prepares meter for accurate readings.<\/p>\n
    \"Prepare<\/a>
    Prepare the glucometer<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    10. Place the unused reagent strip in the\u00a0glucometer or on a clean, dry surface (e.g., paper towel) with the test pad facing up. This step is dependent on the manufacturer’s\u00a0instructions.<\/td>\n\n
    \"DSC_1110\"<\/a>
    Prepare the reagent strip according to the manufacturer’s instructions<\/figcaption><\/figure>\n

    Moisture may alter the test results.<\/td>\n<\/tr>\n

    11. Apply non-sterile gloves.<\/td>\n\n
    \"Apply<\/a>
    Apply non-sterile gloves<\/figcaption><\/figure>\n

    Gloves protect health care provider from contamination by blood.<\/td>\n<\/tr>\n

    12. Keep area to be punctured\u00a0in a dependent position. Do not milk or massage finger site.<\/td>\nDependent position will increase blood flow to the area. Milking or massaging the finger may introduce excess tissue fluid and hemolyze the specimen.<\/p>\n

    Avoid having\u00a0the patient\u00a0stand during the procedure to reduce the risk of\u00a0fainting.<\/td>\n<\/tr>\n

    13. Select appropriate puncture site and perform skin puncture.<\/td>\nYour patient may have a preference of site used. For example, the patient\u00a0may prefer not to use a specific finger for the skin puncture. Or the site may be contraindicated. For example, do not use the hand on the same side as a mastectomy.\u00a0Avoid fingertip pads; use sides of finger.<\/p>\n
    \"DSC_1130\"<\/a>
    Perform skin puncture using a lancet<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    14. Gently squeeze above the site to produce a large droplet of blood.<\/td>\nDo not contaminate the site by touching it.<\/p>\n

    The droplet of blood needs to be large enough to cover the test pad on the reagent strip.<\/p>\n

    \"Gently<\/a>
    Gently squeeze site to produce a large droplet of blood<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    15. Transfer the first drop of blood (or second drop if indicated by agency policy or manufacturer’s instructions) to the reagent strip and apply following the manufacturer’s instructions.<\/td>\nThe test pad must absorb the droplet of blood for accurate results. Smearing the blood will alter results.<\/p>\n
    \"DSC_1141\"<\/a>
    The test pad must absorb the droplet of blood for accurate results<\/figcaption><\/figure>\n

    The timing and specific instructions for measurement will vary between blood glucose meters. Be\u00a0sure to read the instructions carefully to ensure accurate readings.<\/td>\n<\/tr>\n

    16. Immediately press the timer on the meter (unless it starts automatically with insertion of reagent strip).<\/td>\nTiming is critical to produce accurate results.<\/p>\n

    Always check the manufacturer’s instructions because the technique varies between meters.<\/td>\n<\/tr>\n

    17. Apply pressure, or ask patient to apply pressure, to the puncture site using a 2 x 2 gauze pad or clean tissue.<\/td>\n\n
    \"DSC_1146\"<\/a>
    Apply pressure to the puncture site<\/figcaption><\/figure>\n

    This will stop the bleeding at the site.<\/td>\n<\/tr>\n

    18. Read the\u00a0results on the unit display.<\/td>\nEach meter has a specified time for the reading to occur.<\/p>\n
    \"DSC_1152\"<\/a>
    Read the blood glucose results on the glucometer<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    19. Turn off the meter and dispose of the test strip, 2 x 2 gauze, and lancet according\u00a0to\u00a0agency policy.<\/td>\nThis reduces contamination by blood to other individuals.<\/td>\n<\/tr>\n
    20. Remove non-sterile\u00a0gloves and place them in the appropriate receptacle.<\/td>\nThis reduces transmission of microorganisms.<\/p>\n
    \"Remove<\/a>
    Remove non-sterile gloves<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    21. Perform hand hygiene.<\/td>\nThis reduces the transmission of microorganisms.<\/p>\n
    \"Hand<\/a>
    Hand hygiene with ABHR<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    22. Review test results with the patient.<\/td>\nThis promotes patient participation in health care.<\/td>\n<\/tr>\n
    23. Document results according to\u00a0agency policy.<\/td>\nResults will be used to determine the patient’s\u00a0treatment plan.<\/td>\n<\/tr>\n
    Data source: BCIT, 2015; Hortensius et al., 2011; Pagana & Pagana, 2011; Perry, Potter, & Ostendorf, 2014; VCH & PHC Professional Practice, 2013; Weiss Behrend, Kelley, & Randoloph, 2004<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Converting to Canadian (SI) measurements<\/h2>\n

    Many nursing resources are from the\u00a0United States,\u00a0where glucose values are reported as mg\/dl. Canadian laboratories use the international system of units (SI), which are\u00a0mmol\/L. Therefore, it is important to convert your patient’s\u00a0laboratory values to SI units.\u00a0For glucose, divide the mg\/dl by 18 to find the comparable SI unit (e.g., 65 mg\/dl = 3.61 mmol\/L). This conversion chart<\/a> shows specific conversions.
    \n<\/strong><\/p>\n

    Blood Glucose Readings that Require Follow-up<\/h2>\n

    The concerns listed in Table 9.1 must\u00a0<\/em>be attended to and reported immediately to the relevant health care provider.\u00a0Please consult hospital\/unit-specific recommendations for\u00a0exact values. The concerns and actions in Table 9.1 are guidelines only.<\/p>\n\n\n\n\n\n\n\n\n\n
    Table 9.1 Blood Glucose Readings that Require Follow-up<\/caption>\n
    Concern<\/strong><\/td>\nAction<\/strong><\/td>\n<\/tr>\n
    Blood sugar outside “acceptable range” (<2.2 mmol\/L or >20 mmol\/L)<\/td>\nRepeat capillary test to confirm, and report if reading remains out of range.<\/td>\n<\/tr>\n
    Blood sugar <2.2 mmol\/L or >20 mmol\/L<\/td>\nOrder a stat blood glucose (venous sample) by laboratory staff and initiate\u00a0hypoglycemia or hyperglycemia protocol according to agency policy.<\/td>\n<\/tr>\n
    Blood sugar <4 mmol\/L<\/td>\nInitiate hypoglycemia protocol according to agency policy.<\/td>\n<\/tr>\n
    Preoperative blood sugar <4 mmol\/L or >20 mmol\/L<\/td>\nCall physician.<\/td>\n<\/tr>\n
    Post-operative blood sugar >13.5 mmol\/L (acceptable post-operative range = 8-13 mmol\/L)<\/td>\nTest urine for ketones. If positive, monitor urine ketones\u00a0every 4 hours.<\/td>\n<\/tr>\n
    Data source: BCIT, 2015<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
    \n
    \n

    Critical Thinking Exercises<\/p>\n<\/header>\n

    \n
      \n
    1. Describe two methods for increasing blood flow to a patient\u2019s finger prior to lancing the finger.<\/li>\n
    2. What is one thing that you must wait for before administering rapid-acting insulin to a patient on your ward?<\/li>\n<\/ol>\n<\/div>\n<\/div>\n","protected":false},"author":5,"menu_order":2,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-3621","chapter","type-chapter","status-publish","hentry"],"part":3618,"_links":{"self":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/3621","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/users\/5"}],"version-history":[{"count":28,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/3621\/revisions"}],"predecessor-version":[{"id":10173,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/3621\/revisions\/10173"}],"part":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/parts\/3618"}],"metadata":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/3621\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/media?parent=3621"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapter-type?post=3621"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/contributor?post=3621"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/license?post=3621"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}