arterial vs capillary glucose sample and a disagreement @ work - page 2

I had a patient that had a PICC line. I did a PICC blood draw for the lab person. After the draw, a CNA ask me to put a dot of blood on the glucose meter. I told them no, and that they needed to poke... Read More

  1. by   Virgo_RN
    Quote from NJNursing
    I just had a guy with a triple lumen arterial in the right carotid. He ripped it out in a confused state, lost a lot of blood and nearly coded. It happens and it happened in ICU right before his transfer here (ortho/neuro, step-down unit).
    I've never heard of a triple lumen arterial line in the right carotid. What is the purpose of this type of line?
  2. by   NJNursing
    Quote from NancyNurse08
    I've never heard of a triple lumen arterial line in the right carotid. What is the purpose of this type of line?
    I couldn't tell you. With 8 patients and being clinical coordinator, I didn't get to delve into why or when it was put in. I just know it was ripped out and it held up his transfer to our floor for 6 hours until the bleeding had subsided and additional tests were ordered and had come back. I believe he had a CVA and was t-PA'd.
  3. by   NotReady4PrimeTime
    There is never an indication for a triple lumen ARTERIAL line. The line your guy had was probably a triple lumen right internal jugular central venous line.
  4. by   BBFRN
    I agree with everything janfrn has said. Also, if it doesn't have a pressure bag and a transducer attached to it, it's not an art line. The massive bleeding would have been more of a result of the tPA.

    Reaching out on a limb here, but maybe the line was incorrectly placed? Did an xray show proper placement? I don't really see this happening, though, because it's pretty easy to tell when the line has been placed in an art vs vein during placement.

    Glucose is checked via a-lines all the time in critical care, r/t Q1h accuchecks on the insulin gtt patients.
    Last edit by BBFRN on Dec 1, '07
  5. by   NJNursing
    I didn't have the pt when he was in ICU. He had pulled it out before he had ever come to me. I had gotten in report that it was an arterial line that he ripped out, they had a sandbag on it for 6 hours, q 4 hemogram x 24 hours. He also pulled out his NG tube right afterwards. He came to me with a bandage around his neck with a pressure dressing a good 4 inches high. Needless to say, he had some triple lumen something or other. He's now got a picc line, nice and out of the way and they're trying a 3rd attempt at a PEG tube since he's ripped out 4 NG's in a week.
  6. by   starsINmyEYES
    yeah, i agree that if it's less invasive and policies are in place why not kill two birds with one stone, resulting in less trauma to the patient. i mean, i would imagine venous samples are far superior to fingertip samples, especially when you take into consideration that there might be dirt/sugar traces etc on the fingertip to begin with. if you get my drift? very interesting topic though! so thanx for that!
  7. by   nyforlove
    Quote from november551
    Awesome I'll have to see if I can find it somewhere. Ever since I got out of school I lost all my access to academic journals Guess I'll have to pony up some money so I can stay on the cutting edge.
    Great Thread! Did anyone locate that article? Thanks.
  8. by   hypocaffeinemia
    i think the article you're looking for is this:

    [font=verdana,arial,helvetica,sans-serif][font=verdana,arial,helvetica,sans-serif]comparison of point-of-care and laboratory glucose analysis in critically ill patients
    am. j. crit. care., jul 2007; 16: 336 - 346.

    here's the abstract:

    comparison of point-of-care and laboratory glucose analysis in critically ill patients

    by teresita lacara, rn, bsn, caroline domagtoy, rn, bsn, donna lickliter, rn, kathy quattrocchi, rn, bsn, lydia snipes, rn, jonne kuszaj, rn, msn, ccrn and maryclare prasnikar, rn, msn, ccrn. teresita lacara, caroline domagtoy, donna lickliter, and lydia snipes are staff nurses; kathy quattrocchi is a team leader; jonne kuszaj is a clinical manager; and maryclare prasnikar is a cardiovascular clinical nurse specialist in the medical-surgical intensive care unit at rex healthcare in raleigh, nc. corresponding author: teresita lacara, rn, bsn, intensive care unit, rex healthcare, 4424 lake boone trail, raleigh, nc 27607 (e-mail: teresita.lacara@rexhealth.com).

    background blood for point-of-care analysis of glucose levels is often obtained from different sources (fingerstick, arterial or central venous catheter).
    objectives to examine agreement between point-of-care and laboratory glucose values and to determine effects of hematocrit, serum carbon dioxide, and mean arterial pressure on the accuracy of point-of-care values.
    methods point-of-care values were compared with laboratory values. in 49 critically ill patients, blood was obtained first from a catheter for laboratory testing and then from the catheter and via fingerstick for point-of-care testing. bias, precision, and root-mean-square differences were calculated to quantify differences in values between the 2 methods. a t test was used to determine differences in values between each point-of-care blood source and the laboratory value. multiple regression analysis was used to determine if serum level of carbon dioxide, hematocrit, and/or mean arterial pressure significantly contributed to the difference in bias and precision for the point-of-care blood sources.
    results mean laboratory glucose level was 135 (sem 5.3, range 58–265) mg/dl. in point-of-care testing, bias precision and root-mean-square differences were 2.1 12.3 and 12.35, respectively, for fingerstick blood and 0.6 10.6 and 10.46 for catheter blood. values for point-of-care and laboratory tests did not differ significantly. for catheter samples, hematocrit and serum carbon dioxide contributed significantly to difference scores between point-of-care and laboratory values (p < .001).
    conclusions glucose values for point-of-care samples did not differ significantly from laboratory values. for catheter samples, hematocrit and serum carbon dioxide levels accounted for the difference between point-of-care and laboratory glucose values.
  9. by   PiPhi2004
    We use arterial blood, venous blood, capillary blood, whatever. I have never noticed a big difference (when we send down for blood out of art lines, we get a glucose reading, at MOST it may be one or 2 points off from a fingerstick I have gotten around the same time). If were takin blood out of an art line we always just put a dab on the glucometer if its time to test. It's one less stick for the pt. Maybe glucometers are different models and take different things?

close