Checking A Patient's Blood Glucose In His Earlobe?

[Dazglue, ADN, BSN, MSN, RN]

The other night we had a patient whose blood sugar was low after supper and it was checked in his fingers. After about an hour with critical low values, he was given a dose of D50 and it started to go up but it was still low. Another nurse decided to check the patient's glucose in his earlobe and it was almost doubled but was finally in the normal range. I've never seen this before and could not find this in our policy and procedures. Is this a common practice? Just wondering because I have never heard of or seen this before. I will ask my educator tomorrow but would like to know how common this practice is...Thanks.

[chrisrn24]

His earlobe? I've never heard of that. Like they pricked his earlobe?

[Twinmom06, ASN, APN]

I had a pt that had dextrose all over his hands and I stuck his toe to get an accurate reading…why didn't they do a lab draw if it was so critically low?

[Esme12, ASN, BSN, RN]

they don't do immediate lab draws in LTC for they usually don't have a lab.

HUmmmmmm .......ear lobe.........here is what I found......capillary blood from a fingerstick was the standard sample used in home glucose monitoring. Occasionally, a blood sample from the earlobe or heel (infant monitoring) was also used. Capillary samples from the finger or ear lobe have been closely associated with arterial blood values, i.e., their glucose and oxygen properties are more similar to arterial blood values than venous blood values.

However, even with fingerstick blood, concerns have been expressed about the variation in finger sampling technique and changes in peripheral blood flow as these may alter the composition of capillary blood. The main worry that has been expressed is contamination of the test sample, i.e., too much squeezing or 'milking' of the fingertip to produce a drop of blood may cause inaccuracies from either excess tissue fluid or hemolysis.

BestThinking / Articles / Medicine / Internal Medicine / Hematology / Glucose Concentration Difference Between Arterial, Capillary, and Venous Blood (Article)

Hence the difference between the two. It need to be decided which method to follow

[dirtyhippiegirl, BSN, RN]

We do earlobes on our crispier burns all the time. Great place to put a pulse ox, too! But for critical low values, a serum lab value is actually the gold standard on my unit although that can take as long as 45 minutes to come back from lab so we treat off the poc test.

We were actually just discussing instances where an earlobe stick comes up significantly higher than a finger or toe stick -- often with the finger/toe stick being low, but the earlobe being normal and eventually correlating with the blood draw. The only thing we could come up with, at least in regards to our specific patient population, is that our patients are often fluid overloaded and edematous that the fluid is somehow contaminating an improper stick.

/seriously a conversation we had maybe last week

[applewhitern, BSN, RN]

You really shouldn't stick a diabetic patient's toe. Some diabetics already have a decreased sense of feeling in their feet, plus circulation issues, and a stick there could cause infection.

[xoemmylouox, ASN, RN]

You really shouldn't stick a diabetic patient's toe. Some diabetics already have a decreased sense of feeling in their feet plus circulation issues, and a stick there could cause infection.[/quote']

I was thinking the same thing. I doubt one would be hazardous, but doing it several times would not be a great idea.

[CodeteamB]

Anecdotal but my diabetic friend samples from his ear lobes routinely, and doses accordingly, has not had any difficulties, except his ear lobes look awful!

[Lennonninja, MSN, APRN, NP]

I've had to do this before because my patient had such bad PVD that they'd lost all of their fingers! Check with your policy and procedure manual above all though.

[Do-over, ASN, RN]

I go to earlobes if the fingertips won't give an appropriate sample. I think our lancets are very short and sometimes its tough to get a good drop on someone with callouses or edema.

Of course, I try to remember to check if my assessment of the patient matches the BG value.

[Dazglue, ADN, BSN, MSN, RN]

You really shouldn't stick a diabetic patient's toe. Some diabetics already have a decreased sense of feeling in their feet, plus circulation issues, and a stick there could cause infection.

I never mentioned sticking a patient's toe.

[DebblesRN, ASN, BSN, RN]

She wasn't referring to you. Two other posters on page one mentioned sticking toes for blood glucose checks.