Fingerstick Glucose Testing-Do Alcohol Wipes Interfere w/ Results? - page 2

What is your employer's policy and procedure on fingerstick blood glucose testing? My employer doesn't have a policy and procedure on this and my co-workers and I are all in debate as to whether... Read More

  1. by   jojotoo
    Quote from neneRN
    We wipe away the first drop of blood before testing.
    The right answer! The reason that you want to wipe away the first drop, is to remove any contaminant or diluting factor - such as, alcohol, water, or tissue "juice" from squeezing the finger too hard.

    Alcohol vs. soap and water: It shouln't matter, diabetics at home don't use alcohol, they just wash their hands (sometimes!).
  2. by   Paprikat
    This just happened to me about 2 weeks ago. I got 9.4mmol, did not use an alcohol swab, as I was taught it wasn't necessary. The paramedics got 2.9mmol and the paramedic said to always use an alcohol swab and let it dry as there could have been residual sugar (?) on the guy's finger.
  3. by   Myxel67
    Soap and water is better at home--not as drying to the skin. Alcohol swab for convenience if soap & water not easily accessible. Let alcohol dry. I have read that alcohol will cause high reading and dampness from water will cause lower "diluted" results. It's possible that alcohol may have caused problems on older equipment, but I haven't been able to replicate those results. When I have intentionally left alcohol on finger, machine does not recognize specimen as blood and gives an error message. If the finger is damp with water, you can't get a good drop of blood--the blood spreads out into the fingerprint.

    Many students are taught to wipe the first drop of blood. We don't follow that practice or teach that in our glucose certifications. In some of our pts, the nurse or PCT is lucky to get the first drop of blood. We also teach not to squeeze the finger hard, but to stroke with mild pressure from base of finger to about a half inch from tip.

    Most frequent problems I see: Being too brutal--sticking pt much too hard.
    Not getting a big enough sample--dabbing several times instead of applying sample at one time. (causes false low with LifeScan Sure Step Pro)
    Using blood from a line--machines are designed to be used with capillary blood and machine indexes result to be comparable with serum BG level.
  4. by   NJNursing
    I always carry with me 1 alcohol wipe, 1 cotton ball, the monitor with the strip already in it and the sharp. I wipe with the alcohol, dry with one side of the cotton ball, poke, get the blood then use the other side of the cotton ball to put pressure on the bleeding. I've never had a problem that way.
  5. by   PickyRN
    Quote from FutureNurse35
    The medical surgical textbook that I am using says, alcohol should not be used when taking BG to wipe finger. Soap and water should be used instead.
    This was probably written by somebody who hasn't worked in a clinical setting for years, if ever.

    It is impractical to have each patient wash their hands with soap and water before you check their blood sugar. Most of my patients aren't ambulatory.
  6. by   oldiebutgoodie
    I think this is an example of hearsay in nursing. Everybody has an opinion,, but where's the data behind it (other than anecdotal)?

    I tried to find some studies on this issue, and did find this one:

    http://findarticles.com/p/articles/m..._6/ai_90218711

    "Effects of skin preparation on blood glucose monitoring results". It showed no significant difference between alcohol prep, soap and water, or nothing. Unfortunately, it did not measure differences whether alcohol was dry or wet.

    Oldeibutgoodie
  7. by   suzanne4
    If the alcohol or any solution is still on the finger and not dry, then any fluid will cause a decreas in the actual sugar. If you actually go back and review the CDC recommendations for using alcohol, you will see that it needs to be applied in a circular motion and permitted to dry for minutes, not seconds for it to actually be effective.

    When you poke the finger, you should always wipe away the first drop to make sure that it has not been diluted with the cleanser or even body fluids from the patient, and your level will actually be more accurate. And the blood should flow freely, the finger should not be squeezed, or it can dilute the blood sugar by mixing in other body fluids.

    You can verify this with the Med Tech from your lab that is usually in charge over the Glucometer machines in your facility. Remember that they need to be monitored by the lab to meet state and federal requirements.
  8. by   suzanne4
    And remember that the alcohol wipes are not like the alcohol-based cleansing solutions that we use for out hands. You are not using friction when using the wipe.

    If you notice, the prepared IV start kits that come from manufacturers do not contain the alcohol that they once did for the initial prep; you may see them included but that is only to wipe the other off the other prep that was included in some of the sets. But definitely not as the primary cleanser.
  9. by   VegRN
    Quote from PickyRN
    This was probably written by somebody who hasn't worked in a clinical setting for years, if ever.

    It is impractical to have each patient wash their hands with soap and water before you check their blood sugar. Most of my patients aren't ambulatory.
    Amen to that. Our hospital has recently switched from alcohol to soap and water prior to getting blood sugar check. You know what ends up happening? Since most of the pts are bed bound, the blood sugar is taken by the nurse tech without any cleaning of the pts hands. So residual sugar is left on the pts hands and gives us false highs. Whenever I suspect that the high isn't correct, I wash the pts hands and do a recheck myself and more often than not, the number is far far lower.

    I would much prefer training the techs to use the alcohol wipe and waiting for it to dry vs expecting them to wash bed bound pts hands with every blood sugar. How about alcohol wipe the finger upon entering room and then setting up machine? This would give it enough time to let it dry, at least with the machines we use at our facility.
  10. by   Myxel67
    [QUOTE=suzanne4;2179711]And remember that the alcohol wipes are not like the alcohol-based cleansing solutions that we use for out hands. You are not using friction when using the wipe.


    It's impossible to rub two surfaces together and not create friction.
    alcohol is just not a particularly good antiseptic or disinfectant. Participants in our outpatient classes often ask about using alcohol based hand cleaners before fingerstick. We advise against it since many contain moisturizing agents. Soap and water still preferable if feasible.
  11. by   firstaiddave907
    in my medical assistant program they taught us to use alcohol but let it dry before you stick the finger and to wipe away the first drop of blood.
  12. by   PsychRN-Kris
    Thank you all for your thoughts and input.

    I'm still in search of documented guidelines for the CDC, ADA or NIH to settle this debate/issue at work and to aide in writing of our policy. I haven't been able to find anything so far, but if anyone runs across anything please do let me know.
  13. by   MrChicagoRN
    I prefer the pt wash first.

    If not convenient, I'll use a wipe, let it dry, stick, then wipe off the first drop with a 2x2.

    Test with drop #2

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