Accucheck procedure - page 2

Do you follow this procedure for your chemsticks? If not, why not? I was taught this way in nursing school but I seem to see few people follow this on the west coast. Advise please? 1. Has the... Read More

  1. by   AuntieRN
    I am a diabetic....what I was taught by my MD not what I was taught at work was....wash my hands good with soap and H2O before I stick myself...use the first drop of blood....
    Now at work and school we were taught wipe with alcohol...let dry...stick...wipe first drop away then use next drop...we were also taught not to squeeze and try to "bleed" the finger as you get other fluids then.
    Yes alcohol dries out your fingers....and sticking them even twice a day makes them tough and hard to get samples from...trust me finger tips hurt so bad now and I only do mine twice a day...but I am afraid to use my arm because I can not cover it at work and I do not want to take any chances of getting anything...at least my fingers I can put gloves on.
  2. by   ginger58
    Quote from AuntieRN
    I am a diabetic....what I was taught by my MD not what I was taught at work was....wash my hands good with soap and H2O before I stick myself...use the first drop of blood....
    Now at work and school we were taught wipe with alcohol...let dry...stick...wipe first drop away then use next drop...we were also taught not to squeeze and try to "bleed" the finger as you get other fluids then.
    Yes alcohol dries out your fingers....and sticking them even twice a day makes them tough and hard to get samples from...trust me finger tips hurt so bad now and I only do mine twice a day...but I am afraid to use my arm because I can not cover it at work and I do not want to take any chances of getting anything...at least my fingers I can put gloves on.
    JBI Clinical Information Service Evidence Summary Update

    If you're a diabetic and you test your blood sugar (glucose) level, how do you prepare your skin, where do you take the blood from, and does it really matter anyway? It certainly does, according to expert opinion and research reported in an evidence summary produced by the Joanna Briggs Institute Clinical Information Service.

    The experts say that hand-washing with warm water and soap is a good start to testing your blood glucose level. Once you've done that, should you swab your finger with alcohol? No. This can cause false readings, and dry and toughen the skin over time.

    Now for the tricky bit: the jab. Don't aim for the fleshy middle part of the finger-tip; use the outer edge, according to the experts. Gently massage the finger before you jab it, not after. Vigorous squeezing after the finger-prick can dilute the blood with the fluid from your finger-tip cells, and give a false low reading.

    If all that finger-pricking is just too painful, you could consider an automated testing device, which applies a small vacuum to the forearm, lances the skin, transfers blood onto an electrochemical test strip, and measures glucose. Ninety seven per cent of people who trialed the device found it to be less painful than finger-prick stick testing.

    A word of caution, though: research suggests that when blood glucose is low (hypoglycaemia), blood taken from the forearm is much less likely to give an accurate reading than blood taken from the finger-tip or the palm. The results of the study confirmed findings of previous studies, which suggested forearm blood glucose measurements in acute hypoglycaemia were inaccurate, but because the study was small, the authors called for more research.
  3. by   TheCommuter
    I will freely admit that my habits are bad regarding blood sugars.

    There's no way in hell that I would be able to get a confused diabetic resident to the sink to wash their hands. I simply donn some gloves, insert the chem strip into the machine, lance the resident's finger, drop the blood onto the strip, and wait for the result. Several of my residents bleed so poorly that I don't have the luxury of wiping away the first drop.
  4. by   RGN1
    Quote from TheCommuter
    I will freely admit that my habits are bad regarding blood sugars.

    There's no way in hell that I would be able to get a confused diabetic resident to the sink to wash their hands. I simply donn some gloves, insert the chem strip into the machine, lance the resident's finger, drop the blood onto the strip, and wait for the result. Several of my residents bleed so poorly that I don't have the luxury of wiping away the first drop.
    I just use a gauze swab soaped up , then one with just water, then a dry one to clean the fingers (all carried to the bedside at the same time as the glucometer machine - so it doesn't take a second to do) of those who are unable to wash their hands themselves.
  5. by   CapeCodMermaid
    Quote from Chicklet2
    I was taught to not use alcohol swabs b/c the alcohol dries out the fingers especially if your checking their blood 4 times a day. Just cleanse well with normal saline. Also I was never taught to put gloves to do an accucheck or to wipe away the first drop of blood.
    EEEEEEEEEEEEEEWWWWWWWWWWWWWW no gloves? There is BLOOD involved...you have to wear gloves!! Reminds me of school when the instructor told us not to wear gloves when changing a colostomy flange because the 'poor' patient might think we are offended. Hellooooooooooo....there is POOP involved....yuckies. I always wore gloves then and always wear 'em now.
    Our glucometer machine instructions say avoid alcohol if soap and water are available and NEVER squeeze the finger.
  6. by   mandykal
    Finding this strange. I have a client that would not have his fingers pricked to obtain blood. For many years he's been getting pricked on his ear lobe....first time I did a glucose check, it felt odd...
  7. by   RYNOBLASTER30
    Getting a sample is pretty much universal, the technique and process is the same. Only the machines change. You should always try to discard the first drop of blood if possible. Alot of patiets 3rd space, and that initial drop of blood is diluted with serous fluid which may give you a lower than normal result. Also, if the patient is clamped down, or hypothermic, you should really try to obtain blood directly from the vein. Hopefully that type of patient has an arterial or central line. But maybe not.
  8. by   NurseAnnie85
    my instructor in school also told us after wiping with alcohol pad not to fan the finger dry.... i know why not to blow on it to make it dry quicker (ew spit breath germs etc..) even though i know alcohol doesn't take years to dry but why are you not suppossed to fan it like with your hand or something...anyways just curious
  9. by   tiggertoo
    Quote from NurseAnnie85
    my instructor in school also told us after wiping with alcohol pad not to fan the finger dry.... i know why not to blow on it to make it dry quicker (ew spit breath germs etc..) even though i know alcohol doesn't take years to dry but why are you not suppossed to fan it like with your hand or something...anyways just curious
    I believe that the idea is that fanning may/will disturbe dust or other airborne particles in the area and increase the likelyhood of contaminating the area just cleaned.
  10. by   Sunflowerinsc
    At home I wash with soap and water, use injector to prick side of finger,may squeese finger alittle but never "milk" it. Wipe off 1st drop,that will not give a accurate reading ,it will have fluid in it. Now at work, I don't think many pt's could walk to sink to wash! We use acholol pad, wipe with dry gauze pad,wipe off 1st drop. Number 13 in the orginal post was "If there is no injector,use a darting motion to prick the site with lancet." I would say "If there is no injector, "DON'T PRICK THE SITE AT ALL" Or try it on yourself with just the lancet and see how it feels!!!! At ,work of course ,the lancet IS a injector. Used once only.
  11. by   Myxel67
    When I teach pts to check BG at home, it's soap and water, but alcohol pad if out and no convenient place to wash hands. I have diabetes, so I have experimented a little. The worst part about not allowing finger to dry is that you won't get a drop of blood--it just runs all through the fingerprint.
    I have left a lot of alcohol on my finger to mix with blood, but machine does not recognize the sample as blood and gives an error message.

    In teaching nurses and CNAs to use the hospital meters, #16 in OP is something I stress. Get a large drop of blood on side of fingertip and touch pad of strip to the blood drop so that an adequate sample is applied at one time. Many people do not get a large enough drop of blood and end up squeezing and dabbing several times. This causes inaccurate results. One nurse in class checked her partner's BG with the squeeze and dab technique--result 49. When checked again with correct technique BG was 89. We don't wipe away first drop--might not get a second sometimes.

    Also important to recap strip bottle immediately--some CNAs have taken a supply of strips from bottle and put them into the meter case--gives inaccurate results because strips absorb moisture and are exposed to light.

    BG meters are designed to be used with capillary blood and then machine makes adjustment so that results are comparable with serum BG results from lab. I suggest avoiding arterial or venous blood for that reason.

    BG results obtained from alternate site testing are not accurate when BG is changing rapidly--after a meal or if person's BG is dropping quickly from too much insulin, too much exercise, or not enough food. Results can lag by 30 to 45 minutes. Also, without the vacuum lancet device, it's a lot more work and more time consuming to get sample from alternate site. In my own limited comparisons, I have found results from thumb and heel of hand to be comparable to fingertip results.
  12. by   nurse4theplanet
    We calibrate our machines q 24 hrs when the machine prompts.

    I work in ICU. Pts are on strict bedrest, most are sedated or venitilated, and sometimes accuchecks are q 1 hr....so no...they do not wash their hands, nor do I wash their hands for them.

    I use an alcohol swab. Kills just as many, if not more, germs/bacteria as washing hands. If they don't want to use alcohol longterm, then that's their issue...but for my purposes...its the most practical method for acute critical care.

    I then prick and wipe away the first drop of blood with a cotton ball because it is contaminated with alcohol and serous fluid from the tissues. I am not worried about recontamination of the site because the alcohol is effective for several minutes and I have never heard of a pt getting an infection from a FSBS when an antiseptic was used before sticking...now if you injected the needle without using an antiseptic first and introduced bacteria directly into the blood stream via the needle then I could see a problem, but after you prick the finger pressure forces the blood flow out of the vessel and the chances of you introducing bacteria into the bloodstream simply by wiping the surface with an unsterile (gasp) cotton swab over the small pin prick in the peripheral circulation are slim to nil.

    I then hold pressure after I have my sample with a cotton ball...same technique that most labs/ERs/Doctors offices use after a phlebotomist draws blood. No bandaids.

    I don't milk the finger after I stick, I do it before...especially if they have cold hands or delayed capillary refill time.

    If I don't feel like the measurement is accurate, I check it twice. If I still have questions, I get a stat BG sent to the lab.
  13. by   makes needs known
    I recently had a problem at work because I have not been using alcohol wipes to clean fingers before doing blood sugars. I learned at school that alcohol would dry out fingers and lead to compromised skin. I have seen many fingers that our so tender and scabbed that wiping them with an alcohol wipe seems like just another way to cause pain . I also do not use alcohol because of incorrect bs readings. I received a deficiency even though our facility protocol did not say to specifically use alcohol wipes. I'm sure that they are updating that. I will be using alcohol wipes from now on, and drying off with a 2x2.
    Has anyone had a similar incident?

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