Accucheck procedure

[tiggertoo]

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 patient wash her hands with soap and warm

water, if she is able.

2. If patient is in bed, assists to semi-Fowler's position if

possible.

3. Turns on the glucose meter. Calibrates according to

manufacturer's instructions.

4. Checks expiration date on the container or reagent strips.

5. Removes a reagent strip, then tightly seals container.

6. Checks that the reagent strip is the correct type for the

monitor being used.

7. Dons procedure gloves.

8. Selects a puncture site on the lateral aspect of a finger

(heel or great toe for an infant).

9. Positions the finger in a dependent position and

massages toward the fingertip.

10. For infants, older adults, and people with poor

circulation, places a warm cloth on the site for about 10

minutes before obtaining the blood sample.

11. Cleanses the site with an antiseptic pad, or according to

facility policy, and dries it with a gauze pad.

12a. Engages the sterile lancet and removes the cover.

12b. Places the back of the hand on the table, or otherwise

secures the finger so it does not move when pricked.

12c. Positions the sterile lancet firmly against the skin,

perpendicular to the puncture site. Pushes the release

switch, allowing the needle to pierce the skin.

13. If there is no injector, uses a darting motion to prick the

site with the lancet.

14. Lightly squeezes the patient's finger above the puncture

site until a droplet of blood has collected.

15. Wipes away the first drop and squeezes again to form

another droplet.

16. Places reagent strip test patch close to the drop of

blood. Allows contact between the drop of blood and the

test patch until blood covers the entire patch. Does not

"smear" the blood over the reagent strip.

17. Allows the blood sample to remain in contact with the

reagent strip for the amount of time specified by the

manufacturer.

18. Using a gauze pad, gently applies pressure to the

Copyright © 2007, F. A. Davis Company, Wilkinson & Van Leuven/Procedure Checklists for Fundamentals of Nursing

puncture site.

19. Places the reagent strip into the glucose meter. (Some

manufacturer's instructions require you to first wipe the

reagent strip with a cotton ball so that no blood remains on

the test patch. Follows individual manufacturer

instructions.)

20. After the meter signals, reads the blood glucose level

indicated on the digital display.

21. Turns off the meter and disposes of the reagent strip,

cotton ball, gauze pad, paper towel, alcohol pad, and lancet

in the proper containers.

22. Removes the procedure gloves and disposes of them in

the proper container.

[ginger58, ASN, RN]

In response to following all of those steps each time. The machines that we use for accuchecks only needs to be calibrated once every 23 hours, however I tend to do it at the start of my shift. Wiping away the first drop of blood depends on the protocol of where you work because they taught us not to do that, because that would be the cleanest sample right after cleansing with alcohol. So it really depends. Those steps look like a long time but they are really the common sense directions and it only takes a few minutes to do them anyways.

I think the purpose of wiping the first drop away after the alcohol wipe is to be sure no alcohol is present that may influence the sample. The "ol" may increase the blood sugar. We're not worried about cleanest but the most accurate level.

[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.

[ginger58, ASN, RN]

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.

[TheCommuter, BSN, RN]

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.

[RGN1]

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.

[CapeCodMermaid, RN]

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.

[mandykal, ADN, RN]

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...

[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.

[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

[tiggertoo]

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.

[Sunflowerinsc, ADN, RN]

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.

[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.