Accurate Blood Sugars

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I am a new nurse in the ICU and would like to know if anyone has any suggestions on obtaining accurate blood sugars on patients who are so edematous and peripherally constricted (usually on Levo) that the fingerstick samples look serosanguinous. Besides sticking a vein, are there any policies out there for obtaining blood sugars elsewhere on the body? This is especially a concern with insulin drips where we do hourly checks. Thanks for any help!

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Specializes in MICU.

You can try the ear lobe.

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Specializes in ICU.
You can try the ear lobe.

The toes are good as well.

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Specializes in ICU.

does the patient have an a-line? We use the safeset whenever we can... I wouldn't really want to stick someone's earlobe every hour...

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does the patient have an a-line? We use the safeset whenever we can... I wouldn't really want to stick someone's earlobe every hour...

My thoughts, exactly. If they are on pressors, they should have an a-line anyway, right?

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My thoughts, exactly. If they are on pressors, they should have an a-line anyway, right?

Tell that to a resident who hasn't slept in 20 hours.

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toes wouldn't help if they are on pressors... earlobes are unreasonable for hourly checks... and believe it or not very few of our patients have A-lines... even when they are vented and we have to do daily ABG's... boy would an A-line be great then! One current patient has an immature right arm fistula (no R arm sticks), left arm is hugely edemetous and ecchymotic from the daily ABG's and no A-line. We do not have residents (only periodically for a surgery they come from the main hospital) and feel lucky if we can get a midline. Its pretty much a no win situation. :banghead:

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Specializes in critical care.

Do they have a line? Hate to say it but can you send to lab? Our glucometers are not set up for venous samples. We do use saf-set though....

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Specializes in Critical Care.

Hmmmm no aline is definitely a problem. Only other thing I can think of would be a picc line or see if you could draw off a midline. Otherwise, you just do the best you can with the finger stick. Sometimes, warm blankets put on the extremities can help with perfusion, warm up the capillaries. Just a thought.

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Specializes in SICU/CVICU.
Tell that to a resident who hasn't slept in 20 hours.

I hate dealing with residents... i know they have to learn somehow but it's like you have to always point them in the right direction and watch out for crazy orders. In my unit we are expected to function at a resident level. I guess I should feel lucky that we only get a resident following a pt once in a blue moon.

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Specializes in SICU, Peds CVICU.

I would look at your ICU's policy re: the a line. All of our patients are supposed to have a lines if they're on any sort of vasoactive gtt unless they've been on it for >72 hours without it needing to be tittrated. It doesn't seem safe to be relying on a cuff (just my two cents).

Also, sometimes if you use your alcohol pad to push the edema away from the area you're going to be poking it seems to help some. a heat pack would help too.

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