Can you prick a diabetic too hard?

[esunada]

I'm a nursing student and this is second time I've pricked a patient for glucose monitoring. I did everything right I thought, alcohol wipe, pricked the side of the finger, and the patient complained in front of my preceptor that that was the most painful prick he had. He said in general the pricks here are painful and leave marks- the needle is longer at the hospital. The one time I felt I did everything perfectly is the one time I get yelled at and so now I feel unconfident. Did I push the needle in too hard? Is there such a thing as pushing too hard? I wanted to make sure to get the blood. That' the only thing I can think of....

In some ways while my internship is making me more confident in other ways it's making me less confident. I just feel like I'm a slow learner, like I need to do things 3-4 times before it imprints in my brain and even then I'm slow for some things, like filling up a syringe from a vial. Did anyone else feel this way?

Also, this is a stupid question, but whenever peal the backing of a medication, it doesn't peal fully so I have to push it out and twice now it popped out and once it fell on the floor. So I go really slow just to make sure it stays in the med cup. What am i doing wrong??? Grr, nursing makes me feel dumb

[Tait, MSN, RN]

The first time I passed meds was in a nursing home lunchroom. I sent some med flying across the room trying to push it through the backing. I learned after that to be very careful opening meds! :)

As far as the "pricking too hard" some patients are just fussy, and by telling your instructor it sounds like they might just have been trying to cause a little trouble, or for some odd reason thought they were helping teach you something. Perhaps they weren't excited about having a student, or what have you. The only thing you might want to try and change is letting the finger dry a little longer, perhaps he got a little alcohol or what have you in it and it made it sting more. Also the lancets at the hospital are bigger and people get very used to the finer needles they use at home and make a fuss no matter what.

Don't let these incidences break down your confidence, they aren't worth it.

[kool-aide, RN]

Don't stress out about the finger sticks..

The lancets my hospital uses have 3 different settings for the depth of the stick. Before you stick the pt, feel the finger that you're using... if the skin is super thin, use the most shallow setting on the lancet; vice versa for thick skin.

If you're questioning which setting to use, just go with the deepest. It may "sting" the pt a little more, but (for the most part) you'll be sure to get the drop of blood and not have to stick them a second time! Most diabetics are used to the FSBG anyways..

Don't worry about it! Everything will be okay!

[CrunchRN, ADN, RN]

Are you making sure that the alcohol is dry before you prick their finger? Also, you don't need to use any force. Just hold it on contact with the finger and you can milk it if you aren't getting enough blood.

[dorisc1981]

.....and the Oscar goes to. My God I know it might sting or hurt a bit but this patient made it seen like you were butchering him. I will just let it go or if you see the patient again, "What did I do wrong?, so next time this won't happen again. You need to learn right. Some of these patients too sensitive.

[thinkertdm]

Short of stabbing it into the bone, you can't really do it too hard. This person was just being a baby.

Also, check the finger (or ask the patient) to find one that is least used. If I forget which finger I used, I usually default to my pointy finger, and if it gets stuck numerous times in a day, it can be a little sensitive.

[Tait, MSN, RN]

Thumbs can be handy on people who get stuck a lot as well, as they are often ignored. :)

[belgarion]

We get a lot of patients who spent most of their lives working in oilfields, on ranches, or farming. These occupations are not exactly known for being injury free. I've seen guys with a three inch mesquite thorn sticking out of their leg just pull it out, pour beer on it, and go back to work. Now I have some of these men as patients and it's ridiculous the fuss they make over a finger stick. You'd think I just killed them. At he same time, the little wimpy guy who was scared of his own shadow in school never even flinched over having an 18ga angiocath inserted. Go figure.

[nursinmama921]

When I was a nursing student I also the same problem with one of the patients I was caring for and it did not help that his skin was thick like leather!! You will eventually get the feel for it depending on thickness of skin etc. What I have found that helps, especially with geriatric patients, is massaging the finger you are using as this usually helps increase blood flow to that finger. Also squeezing the finger and tightening the skin of the finger you are using will usually make it easier for the lancet to penetrate the skin and will also decrease the force you will need when using the lancet. It will be like second nature to you before you know it! Keep your head up and try to remember that EVERY nurse has been in your position(maybe not with the same issue)...even your instructors!

[classicdame, MSN, EdD]

As a diabetic I will add that there are areas more sensitive then others. You can always ask the patient to do it and then you finish the task.

[queenjulie, RN]

Also, this is a stupid question, but whenever peal the backing of a medication, it doesn't peal fully so I have to push it out and twice now it popped out and once it fell on the floor. So I go really slow just to make sure it stays in the med cup. What am i doing wrong?

Just keep going slow! :) I cannot tell you how many pills I shot out onto the floor my first semester of nursing school. It was horribly embarrassing. But I just do it directly, straight into the cup (like, I hold the pill pack directly against the med cup) and try to push slowly. Of course, then the patient tries to swallow it and it ends up falling out of his mouth onto the floor, but at least that's not my fault!

And yes, hospital lancets can be longer and thicker than the one's patients use at home, so it can hurt more, but there's not much you can do about it. I think it's better to do it a bit deeper once then to have to do it twice!

[Rob72, ASN, RN]

As a diabetic I will add that there are areas more sensitive then others. You can always ask the patient to do it and then you finish the task.

And, from another diabetic, that's the best answer.

I remember the nasty stamped sheet-steel blades. Before the advent of lancets, I was always partial to using (and receiving) a Bard-Parker #11, eye-balled to 2.4mm depth.