No More Fingersticks for Techs!! - page 3

Is this happening where you all are? I live/work in New York City and work in a city hospital, and in the past few months, the BON sent a mandate stating that techs, CNAs, PCAs, etc...can no longer... Read More

  1. by   criticalHP
    Michigan is mixed. I've worked at big hospitals that allow techs to do fingersticks, and small ones that only the RN do figersticks. I have always found it frustrating that some techs would not report hi or low to me, but would chart it. While charting a hi or low is required, a verbal on all critical values is also reuqired-do all techs kow this? Apparently not. I think RN's should be responsible to obtain fingersticks- it is ultimatley going to require the RN attending to the pt, and in this way it is done without delay in needed treatment.
  2. by   Tait
    Quote from criticalHP
    Michigan is mixed. I've worked at big hospitals that allow techs to do fingersticks, and small ones that only the RN do figersticks. I have always found it frustrating that some techs would not report hi or low to me, but would chart it. While charting a hi or low is required, a verbal on all critical values is also reuqired-do all techs kow this? Apparently not. I think RN's should be responsible to obtain fingersticks- it is ultimatley going to require the RN attending to the pt, and in this way it is done without delay in needed treatment.
    99% of everything with a patient requires the attention of the RN ultimately.

    Tait
  3. by   blondy2061h
    Our aids can't do fingersticks, but we actually draw a plasma glucose off of the patient's line for most of our glucoses.
  4. by   WalkieTalkie
    Quote from blondy2061h
    Our aids can't do fingersticks, but we actually draw a plasma glucose off of the patient's line for most of our glucoses.

    Heh, your lab must be a lot faster than ours... or do you actually have a bedside machine that can interpret plasma glucose instead of whole blood? If we ever have to draw hourly glucoses, we are usually drawing another one before the first one's results are even posted. *sigh*, I know, and I do work at a major medical facility.
  5. by   blondy2061h
    Quote from c0ntagion
    75% of our patients in the ICU have Q1-2 hr glucoses, and if they are not Q1-2, nearly all patients have at least Q4-6 hr ones. Thankfully our techs do them. I couldn't even imagine trying to keep track of everything else I do and be doing hourly finger sticks. I certainly don't mind doing them if the techs are busy, but there are simply too many, especially when my patient is on an insulin gtt.

    The techs take competencies/training on this, and know when to alert the nurse, and most of them are very good about this. The glucometer is also uploaded wirelessly and its results will show up under our patient's lab values in the computer. The techs also write them on a strip of paper taped to the inside of the patient's door. I rarely have problems with techs taking glucoses, and they are able to do them in a much more timely manner than I would be able to do... especially if one of my patients is occupying a lot of my time.
    How many patients do you have? I usually have 1-4 patients and definitely have time to do my own glucoses, even for those on insulin drips. Our insulin drip protocol has recheck frequencies from 20min to 3 hrs. Even for our drip patients, if they have a central line we draw the blood for them off the line. It's just much nicer, and much less of a bleeding risk in our thrombocytopenic patients. I know was generally have less drips than a typical ICU, but we still have some very med-heavy patients and I've never found it to be especially burdensome to get my own glucoses. I'm in the room hourly doing something anyways.
  6. by   blondy2061h
    Quote from c0ntagion
    Heh, your lab must be a lot faster than ours... or do you actually have a bedside machine that can interpret plasma glucose instead of whole blood?
    No, we send them to the lab. We generally get results in 15-30 min. The 2 hours when AM labs are being drawn are the only time the lab is slower than that, generally. Our patients with actual unstable glucoses are generally on insulin drips (then we draw blood off line and run on glucometer). Our q6h glucose, SSI patients are generally just occasionally hyperglycemic from TPN and/or steroids.
  7. by   Piki
    the RNs have always done them here.
  8. by   WalkieTalkie
    Quote from blondy2061h
    How many patients do you have? I usually have 1-4 patients and definitely have time to do my own glucoses, even for those on insulin drips. Our insulin drip protocol has recheck frequencies from 20min to 3 hrs. Even for our drip patients, if they have a central line we draw the blood for them off the line. It's just much nicer, and much less of a bleeding risk in our thrombocytopenic patients. I know was generally have less drips than a typical ICU, but we still have some very med-heavy patients and I've never found it to be especially burdensome to get my own glucoses. I'm in the room hourly doing something anyways.

    We have 2 patients. We are not allowed to put "safe sets" on anything but arterial lines (guess our central line infection rates were going up from people improperly utizlizing it or something).

    I work in a pretty high acuity unit, so it's not unusual to have a patient with a balloon pump in one room and a patient on SLED in the next, each having vasopressors which need to be titrated. I will often do my own glucoses if I'm not constantly running back and forth between the two rooms. Of course, the more pressors I add on, the more unstable the patient's sugars become, and it's also not uncommon for both patients to be on insulin gtts with Q1-2 sugars (Q2 after stable x 4 within the 70-120 range).

    From what I understand, both of the situations above would be 1:1 at a lot of facilities? The only time we have 1:1s is with citrate SLED, ECMO, and our fresh heart transplants, or if someone is extremely unstable. When I have one of these patients, I will always do the glucoses because it only makes sense
  9. by   blondy2061h
    Quote from c0ntagion
    We have 2 patients. We are not allowed to put "safe sets" on anything but arterial lines (guess our central line infection rates were going up from people improperly utizlizing it or something).

    I work in a pretty high acuity unit, so it's not unusual to have a patient with a balloon pump in one room and a patient on SLED in the next, each having vasopressors which need to be titrated. I will often do my own glucoses if I'm not constantly running back and forth between the two rooms. Of course, the more pressors I add on, the more unstable the patient's sugars become, and it's also not uncommon for both patients to be on insulin gtts with Q1-2 sugars (Q2 after stable x 4 within the 70-120 range).

    From what I understand, both of the situations above would be 1:1 at a lot of facilities? The only time we have 1:1s is with citrate SLED, ECMO, and our fresh heart transplants, or if someone is extremely unstable. When I have one of these patients, I will always do the glucoses because it only makes sense
    Yeah, definitely sounds high acuity. Hope I didn't sound like I was accusing you of being lazy or anything, because I definitely didn't mean it to sound like that.

    I'm not familiar with a "safe set." Do you not typically draw blood off central lines?
  10. by   WalkieTalkie
    Quote from blondy2061h
    Yeah, definitely sounds high acuity. Hope I didn't sound like I was accusing you of being lazy or anything, because I definitely didn't mean it to sound like that.

    I'm not familiar with a "safe set." Do you not typically draw blood off central lines?
    LOL, no offense taken.

    A "safe set" is an extension which connects to the pressure tubing. 10 ml of blood is drawn back into a syringe device and then locked off - that's the "waste." There are ports distal to this which blood can be obtained from with a syringe. The 10 ml of blood is then unlocked and flushed back into the patient, and then the fast flush is utilized to flush through the extension tubing. We don't access the central lines for glucoses unless it's at a longer time interval (like 4-6 hours) just because we'd be wasting 240 ml of blood a day on some of our poor patients... heh.
  11. by   blondy2061h
    Yeah, I've never seen a safe set used. We have special positive pressure caps that have an antimicrobial layer or some sales pitch to that effect in them. Just draw flush, draw back 10 cc waste, draw out 2ml blood, flush again. Safe set sounds like interesting idea to prevent blood waste. I think for our patients the advantage of not sticking them with such low platelet counts outways the risk. Plus, many of our patients have 5 lumen central lines so we can often avoid disconnecting a line to draw a glucose.
  12. by   Hygiene Queen
    As long as the tech understands the WHY of reporting abnormals, why shouldn't they do fingersticks? It's like vitals. Understanding WHY should behoove the tech to report their findings with integrity.
    I find it disturbing that a lot CNA's are not being taught this.
  13. by   blondy2061h
    Quote from Hygiene Queen
    As long as the tech understands the WHY of reporting abnormals, why shouldn't they do fingersticks? It's like vitals. Understanding WHY should behoove the tech to report their findings with integrity.
    I find it disturbing that a lot CNA's are not being taught this.
    I doubt it's the CNAs aren't being taught it, but more that for some of them it's not "sticking." I have one aid I work with who's just awesome. She understands the importance of reporting vital signs, even down to interpreting it past just a raw number (BP of 95/50 in someone who's sleeping soundly and has been 100/60 all week versus in someone who previously had HTN and is also febrile and tachy). And then we have the aids who can't seem to hear the call light and could really care less if the O2 sat was 75%, they'll report it when they're done with vitals. Yet they've gone through the same training. One just cares about the patients while the other about the paycheck. The same goes for nurses, though the effort taken to get there tends to sway the nursing side of things a bit more.

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