Accucheck procedure

Specialties Geriatric

Published

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.

Specializes in Critical Care, Pediatrics, Geriatrics.

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.

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?

Specializes in Gerontology, Med surg, Home Health.

Follow the directions that came with your glucometer. You can't be cited if you do that.

I would do what cape cod recommends. I would also follow the rules when being observed. It's always good to practice good habits first, then do what most people do, create their own habits.

I'm not at all surprised that you don't use alcohol wipes, I've seen facilities that only use saline wipes only.

Just remember the chain of infection....portal entry (alteration of skin integ...)

Specializes in med/surg.

I have yet to find a glucometer manufacturere that DOES recommend alcohol wipes - aside from the "drying out" issue they can interfere with the results because alcohol wipes contain trace sugars, think how alcohol is produced!

I used to work in the UK & all manufacturers stressed the importance of NOT using alcohol wipes there. Now I'm in Canada & the training here also emphasises NOT using alcohol wipes. All you need do is get your patient to wash their hands, if they're able, or assist them to do so if not.

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