Accucheck procedure

mandykal, ADN, RN · Dec 28, 2006

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.

I don't do #15, but @ times I do lose the first drop when it smears. That's when I know I've pricked too hard. I like the perfect shape of a drop b/c the strip just absorbs the drop.... we use so much strips that we are far from exp date because they order supplies every two weeks.. As for calibration, we have the 11-7 shift calibrating the machine once daily...

And yeah, what they teach you in nursing school isn't the only way of practicing.... There are many ways to performing any procedure, but they all should have the same goal without ever compromising the pts safety.

rintin02 · Dec 28, 2006

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.

Mommy TeleRN, RN · Dec 28, 2006

Our machines must be calibrated (quality control) every 24 hrs. It prompts you when it is time.

The way I was taught is:

Apply gloves

Scan pt armband, insert strip into machine

Cleanse finger good with alcohol pad, let dry

Prick with lancet (ours have a little cap you pull off, then a little plunger)

put drop on strip (I wasn't taught to wipe first drop)

apply pressure with cotton ball while strip is reading

toss everything where needed (ie lancet into sharps)

I will sometimes place arm in dependant position if drop isn't freely coming but usually it's not an issue.

S.T.A.C.E.Y, LPN · Dec 28, 2006

In school we were taught not to use an alchol wipe as it can skew the results, and that you are always to wipe away the first droplet as it is considered contaminated from the stick.

Everything else is the same as you stated.

Mommy TeleRN, RN · Dec 28, 2006

Interesting Stacey - as we keep alcohol pads stocked in with the machines. I'll have to see if I can find a P&P on it. So how do you all cleanse the skin? And do you use gauze to wipe the first drop so you aren't recontaminating when wiping?

S.T.A.C.E.Y, LPN · Dec 28, 2006

Ok, so I'll admit to not having done my own research here, and just trusted what my instructors and several nursing students found from their own research. After a quick google search, I found this from the Mayo Clinic-How to Check your blood sugar: Wash your hands with soap and warm water. Dry them completely. If you don't have access to soap and warm water, use an alcohol pad to clean the area you plan to stick. Because alcohol can affect your blood sugar reading, dry the area completely before puncturing your skin. So ya, have the patient wash their hands. If you do use alcohol, just always make sure it dries (how many people actually wait that minute until its dried???)

And as for wiping the first blood drop away (again, no research of my own here) I was told it was b/c your skin has fluids of its own, when you puncture the skin that first drop of blood contains a significant amount of this fluid--therefore not just a drop of blood. I'd be curious to see if this actually makes a difference in the numbers or not, but I'm not up for doing any research on that right now....its my Christmas break off from school.

Mommy TeleRN, RN · Dec 28, 2006

LOL Stacey... I hear ya! Maybe a diabetic poster can tell us how the alcohol might effect the reading. I have no way to experiment lol

I'll look up our policy and let you all know what I find out.

PS - if it is a pt that can obey commands and hold the finger up and keep it from getting dirty again, I'll usually wipe with the alcohol first then prepare everything else while it's drying. Some pt are kind of out of it and will recontaminate the finger so you have to hold it while it dries.

Chicklet2 · Dec 28, 2006

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.

marjoriemac, LPN · Dec 28, 2006

Education vs practicality! Do diabetics at home use the educational technique???

RGN1 · Dec 28, 2006

Interesting Stacey - as we keep alcohol pads stocked in with the machines. I'll have to see if I can find a P&P on it. So how do you all cleanse the skin? And do you use gauze to wipe the first drop so you aren't recontaminating when wiping?

You should not use swabs because alcohol can affect the result (as per maufacturers intructions). I do make sure I wash the patient's fingers first because even newsprint has gucose in it! I get ambulant patient's to go wash with soap & water, those that are bed-bound I wash with a flannel, soap & water. I don't wipe the first drop. Our workshops are run by the manufacturer of our machine so we follow their own procedures & that is what they stipulate (along with calibration, dates etc) so I guess they know!

RGN1 · Dec 28, 2006

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.

As a matter of pure personal protection you absolutely should wear gloves!! let alone infection control issues etc etc!!

What diabetics do in their own homes is up to them because it's only their flora & fauna they're dealing with. I won't even change bed linen without a pair of gloves on. I've learned that even innocent looking bed sheets can contain nasty surprises!!