Glucose Testing

There are lots of options for you to look at. I agree, Tenderfoots give you too much blood. Have you tried using the preemie size on full term babies for glucoses? When I get in the office on Monday, I will give you some names of other types of lancets. I know Hawaii Medical has one that we really liked but I can remember the name right now. One thing in Tenderfoot defense though, you will get a more accurate sample because of the depth especially if you warm the heel.

What are you using as your low? How many deliveries a year does your hospital do? We just changed to 50 by bedside glucose and that requires a serum. A true hypoglycemic episode would be a serum of 45.

My unit delivers almost 2,000 babies year year. We use use 40 as our low and then give the glucose and formula --- after feeding, if the sugar doesn't come up, we do a serum level.

I would really appreciate if you can let me know the name of the lancet that you like. I want to see if our unit is following evidence based and best practice nursing. Thank you...

The lancets that are actually for the glucometers can be ordered in a neonatal size. Just remember that the tenderfoots make a large enough cut in teh fot to extract enough blood for lab draws.

If you have a kiddo that requires frequent checks along with routine labs their little heels begin to look like hamburger in no time. Those scars stay.

I researched this a few years ago for the same reason. I think it may have been the lifescan people that maybe had a neo size.

Another factor to consider is cost to the unit. The tenderfoots cost about $1.40 each and the glucometer lancets about $0.15.

Another place to look is teh company that makets the wee thumb soothie.

Two of the names that I remembered are the Neet-Nick and the Sugar Plum. The Sugar Plum is from Hawaii Medical. I will look for more info and pricing information tomorrow.

Check into Surgilance at www.surgilance.com , Sugar Plum by Hawaii Medical, and the Quickheel lancet from BD. The surgilance comes in different sizes depending on how much blood you want.

We had a box of those tiny lancets that are meant to be used with the accucheck machine, but those ran out. They were just like a pin prick - just a point, not a blade like the neonatal lancets. They were great to just get a tiny drop of blood.

We haven't ordered more and I don't think we will be - I was just about the only person that seemed to know about those wonderful lancets. Everyone else would use a regular lancet and massacre the heels for that tiny smidgen of blood!

In the meantime, if all I need is an accucheck, I'll grab a 24 gauge needle and lightly poke the baby's heel with that. I know you can't control the depth with a regular needle, but I'm telling you, I barely break the skin surface with them and that's all it takes to get a drop of blood.

There are many of the more experienced nurses I work with that use 25 gauge needles for blood sugar checks. It's not a skill I have aquired. I use a micro-preemie size tenderfoot. The ones we are supposed to use to draw labs on kids 1400 grams. Also with frequent blood sugars I find that most of the time a warmed heel will bleed from one of the previous heelsticks (enough for a bedside glucose check).

I agree it's a travesty to keep sticking the kids with the regular newborn lancet (tenderfoot) over and over.

Also with frequent blood sugars I find that most of the time a warmed heel will bleed from one of the previous heelsticks (enough for a bedside glucose check).

I agree. Instead of using a heel warmer, I'll do what we used to before they were invented - a very warm, wet washcloth wrapped around the foot and ankle, secured in a diaper. (I actually prefer to do this for all my labs - heelwarmers don't work half as well as our old method!) The warm, moist heat really helps bring blood to the surface, plus the wetness will soften scabs from old heelsticks. When you unwrap, all you have to do is rub an alcohol swab (or saline wipe if that's what your unit uses) and a sterile 2x2 over the heel and more than likely you'll get a drop of blood from somewhere.

Don't know the brand, but ours make a pin-point poke to get just a drop of blood. Our glucose protocol requires checks at admission, 1 hr, 2 hr, 4 hr, and so on...I have found that a good rub with the alcohol pad at the 1 hr mark will sometimes get the heel to bleed without the poke...the only problem is that the alcohol has GOT to sting like crazy! So which is worse?

Jenny

We don't have an accu-check on our unit, but we have an ABG analyzer that does lytes/glucoses. Unfortunately, we have to obtain 0.3ml in a cap tube just to get a glucose...way more blood than necessary, especially for a micropremie. It's truly frustrating when you've just obtained blood for a glucose or ABG and the machine eats the sample without giving a result...and we have to do it over again...

We don't have an accu-check on our unit, but we have an ABG analyzer that does lytes/glucoses. Unfortunately, we have to obtain 0.3ml in a cap tube just to get a glucose...way more blood than necessary, especially for a micropremie. It's truly frustrating when you've just obtained blood for a glucose or ABG and the machine eats the sample without giving a result...and we have to do it over again...

You should ask your management if they'd consider getting an accucheck machine. We never had one until 2-3 years ago. We had asked for one, and the hospital had just bought all new ones and had to inservice all of the nursing staff on them, so we bought one too and all of our nurses got a mandatory 30 minute inservice on it. It was a bit of a pain at first to get everyone checked off, but it was worth it!!! They're pretty cheap, as compared to most other hospital equiptment. PLUS - I think the cost cancels itself out because I believe the hospital charges less for an accucheck glucose than one run by the lab - even the NICU lab machine.

I agree. Instead of using a heel warmer, I'll do what we used to before they were invented - a very warm, wet washcloth wrapped around the foot and ankle, secured in a diaper. (I actually prefer to do this for all my labs - heelwarmers don't work half as well as our old method!) The warm, moist heat really helps bring blood to the surface, plus the wetness will soften scabs from old heelsticks. When you unwrap, all you have to do is rub an alcohol swab (or saline wipe if that's what your unit uses) and a sterile 2x2 over the heel and more than likely you'll get a drop of blood from somewhere.

You have to be very careful! We had a baby brought in to our unit with blisters on a foot from someone doing this.

We use Quickheel lancets for everything, as our manager didn't want to spend money on two kinds of lancets. Maybe this should be our next Unit Based Council project.......I hate seeing feet turned into mincemeat. I may try the 25ga needle stick instead.