I am the only nurse getting high blood glucose numbers

[ricksy]

Okay guys. I am a 48yr old new nurse...hired by a LTC that I like. I DO KNOW HOW to take blood glucose ... so that is NOT the problem. I am 2nd shift and have a pt who has DR order to call him if BS is above 400. I do accu-check before supper around, say 430pm. The last three times I have worked, and done the check, I have gotten counts OFF THE charts..in high 400's and once even not countable on the monitor. Protocol is to call Dr. and family...adminster as perscribed...chart, recheck in two hours...chart...and fill out lots of paperwork. When I called the Dr second time he seemed surprised. The family asked if "what are you feeding him". I even recheck when they are that high. I think the nurses that I work with are accountable and professional...but why am I the only one to get high counts.../ Hmmmmm...help!

[applewhitern, BSN, RN]

Don't know if this helps or not, but I read the stuff on our Accucheck machine, about the alcohol. It can make a difference, but not that great of one. I forget the exact number, but I think it said it could give a false reading of about 40-60 numbers. I doubt alcohol is the problem here, anyway, since the blood sugar has been 400. I would look at the whole picture, what meds the patient is on, times fed, etc.

[carolinapooh, BSN, RN]

....what the patient may be sneaking just before your shift....oh, it happens....

[cav5]

I have to ask-if you cover for the high and the number two hours later is normal then it is not machine nor the technique-it is a true high.

I work with kids-the patterns always tell the tale. One number may be out of wack but the pattern never lies. If you work regular shifts (Tuesdays and Thursdays etc) then sometimes it is something they forgot they did on Tuesdays and Thursdays or didn't do for that matter.

the AIC is also a good indicator-quick check on a pattern of highs and lows.

I don't think anything is wrong with the technique or the other nurses-I believe in innocent before guilty.

For me, it was a kid who walked to art and music class only on Tuesdays and Thursdays-drove me crazy until I figured out the pattern and what was causing it and corrected for it. Who knew! :)

Look for the patterns-they always tell the truth.

Sometimes I miss the days of ICU when you got to control everything in and out-OCD and I know each other well:)

[GLORIAmunchkin72]

"Wipe that 1st drop of blood away with a dry 2x2, not an alcohol pad. The practice of using an alcohol pad to wipe away that 1st drop contaminates the next drop and the glucometer will display an abnormally high reading."

This makes sense!

[creamcheesepuff]

I always wiped the finger to be poked first with alcohol wipe....I would wait for it to dry thoroughly, waving my hand against it to speed it up.but yes, alcohol left in the blood sample will contaminate it and alter the reading......wipe with alcohol first. let dry a bit, poke finger and wipe first drop off with sterile gauze, then get the next drop which should be fine for an accurate reading.

[nmercer1]

I was actually thinking the same thing...it's seems strange that the pt. is only in the 400's when you are there. I would also look at the time of day, maybe the other people are checking him later/earlier. Does the resident know if they have been checking his blood glucose?? I would ask him, in a round about way.." What was your blood sugar earlier or yesterday?".

[lynnb55]

I would make sure that the strips are not outdated and if your meters use a code key, make sure that the code key matches the strips. You could also recheck the blood sugar again, or have some one else recheck the blood sugar after you have. Also I find it appaling that nurses are documenting lower blood sugars so they don't have to do all the paper work. That is considered falsifying records!!!!!

[turnforthenurse, MSN, NP]

You should clean the finger with an alcohol pad, wait for it to dry, then after you use the lancet wipe the first drop of blood with a cotton pad or 2x2 gauze, not again with the alcohol pad...then take the second sample of blood. I have seen sugars falsely elevated when nurses and CNAs take that first drop of blood without wiping it away at first.

If you're getting elevated readings, recheck or even better, recheck with a different machine. I recently had a patient where I rechecked the sugar three times because the machine kept reading "HI" (>600). Our policy is to recheck with a fresh drop of blood, notify the physician and verify with a lab draw. Lab result came back and sure enough the blood glucose was well over 1,000.

If you are the only one ever getting elevated readings on this patient and no one else is, it either your technique (not doing what I mentioned above) OR the others aren't actually checking the patient's blood sugar.

[CountyRat]

Avoid squeezing the finger to get the drop bigger. Easier said than done, especially with a fast clotter, but if you "milk" the finger to increase bleeding, you will also squeeze lymphatic and extracellular fluid into the sample, which can change the results.

[ayla2004, ASN, RN]

we dont clean with alocohol pad just soap and water as alcohol can cause harderning of finger tips that is painful and could lead to difficulty manipulating small object due to lack of sensation.

[jalyc RN]

I worked from 1972 till 2009 and have never heard of wiping off the first drop either. Must be some new idea. Actually I have been diabetic myself since about 2007 and use no alcohol for FS, injections, or mixing. No problems at all with this.

[Soozydoc]

I would have to sadly agree with 3aremyjoy. They are not getting done (and treated) OR if an abnormal value is a result, it's most likely being reported at an under 400 value.