Insulin Nightmare Well Sort Of

pagandeva2000, LPN · May 20, 2008

This is prob. nursing 101, but I had a close call today. There was a resident who had a stroke with left sided weakness. Needless to say she is unable to wash her hands like we do. I took her blood sugar at dinner it read 400 even. I of course used alcohol wipe. So I went to the med cart and was drawing up 12 units of Regular insulin. THEN a thought came in my head. When was the last time she had a good hand washing. So before giving her the insulin I washed her hand with soap and water patted dry and retook the sugar. It was 87. HOLY MOLY I couldve put her into insulin shock. Come to find out she was snacking on M & Ms during the afternoon. and the sugars must have stuck to her hands. The alcohol did not fully clean up the sugar. Now when I have a high blood sugar I will fully wash the patients hands. Just thought I would spread the word in case this happens to anyone else.

You learn something new each day. They have also said that we should never take the first drop of blood after the fingerstick, because it is inaccurate. We remove the first drop and then, the rest of it is used in the glucometer. I guess it would make sense, then, to wash their hands to see what happens, and also, maybe do it on the opposite hand as well for clarity. Thanks for sharing!:wink2:

cursenurse · May 21, 2008

You learn something new each day. They have also said that we should never take the first drop of blood after the fingerstick, because it is inaccurate. We remove the first drop and then, the rest of it is used in the glucometer. I guess it would make sense, then, to wash their hands to see what happens, and also, maybe do it on the opposite hand as well for clarity. Thanks for sharing!:wink2:

I've always wondered, why is the first drop not to be used? I've never received a rationale as to what makes the first drop inaccurate. Also, what do you do for those folks who you can barely get a drop from?

Price 2002 · May 22, 2008

I am getting close to graduation and I would not have thought of that. Thank you so much for posting that. This is something that will stick with me! :yeah:

RFWB · May 24, 2008

You learn something new each day. They have also said that we should never take the first drop of blood after the fingerstick, because it is inaccurate. We remove the first drop and then, the rest of it is used in the glucometer. I guess it would make sense, then, to wash their hands to see what happens, and also, maybe do it on the opposite hand as well for clarity. Thanks for sharing!:wink2:

This is interesting and will certainly make me wonder next time I give a hefty dose of sliding scale insulin - but here's something else to think about. I'm finishing clinical rotations for my LPN, going to graduate after the summer. It is hospital policy here at one of my clinical sites (a large, downtown medical center with an EXCELLENT reputation and a fairly large research base) to NOT use alcohol at all before finger sticks, because the cleansing effectiveness of the alcohol is now being disputed and the sugar base of the ETOH has been noted to RAISE the blood sugar result (sometimes making the difference between coverage or not, etc.).

Anybody else run into similar policies? Thoughts?

OgopogoLPN, LPN, RN · May 24, 2008

This is interesting and will certainly make me wonder next time I give a hefty dose of sliding scale insulin - but here's something else to think about. I'm finishing clinical rotations for my LPN, going to graduate after the summer. It is hospital policy here at one of my clinical sites (a large, downtown medical center with an EXCELLENT reputation and a fairly large research base) to NOT use alcohol at all before finger sticks, because the cleansing effectiveness of the alcohol is now being disputed and the sugar base of the ETOH has been noted to RAISE the blood sugar result (sometimes making the difference between coverage or not, etc.).
Anybody else run into similar policies? Thoughts?

We were not taught that. We were told you don't swab with alcohol before a finger stick because the alcohol is very drying and even more so on the hands of a diabetic. The eldery already have impaired skin integrity and the alcohol just adds to it.

We were taught to wash their hands gently and dry thoroughly.

BinkieRN, BSN, RN · May 24, 2008

We were on vacation last summer and my Dad was having trouble with his accucheck. I said here let me show you. It was 355. I almost fainted. Then I realized I had put some gum in my mouth about 5 minutes prior. I washed my hands. Checked again. 98. Whew, scared me! Dad's BG was ok too :rolleyes:

elizabells, BSN, RN · May 24, 2008

I've always wondered, why is the first drop not to be used? I've never received a rationale as to what makes the first drop inaccurate. Also, what do you do for those folks who you can barely get a drop from?

The first drop contains more fluids from the cells that have been lanced during the stick, thus making the result less accurate. If you wipe it away you get more straight blood. On the hard cases I usually use the first drop and pray.

bluegeegoo2, LPN · May 24, 2008

I have 2 stories from each end of the spectrum: The first was a pt of mine who was notorious for having low BS's in the a.m. I took her BS at it was in the 400's. I nearly fainted! Then, another nurse (much more experienced than I) told me to check it again but clean her finger well. Guess what? Her BS was 38. The 3rd check was 40. I don't like sticking people more than once, but if I had covered her, I would have killed her. She rec'd the glucagon and all was well. The second story is about another nurse I work with. She had taken a BS and it was 29. She was preparing the call the Dr. for a glucagon order, but decided to use a different monitor just to make sure. The 2nd check revealed 127. The "hundreds" place on the other monitor was malfunctioning, therefore not visible. If she had rec'd and given the glucagon, he'd have gone through the roof! It always pays to check and re-check if necessary. An extra fingerstick or 2 is far less traumatic than a diabetic coma/death.

elizabells, BSN, RN · May 24, 2008

I've also had it happen where the reading from a stick vs a venipuncture were wildly different - heelstick (repeated x 2 on opposite feet, same machine) was around 200, but a drop from the venous labs we were drawing anyway, again the same machine and bottle of strips, was totally normal - around 80. We never managed to explain it, and I've never had that happen again.