Questions for you... is everyone still doing fingerstick blood sugars in their ICU? As of yesterday we are no longer allowed to. We can either draw off a central line or PICC, or we have to use a butterfly to get a sample (we can choose arterial or venous sample in our accucheck). Our director says that there has been a ton of research that shows there have been many incidents/deaths because of inaccurate readings, and soon this will be mandated. I believe this is mainly in grossly edematous patients, as the serous fluid you get in the fingerstick does not contain the same glucose as the blood. (new grad here, so if my though process is wrong let me know!) I asked to see the research and haven't gotten anything yet. Just curious if this is only us, or if anyone else is doing the same. My concerns are BSI's going up due to frequent access of lines, or even needle sticks increasing. Plus, what about the DKA patient who has no line and needs 1hr glucose checks? They are going to get stuck an awful lot. Or what about the patients that get downgraded and are still very edematous, this protocol change is only in ICU..their fingerstick will be still be inaccurate regardless of what floor they are on. I want to do best for my patient, just curious if anyone else has gone this route. Thanks!
I called and spoke to the FDA in regards to this. The person I spoke to, who was a nurse thought it was a ridiculous idea to either place a central line or stick someone on an hourly basis. I have also yet to see any research that's been done on the pediatric population that I work with in regards to this mandate but that's not stopping implementation. Unfortunately, my facility has implemented this based on location. If your an overflow patient adult or pediatric and located in an ICU bed you will be subject to this. As mentioned before in this thread what, lies at the root of this is a lack of what defines a critical patient. Leave it to the regulators and bureaucrats who in the name of patient safety have found a way to elevate the potential for risk and injury.
We aren't doing that, however, if the result is too low or too high we have to get a lab draw to confirm before we treat.
Can I just say how dangerous I think this practice is for a critical low. Sorry pt that is unresponsive with a BG level of 14, I can't treat you until lab comes up, stick you and we get the results!!!!
You're right--we treat a symptomatic low blood sugar. If we have a patient who is talking to us, following commands, etc and their blood sugar reads 30's, I'll get a lab confirmation. If they're symptomatic I'll treat while sending a lab confirmation. If our lab proves the POC wrong (only happened once the past 3 years) I'll tell the ICU doc and he'll usually tell me to give an extra few units of insulin or ride it out.
If if you're drawing blood sugars from a PICC are you wasting blood or do you have all of your PICCs set up to some sort of vamp? Wasting blood every time seems outrageous when they're on q1 hour checks.
Old post but any research found??? I was following a nurse that told me I have to draw blood from the A-line when a patient is on vasopressors or hypothermia treatment. It isn't a large amount, we take a syringe and draw back a TINY amount (just the tip) and tap it onto the glucose strip.
When I was with my preceptor she said she's never heard of it and unless their fingers are black, we can do finger sticks.
Old post but any research found??? I was following a nurse that told me I have to draw blood from the A-line when a patient is on vasopressors or hypothermia treatment. It isn't a large amount, we take a syringe and draw back a TINY amount (just the tip) and tap it onto the glucose strip.
When I was with my preceptor she said she's never heard of it and unless their fingers are black, we can do finger sticks.
I just want to get the right answer!!!
Arterial line is best. Especially if they are on pressors or cold (hypothermia protocol), or even have very calloused hands. When I have an art line available I never use finger sticks.
I have heard nothing new on this. Since the disclaimer from the package insert on the strips says the should not done via a finger stick on ICU patients we are mandated to do it that way. I agree it's probably best for someone who's on invasive drips and probably has a number of invasive lines. However, when you are taking care of a 1 year old that is awake and alert and doing what 1 year olds do the odds are pretty slim someone is going to place an invasive line solely for the purpose of doing POC blood glucose levels. I have seen more then a few children that fall into this category. Unfortunately there still exist no clear definition on what constitutes a critical patient other then an admit to the ICU. If any studies were done on the patient who is not in a shock like state or pediatric age group to validate how relevant this process is for them I would love to see them.
James Bond
8 Posts
I called and spoke to the FDA in regards to this. The person I spoke to, who was a nurse thought it was a ridiculous idea to either place a central line or stick someone on an hourly basis. I have also yet to see any research that's been done on the pediatric population that I work with in regards to this mandate but that's not stopping implementation. Unfortunately, my facility has implemented this based on location. If your an overflow patient adult or pediatric and located in an ICU bed you will be subject to this. As mentioned before in this thread what, lies at the root of this is a lack of what defines a critical patient. Leave it to the regulators and bureaucrats who in the name of patient safety have found a way to elevate the potential for risk and injury.