protocal for accuchecks and urine dips for glucose/ TPN

dawngloves, BSN, RN · Jul 7, 2005

We do q8 unless unstable. Then it could be q3 or even q hour! :uhoh21:

suzanne4, RN · Jul 7, 2005

Only accuchecks, not doing urine dipsticks anymore.

BittyBabyGrower, MSN, RN · Jul 7, 2005

No urines here anymore either...lots of these kids spill glucose.

We check the accucheck before the intital bag, one hour after and then again in the AM. Then we only do checks if we change the glucose concentration and that is 1-2 hours after the bag change. Most of these kids get weekly panels, so we just use the glucose on that.

Gompers, BSN, RN · Jul 7, 2005

Wow...compared to everyone else, we are VERY lenient when it comes to accuchecks and TPN.

Most kids on TPN have glucose, lytes, and calcium levels checked each morning. Only if there is a problem do we recheck it later on. We never check after hanging a new bag unless the baby is having glucose problems. Even if we're going up or down by 1-2% dextrose, we don't recheck. If a kid is on steroids we might check 2-3 times a day instead of once since they tend to have issues, but that's it.

Our docs and nurse practitioners are very against doing "routine" labs. Other than morning blood gasses for kids on vents, and the above mentioned labs for babies on TPN...it's all on a PRN basis. One of our nurse practioners is a big advocate against unneccessary heelsticks in babies.

We've never had a mix-up with pharmacy screwing up the % of dextrose in the bags.

Are we the only ones?!?!

dawngloves, BSN, RN · Jul 7, 2005

Wow...compared to everyone else, we are VERY lenient when it comes to accuchecks and TPN.
Most kids on TPN have glucose, lytes, and calcium levels checked each morning. Only if there is a problem do we recheck it later on. We never check after hanging a new bag unless the baby is having glucose problems. Even if we're going up or down by 1-2% dextrose, we don't recheck. If a kid is on steroids we might check 2-3 times a day instead of once since they tend to have issues, but that's it.
Our docs and nurse practitioners are very against doing "routine" labs. Other than morning blood gasses for kids on vents, and the above mentioned labs for babies on TPN...it's all on a PRN basis. One of our nurse practioners is a big advocate against unneccessary heelsticks in babies.
We've never had a mix-up with pharmacy screwing up the % of dextrose in the bags.
Are we the only ones?!?!

You should see how torn up some of our pts heels are! When I hear q 3hour Accu checks and the kid has no UA, I want to scream! I try and use the micro preemie Tenderfoots on the frequent heel stick kids.

Gompers, BSN, RN · Jul 7, 2005

You should see how torn up some of our pts heels are! When I hear q 3hour Accu checks and the kid has no UA, I want to scream! I try and use the micro preemie Tenderfoots on the frequent heel stick kids.

You know what we got that's great, when all you need is an Accucheck - it's the tiny lancets that they use for the diabetic kids in Peds. They are just like those pin-prick type ones, just a tiny dot instead of a whole slash. We can use them on kids over 1 kg, and they really help save the heels, not to mention the blood supply since you only get a drop and then it stops.

dawngloves, BSN, RN · Jul 7, 2005

You know what we got that's great, when all you need is an Accucheck - it's the tiny lancets that they use for the diabetic kids in Peds. They are just like those pin-prick type ones, just a tiny dot instead of a whole slash. We can use them on kids over 1 kg, and they really help save the heels, not to mention the blood supply since you only get a drop and then it stops.

You like those? Makes me nervous that I'll poke too hard or not hard enough and will just have to stick again. Any tips?

Gompers, BSN, RN · Jul 8, 2005

You like those? Makes me nervous that I'll poke too hard or not hard enough and will just have to stick again. Any tips?

Well the ones we have hit about the same depth as the regular lancets we use on the babies, so we use the same amount of pressure when using either one. Only difference is the size/shape of the cut. They make the pin-prick ones with different depths, I believe, so check that out too to see what your hospital offers.

What we used to love were the old microtainer brand lancets - pink, blue, green ones, remember? The non-safety ones - once you clicked the lancet the first time, you could use the plunger to move the blade up and down on your own. So we'd click them first, just into the air, and then instead of having to really press down on the baby and do a full stick, we could hold it against the heel and gently press lightly, making a tiny shallow prick instead of a huge deep one. Those were perfect for accuchecks. But since they aren't "user safe" now we got rid of them.

sparkyRN · Jul 9, 2005

We no longer use accuchecks and haven't done urine dips in over 15 years. Most babies on TPN get a minimum of qd lab (lytes, bili, gluc, etc.) more often for the newer ones or if there's a swing in the lab values. Once they are on full feeds they'll get a nutrition profile once or twice/week.

JVanRN · Jul 10, 2005

We have a TPN Protocol we follow. It goes something like this:

After 3 days the kid gets a ton of labs done: CBC, BMP, Liver enzymes, bili t/d ect...they get the same labs every 2 weeks after that while on TPN. Every week we draw a blood culture and do a urine culture. There are a few other labs that I cant remember.

On a daily basis we do UA chems and accuchecks. On doctor wants the UA chems q8h. One doctor only once a day. One doctor also wants a serum glucose qam as well...the other one only wants one if the accucheck is abnormal.