Q 30 Min Finger Sticks For Glucose And Macerated Fingers????

RN34TX · Sep 21, 2005

Your patient needs an A-line.

That's what we do for those patients on that insulin protocol.

Editorial Team / Admin · Sep 21, 2005

We instituted an insulin protocol recently and have found that the finger sticks for blood glucose are destroying the patient's fingers. Any suggestions re products that due less damage to the fingers, other protocols for obtaining blood, etc., would be appreciated.

Hello, brutuss7,

Could you utilize the alternative site testing glucometers???

brutuss7 · Sep 21, 2005

Hello, brutuss7,
Could you utilize the alternative site testing glucometers???

What exactly is this?

Editorial Team / Admin · Sep 21, 2005

What exactly is this?

Hello again,

Many glucometers can accomodate the alternative testing site. Anterior forearm, for example. This saves the fingers. Many individuals use these for private use. Maybe you can approach your institution about this.

PM me for brand names if you are interested.

papawjohn · Sep 24, 2005

Hey Y'all

I run a lot of insulin gtt's. I don't see the need for q30m accuchecks. We do them q1h. You might start by seeing whether your protocol isn't faulty. Ours usually have changes in the rate of the insulin gtt in 0.5 unit/hr increments so changes tend to be gradual.

So if we can assume (we all know what happens when you 'ass-u-me', right?)

that you're doing 24 finger sticks/day and assume that the Pt has all his fingers--we are only sticking each finger 2 1/2 times per day. Now fingers have two sides and a middle. So if the Pt's fingers are getting punctured like they were hit by bird-shot--look for the other fingers or other sides of fingers that are not getting stuck. I almost guarantee that if you turn the hand over and look at the posterior (the 'trailing') side of his fingers, you find virgin territory. (WHOOPS--do I get penalty points for saying 'v####n' ?)

I looked into the question of 'alternative' glucometers. As you might expect, it's an administrative nightmare. The Lab people have to certify our AccuCheks so the Lab-Nursing Committee has to get involved. There are MDs on these committees and they NEVER have strong opinions on anything do they? Then the Policy and Procedure people get involved because there is a difference in the cost of the two procedures....so how do you decide who gets the 'old' and who the 'alternative' glucometer. The Supply people have to decide which one to buy....I could go on and on.

What a way to run a railroad, eh?

Papaw John

sharann, BSN, RN · Sep 24, 2005

Your patient needs an A-line.
That's what we do for those patients on that insulin protocol.

How about a central line?

CCURN · Oct 5, 2005

A line would be nice

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · Oct 5, 2005

Sometimes when fingers get sore from frequent finger sticks, we use earlobes. Ears don't seem to clamp down as easily as other peripheral areas. Works pretty well.

mountain_rn · Oct 5, 2005

A-Line, TLC, PICC. Also would definatley re-evaluate EBP issues on q30 min accuchecks. Have used forearm in past and have noted BG's to be basically the same.

rstewart · Oct 14, 2005

A-Line, TLC, PICC. Also would definatley re-evaluate EBP issues on q30 min accuchecks. Have used forearm in past and have noted BG's to be basically the same.

I believe that widespread continous perioperative glucose monitoring is just around the corner----the technology already exists.

The sad part is with the rush to move patients out of the intensive care units many times the patients are taken off their drips before the research suggests (the lower levels of care are not provided the resources, human and equipment to continue).-----the result being a bunch of checking/sticking without any improvement in outcomes.

For DKA patients I think it would be hard to justify a-lines etc. simply for glucose sampling. They aren't cheap and they have risks of their own. Additionally, when you consider the necessary wastes, q half hour sampling can result in significant blood loss for some patients.

dfk, RN, CRNA · Oct 17, 2005

i'm sorry.. but using a-lines and central lines for obtaining blood glucose is such a waste of blood (volume) and not to mention infection potential for central lines.. especially in a critical individual with h/h 8/24 give or take a point.. i agree with the anterior arm approach or the like.. i have seen something a few years ago that was in trial.. glucose testing that was similar to O2 sat (infrared).. that would be quite nice for the patient.. also, give it some time, but in the near future, we will be able to do labs and the like by a simple spit test.. several times a day even.. just spit and result..