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Specific patient preparations

Patients should be advised to wash their hands prior to testing or the test area should be cleaned with soap and water and then dried. Use of alcohol gel should be avoided to ensure noncontamination of the result. The patient should be encouraged to warm their hands before sampling to encourage blood flow and to obtain an adequate amount of blood to cover the test strip (Dale 2006, Wallymahmed 2007).

Procedure guideline 12.8 Blood glucose monitoring

Essential equipment

Blood glucose monitor

Test strips

Control solution

Singleuse safety lancets

Gloves

Cotton wool/gauze

Sharps box

Preprocedure

Action Rationale

1 Before taking the device to the patient, the monitor needs to be checked for the following:

Testing trips are in date and have not been left exposed to air

The monitor and test strips have been calibrated together

If a new pack of strips is required, the monitor is recalibrated

Internal quality control carried out in accordance to trust guidelines

Result of internal quality control is recorded in equipment log book and signed.

To ensure accuracy of the result and ensure patient safety (Roche Diagnostics 2004, C).

2 Explain procedure to the patient. The patient should give consent to the procedure. Explanation may allay any fear or anxieties (NMC 2008b, C).

Procedure

3 Ask patient to sit or lie down. To ensure the patient’s safety and minimize the risks if they feel faint when blood is taken (Roche Diagnostics 2004, C).

4 Wash hands and put on gloves. To minimize the risk of crossinfection and contamination (Fraise and Bradley 2009, E).

5 Take a singleuse lancet and if it has depth settings, ensure the correct setting is used (most commonly middle one). To minimize the risk of crossinfection and accidental needlestick injury (Fraise and Bradley 2009, E).

6 Take a blood sample from the side of the finger using the lancet, ensuring that the site of piercing is rotated (see Action Figure 6). Avoid frequent use of index finger and thumb. Other areas may be used if finger or palm of hand unusable. The finger tip may need ‘milking’ from palm of hand towards finger to gain a large enough droplet of blood. The side of the finger is less painful and easier to obtain a hanging droplet of blood. Sites are rotated to avoid infection from multiple stabbings, area becoming toughened and to reduce pain (Roche Diagnostics 2004, C).

7 Insert testing strip into blood glucose monitor and apply the blood to the testing strip. Some strips are hydrophilic and are dosed/filled from the side instead of dropping blood directly onto the strip. Ensure that the window on the test strip is entirely covered with blood (see Action Figure 7). The window on the test strip allows verification of a correctly dosed strip which needs to be covered to ensure accurate results (Blake and Nathan 2004, E; Roche Diagnostics 2004, C).

8 Insert testing strip into blood glucose monitor. To initiate the process of analysis. E

9 Dispose of lancet in a sharps container. To reduce the risk of needlestick injury (Roche Diagnostics 2004, C).

10 Place gauze over puncture site and monitor for excess bleeding. To ensure patient safety (Wallymahmed 2007, C).

Postprocedure

11 Once result is obtained (see Action Figure 11), document and sign. To ensure accuracy (NMC 2009, C; Roche Diagnostics 2004, C).

12 Report any unexpected results. To ensure appropriate treatment and obtain optimal blood glucose range (Wallymahmed 2007, E).

Action Figure 6 Blood glucose taking: Step 1. Take a blood sample from the side of the fi nger using a lancet, ensuring that the site of piercing is rotated.

Action Figure 7 Blood glucose taking: Step 2. Insert the test strip into the blood glucose monitor and apply the blood to the test strip. Ensure that the window on the test strip is entirely covered with blood.

Action Figure 11 Blood glucose taking: Step 3. Read the result.

Problem-solving table 12.7