Management of Central Venous Access Devices. Blood Glucose Monitoring

Transcription

1 Management of Central Venous Access Devices Blood Glucose Monitoring

2 Purpose To provide education on the standard of care regarding the use and monitoring of the Accu- Chek Blood glucose machine, including quality controls, patient testing, comment codes and documentation. Content provided by: Institute for Nursing This module is not intended to be all inclusive, but rather provides an overview of salient points related to the Accu-Chek blood glucose device. 2

3 Glucometer Equipment Hand held meter Base unit Accessory box 3

4 Base Unit Return hand-held meter to base unit Base unit is a battery charger Networked to lab Pt. and QC information is downloaded to lab System can store 4000 results Green light indicates unit is properly docked 4

5 Battery Hand held meter contains a rechargeable lithium ion battery Fully charged battery lasts 3 hours 5

6 Accessory box Stores: Glucose control solutions Test strips Alcohol preps Lancets Quick reference guide Gauze 6

7 Test Strips Humidity and light sensitive. Re- cap vial immediately Vial must be dated when opened The test strip vial is stable until expiration or for 30 days after opening Each new vial of test strips contains a calibration key 7

8 Calibration Key A computer chip Contains data regarding test strips Has a 3 digit code imprinted on it Remains in machine until a new vial of strips is put into use Change when opening a new vial of strips 8

9 Glucose Control Solutions Level 1 (Lo) Level 2 (Hi) Label bottle with date & time when first opened & with expiration date Discard after 90 days Control solutions are to be labeled 9

10 Glucose Control Solutions Gently mix control bottle 3 times Open bottle and discard first drop of control into gauze pad Run control Wipe nozzle of bottle before recapping control bottle 10

11 Main Menu 11

12 Review Results Third option on main menu screen Accesses all test results stored in that machine Excellent if you forgot to document a result 12

13 Quality Control Testing (QC test) 13

14 Quality Control Performed once every 24 hours Both control solutions are used The machine will not perform a patient test until quality control testing is performed successfully 14

15 Quality Control Procedure (1 of 3) Always wear disposable gloves Turn power on Meter performs self-check Select Scan / Scan your ID badge or Manually enter ID number Select Control Test Select Scan / Scan solution bottle or confirm by yes/no or verify control lot number If correct hit Yes to continue If No: Enter in new control Lot # found on side of 15 control vial

16 Quality Control Procedure (2 of 3) Select Scan / Scan or verify strip code # by yes/no Insert test strip into meter Apply control solution Wait 20 seconds 16

17 Quality Control Procedure (3 of 3) Read results Select Comments Select appropriate comments (see next slide) Select up to 3 comment codes Select to confirm comments Select when done Remove used strip Repeat steps for next control level Turn off 17

18 Quality Control Comment Codes Passed QC: Accepted Maintenance Screen Cleaned meter after each use After each use, with control testing, and when contaminated Checked expiration dates 18

19 Quality Control Comment Codes Failed QC: You must select Will repeat test May choose up to 3 add l comments Additional Optional code comments: Wrong control level Operator error Replace strip vial Replace control vial 19

20 Patient Testing 20

21 Safety Precautions During Collection Infection Control This is an invasive procedure Gloves must be worn. Health & Safety You must use the lancing device provided by the hospital and lancet and strips must be disposed of in a clinical sharps waste container. Ensure the device and workstation are kept clean also. 21

22 Reasons for doing Blood Glucose Monitoring As per order medical hx of DM Patient symptomatic (what are some symptoms?) Patient on hyperalimentation (TPN,PPN) Additional reasons 22

23 Special Considerations All Ages Explain what you plan to do Geriatric Patient Circulation may be compromised, place extremity in dependent position Bones may be arthritic/brittle, use care if moving the extremity Pediatric Patient To a child this is a needle, do not minimize what you are doing Infant Do not performs heel sticks if the infant is able to stand 23

24 Acceptable Blood for Testing The ACCU-CHEK Inform Meter uses the following types of blood for testing: Capillary Venous Arterial Cord Neonate 24

25 Patient Testing Always wear disposable gloves any testing Turn power on Meter performs self-check Select to continue Select Scan / Scan your ID badge/enter ID # Select Patient Test Select Scan / Scan or manually enter patient medical record # or Patient Identification # (per facility) Select Scan / Scan or verify strip code # Insert test strip into meter Follow procedure for obtaining blood* 25

26 Procedure for Obtaining blood* LANCET 26

27 Patient preparation for lancing Sites for lancing avoid using the forefinger and thumb. Lance the outer aspect of the finger pad only, no lower than the nail bed avoiding the nail. 27

28 Lancets (Different colors = different sizes) 28

29 Procedure for Obtaining Blood -Fingerstick Technique (1 of 2) Identify patient using 2 identifiers Explain what you are doing Put on disposable gloves Grasp finger gently, but firmly. Puncture site must be warm and not swollen. Cleanse area of finger with alcohol prep. Allow alcohol to air dry. 29

30 Procedure for Obtaining Blood -Fingerstick Technique (2 of 2) Puncture skin with lancet. Apply moderate pressure to finger and release to form drop of blood. Avoid vigorous massage and wipe off first drop of blood* Use side of finger for best result 30

31 Strip Dosing getting the blood in the strip Touch and hold drop of blood to the edge of the curved yellow window Blood goes in the side of the strip, not on top of the strip! Blood will be pulled into strip automatically. Fill yellow window completely. If any yellow is still visible in window, sample size is too small. Sufficient sample size is required to 31

32 Effective Strip Dosing Specimen is unacceptable if: Insufficient sample size Sample not applied to test strip within 15 seconds Blood was smeared onto strip top or bottom Alcohol was not dry 32

33 Patient Testing Wait 20 seconds Read results Select Comments * Select appropriate comments Select up to 3 comment codes Select to confirm comments Select when done Remove used strip. Clean the meter. (after each use) Turn off and document results 33

34 Patient Comment Codes Accepted Repeated test Treated patient RN notified (ancillary should always use this) MD notified (RNs only) STAT glucose to the lab No patient ID # Operator error Clean machine 34

35 Critical Patient Values Adult >400mg/dl < 60 mg/dl Newborns >200 mg/dl <45 mg/dl Note: All critical values must be repeated and confirmed. Give glucose value to RN, immediately. 35

36 Results A reading of HI = >600 mg/dl A reading of LO = <10 mg/dl Actions Repeat fingerstick immediately (use a different meter if patient condition does not match) Confirmation blood sample MUST be sent to the lab LIP notified of result 36

37 By the way Lab Dept. downloads data: Do not enter a false user ID Do not enter a false patient ID Do not bypass controls Doing so will lead to disciplinary action, including termination 37

38 Competency Initial validation takes place during orientation, and again in six months Subsequent validation is done on an annual basis A bar code label will be affixed to the front of your ID badge, Can be obtained on site. Re-validation must be done ANNUALLY 38

39 Competency Checklist Print Last Name, First Name (legible) ID# Date Unit Perform return demonstration (QC) Obtain signature of validator Sign bottom of form Turn form into educator after completion 39

40 References Accu-Chek Product Literature Nettina, S.M. (2006) Diabetes Mellitus Lippencott Manual of Nursing Practice (8 th ed.) Lippencott Willaims and Wilkins, Ambler, PA. 40

41 You have completed this module It is required that you take a post assessment after completing this module. Passing score is 100%. Complete the Blood Glucose Monitoring Quiz, which is located on the Quia site For the competency Blood%20Glucose%20Monitoring.pdf 41