Year 1 MBChB Clinical Skills Session Blood Glucose Monitoring

Transcription

1 Year 1 MBChB Clinical Skills Sessin Bld Glucse Mnitring Reviewed & ratified by: Dr V Taylr-Jnes, Cnsultant Anaesthetist Ms C Tierney, HARC Elements discussed with Ms Lesley Lamen, Diabetic Nurse Specialist RLBUHT

2 Bld Glucse Mnitring Aims and Objectives Aim: Fr the student t be able t take a capillary bld glucse safely. Objective: T understand the indicatins fr perfrming capillary bld glucse. Objective: T understand hw t btain a capillary bld sample and be able t test this safely Objective: T understand hazards f bld testing and safe waste dispsal Objective: T be aware f sme f the factrs affecting validity/ reliability f capillary bld glucse mnitring. Thery and backgrund Capillary bld glucse testing is a quick and cnvenient tl fr assessing a patient s bld glucse, please remember the gld standard wuld require a venus sample. Bld Glucse Glucse is an imprtant carbhydrate and vital surce f energy. Bld glucse levels are tightly cntrlled by hmestatic prcesses t range between mml/l. In healthy individuals the level remains in this range despite varying amunts f fd, exercise r fasting. There are a number f cnditins where this cntrl may be lst resulting in higher r lwer bld glucse e.g. Diabetes mellitus Cushing s syndrme Pancreatic carcinma Bld Glucse Testing This prvides a rapid diagnstic tl in an unwell patient t aid diagnsis, fr example in A&E departments, walk-in centres, GP surgeries, r by paramedic/ambulance services. This test will be perfrmed regularly in these area. Hwever bld glucse testing als enables bld glucse mnitring, ver the curse f a day r lng term, usually t maintain ptimum levels. e.g. self-mnitring, care hmes, diabetic clinics, palliative care etc. Hyperglycaemia is a patient with an elevated bld glucse level Hypglycaemia is a patient with a lw bld glucse level

3 Nrmal and diabetic bld glucse levels Fr the majrity f healthy individuals, bld glucse level in is abut 4 mml/l Shrtly after a meal the bld glucse level may rise temprarily up t 8 mml/l Fr peple with diabetes, bld glucse level targets are as fllws: Befre meals: 4 t 7 mml/l fr peple with type 1 r type 2 diabetes After meals: between 5-9 mml/l fr peple with type 1 and under 8.5mml/L fr peple with type 2 Symptms f hyperglycaemia Symptms are ften insidius in nset yet may include: Plydipsia (increased thirst). Headaches. Difficulty cncentrating. Blurred visin. Plyuria (frequent urinatin) Fatigue (weak, tired feeling) Weight lss. Bld glucse levels greater than 7.0 mml/l when fasting Bld glucse levels greater than 11.0 mml/l tw hurs after meals (Diabetes.c.uk 2017) Symptms f Hypglycaemia [Bld glucse less than (<) 4 mml/l (Diabetes.c.uk)] Early symptms f hypglycaemia, are usually f rapid nset and may include: Dizziness. Feeling shaky. Feeling sweaty Hunger. Headaches. Irritability. Cnfusin. Punding heart; racing pulse. Pale skin Results f Hypglycaemia and Hyperglycaemia Hyperglycaemia Althugh bld sugar levels exceeding 7 mml/l fr extended perids f time can start t cause damage t internal rgans, symptms may nt develp until bld glucse levels exceed 11 mml/l. Hypglycaemia Mild hypglycaemia is usually treated quickly and is nt usually assciated with lng term health prblems, hwever, severe hypglycaemia will need treatment, if untreated it culd ptentially lead t cma and death (Diabetes.c.uk 2017).

4 Type Target befre meals (pre prandial) Target 90 minutes after meals (pst prandial) Nn-diabetic Diabetes.rg.uk (2015) Type 2 diabetes (Diabetes UK Cuncil f Healthcare Prfessinals 2015) Type 1 diabetes Nice Guidelines 2015 Children w/ type 1 diabetes Nice Guidelines t 5.5 mml/l under 8 mml/l 4 t 7 mml/l under 8.5 mml/l 4 t 7 mml/l 5-9 mml/l 4 t 7 mml/l 5-9 mml/l Patient Safety Other safety issues A small, sharp, dispsable lancet is used t prick a finger and btain a small drp f capillary bld. Please revise and be familiar with: Universal precautins Safe handling f sharps and needlestick prcedures Minimising cntaminatin / injury Cntrl f bleeding

5 Crrect dispsal f cntaminated waste Fainting Only a small drp f bld is btained s fainting is unlikely. Hwever peple can feel queasy at the sight f bld r the thught f pain, ask the patient if they have any cncerns r histry f fainting. If required psitin the patient n a bed/cuch because if the patient faints yu have t maintain their safety. If yur patient faints summn help by shuting fr assistance, place the patient in a safe psitin (ideally flat with legs raised), stay with them until they have recvered. Maintain their airway, check their bld glucse (dispse f sharps safely), get further help if bld glucse is abnrmal r they d nt recver. Selecting an Apprpriate Site If the patient is unwell, hyp r hyperglycaemic a capillary bld sample may be taken. Be aware that accuracy f reading varies frm site t site, generally, the higher the bld flw, the mre accurate the measurement. Fingertips are used as the bld flw here is 7 times higher than ther sites. There are ther sites which can be used if fingertips are unavailable, speak t staff in the department fr advice n what is apprpriate fr each patient, sme sites that may be used; Palm Frearm Upper arm Thigh Calf Ears Heel Selecting an apprpriate finger D nt use a finger if there are any Wunds Rashes Skin lesins Evidence f infectin And avid dminant hand, thumb and index finger D nt use the same site repeatedly Maximise bld flw t fingertip by: Ensuring a warm envirnment Washing hands in warm water Lwering arm belw heart level Cpyright image; Crystl at Inaccurate results Please be aware that many cnditins may give inaccurate results. In these cases a venus sample shuld als be taken, and is the mre reliable sample. Cautin shuld be taken with patients presenting with the fllwing; Cyansis

6 Pr peripheral perfusin Peripheral edema r swelling Patients suffering with excessive bld lss/ anaemia Patients with an intravenus infusin in clse t the puncture site Severe dehydratin/ shck Prcedure Prepare yur equipment befre yu begin, listed belw is the equipment yu shuld require; Suitable envirnment Glves (nn-sterile) and aprn Hand-washing facilities Bld glucse meter (glucmeter) Bld glucse test strips (in date, crrect cde) Safety Lancets Sharps bx Swab / sticking plaster, t stp any bleeding Dcumentatin Hand washing Bth yu and the patient shuld wash and dry yur hands thrughly with sap and water (this remves surface cntaminants which may alter reading e.g. if the patient has been handling sugary sweets). Avid alchl hand wash as alchl dries and hardens the patient s skin with frequent use. If used at least 30 secnds shuld elapse befre taking the sample t ensure all residue has evaprated. Any residue f water, sap r alchl will give a false result. Yu must wear glves and aprn as per natinal guidance (epic3, Lveday 2014) Glucmeters (Bld Glucse Meter) There are many devices available Yu shuld familiarise yurself with the type f device used in yur particular clinical area Ensure that yu adhere t Trust and manufacturer guidelines Devices that yu may see in the Trusts require users t be trained in their use. These devices link directly with the labratry thrugh scanning f barcdes and aim t ensure that n data is lst.

7 Ensure the machine has been recently calibrated as per trust plicy and ensure the crrect test strips are used with the crrect machine Bld Glucse Test Strip These are single use, individual test strips are stred in an airtight cntainer. Yu shuld: Check the expiry date Ensure the cntainer is tightly clsed (prlnged expsure f strips t the air will give false results), discard if required Test strips cntain enzyme-impregnated reagent and they must be kept in a cl, dry envirnment away frm heat r light There are tw ends t the test strip The glden end is inserted int the glucmeter. The tip f the yellw windw is tuched t the bld drp and draws up bld. Ensure test strip is cmpatible with meter. (Check the cdes match, if applicable) Take test strip ut f bttle and replace cap n bttle immediately aviding prlnged expsure t air Insert a test strip int the meter nly when yu are ready t btain the bld sample Single use Lancet Yu will cme acrss different lancets in yur Trusts, there are different needles fr different depths. Sme examples belw; Single use Lancet with different depth settings In this case, twist the purple cap t the depth yu require. Set n high it will pierce the patients skin deeply, n medium it will pierce the patients skin mre superfucailly.

8 Prcedure The side f the finger is the preferred puncture site. (Avid texting r typing fingers.) Apply the lancet with a little pressure t the side f finger. Warn the patient e.g. sharp scratch As yu press the trigger dwn Dispse f lancet immediately in sharps bin. If capillary bld sample nt immediately available, cunt t 5 then squeeze the finger frm the bttm t btain a small drp f bld (apprx. 0.6 micrlitres). Tuch frnt edge f yellw windw f test strip t drp f bld and the test strip draws up bld DO NOT put bld n tp f strip. Please avid tuching the puncture site and avid smearing the bld (test strips will nt wrk) The test strip shuld tuch the apex f the bld drplet

9 The bld glucse level shuld then be displayed n the glucmeters screen. Dispsal f waste Lancets must g immediately int the sharps bin after use, please dispse f glves, aprn, paper twel, gauze and strips int range clinical waste bag. Ensure that yu wash yur hands fllwing the prcedure. Dcumenting Results Please reprt abnrmal results immediately t a senir member f staff, and dcument clearly. Any abnrmal readings will need re testing and a venus sample shuld be taken, by a member f staff qualified t d s.