Abbott PXP Glucose Meters 2015 Resource: Lin Gustafson, MT(ASCP) Point of Care Coordinator, Laboratory
Objectives After you complete this Computer-Based Learning (CBL) module, you should be able to: Explain meter operation and maintenance. Describe glucose meter testing protocol. Describe documentation requirements for patient and control results. Explain basic glucose meter troubleshooting.
Basic Operation To operate the Abbott PXP glucose meters, you must know: How to use the Scan key. How to use the Clear button. When and how to replace batteries. How to enter the operator ID and the patient ID.
Basic Operation Scan Key The Scan key turns on the laser scanner to read bar codes. To operate, press and hold Scan key. Move the green beam over the bar code. A red light will flash. The meter beeps when it reads the bar code. Hold Scan key until meter verifies bar code ID. Slowly move the meter, if needed, so that the green beam is directly over the barcode
Basic Operation Scan Key Precautions Never look into the bar code scanner. This may cause permanent eye damage. If you hold the Scan key button for three seconds, the scanner stops. Reposition the scanner and try again. hold the scanner 3-7 inches from the barcode and at a 30 to 135 degree angle to the barcode. to cut down on glare: Umbrella your free hand over the barcode while scanning.
Basic Operation Clear Button Use the Clear button to: Clear a bar code scanned by mistake. Back up one space. Clear a numerical code from the monitor after pressing enter. Return to a previous screen. Press Clear two times to clear all numbers shown in the display.
Basic Operation Battery Replacement A low battery power message is a CRITICAL alert. Change batteries immediately! Meter requires two AA batteries The battery indicator signal is located in the upper right hand corner of the meter screen.
Basic Operation Enter Operator ID To enter your operator ID: Scan your employee badge bar code to enter your operator ID. If your ID is invalid and your certification is current, place the PXP in a docking station to upload the meter again. This reinstalls the list of valid operators. If you have a problem, phone Lin Gustafson, POCC, at 678-312-2902. Never allow anyone to use your badge bar code. Remember you are legally responsible for all tests performed using your operator ID.
Basic Operation Enter Patient ID To enter the patient ID: Scan the patient s billing account number, found on the patient s wrist band. If you can t scan the wrist band, inform the charge nurse immediately to get a new wrist band for the patient. Scanning is for positive patient identification. Scanning prevents manual entry errors and results going to the wrong patient chart. If you must manually enter a number, double check it before you press the Enter button. This should be a rare issue.
Patient ID, cont. After scanning the patient s armband: If the patient s demographic information is available, the patient s name, DOB and sex will display under the patient account number on the meter screen. If the information is correct, press 2 to confirm. If the information is incorrect, press 1 to re-enter ID.
Patient ID, cont. If the patient s demographic information is unavailable, the message patient data not found displays on the screen under the patient account. Verify that the patient account number, located at the top of the screen, is correct. If the patient account number is correct, press 2 to continue. If the patient account number is incorrect, press 1 to re-enter ID.
Quality Control (QC) Testing When you open a new set of control solutions: Discard old set of controls. Write the new expiration date on the control bottles using the expiration labels in the meter boxes. For more labels call x22902 (GMC-L) or x26700 (GMC-D) DO NOT write on the barcode. Test low and high levels of controls once every twelve hours. Control solutions expire 90 days after opening or at the expiration date on the bottles, whichever comes first.
Performing a QC Test To perform a quality control test: Swirl the control solution several times before applying it to a test strip. Discard first drop to get rid of any air bubbles Apply and hold QC solution to test strip until the meter beeps Keep the meter in a horizontal position whenever performing patient or QC testing.
Out-of-Range QC Results If your QC test result is Fail, enter the appropriate comment code. For example: Repeat test (code #1) Procedure error (code #4) Check QC solution expiration date and fluid level. If QC solution is adequate, repeat test using same solution.
Out-of-Range QC Results, cont. If QC remains out of range, repeat test using new QC solution. If you are unable to resolve QC problem: Take meter out of service and exchange for a new meter. Notify Lin Gustafson, POCC at 678-312- 2902.
Out-of-Range QC Results, cont. Possible causes of out-of-range QC results include: Air bubbles in control solution. Test strips or solutions compromised because of improper storage. QC solution opened for more than 90 days. Controls not mixed prior to testing.
Docking the Meter Dock the meter every four hours. Place the PXP glucose meter in the docking station after performing the QC test. A two-way data transfer occurs each time the meter is docked. The meter uploads patient and control results to the Abbott computer system. The computer system downloads new operator and lot information to the meter.
Data Upload Procedure Place the PXP in a docking station to start the data upload. The PXP meter displays: Upload successful, turning off. Do not remove the meter until the arrows are replaced by the Menu Mode screen
Patient Blood Glucose Testing When obtaining a capillary finger stick blood glucose sample: 1. Use the patient s middle finger or ring finger. 2. To clean finger, wipe with alcohol. 3. Allow alcohol to air dry. Finger must be dry before puncture. 4. Puncture the patient s finger. The puncture should be made slightly off center from the central, fleshy portion of the fingertip. makes it unsuitable for puncture. The side and tip of the finger should be avoided, as the tissue is about half as thick as the central portion of the fingertip.
Patient Blood Glucose Testing, cont. 5. To initiate blood flow, apply gentle pressure to the finger, then release pressure. Repeat, if needed. 6. Avoid excessive squeezing (milking) of the puncture site, this may cause hemolysis and/or tissue fluid contamination of the specimen. 7. Wipe away the first drop of blood. 8. Use a second drop for testing. Allow a nice size drop to form before applying to the test strip. Perform all testing with the meter in a horizontal (flat) position. Do not allow blood to enter the strip port.
Repeat Patient Blood Glucose Testing If you have to repeat the test because of an out of range result or error, perform a new finger stick using a different site. 1. Clean finger with alcohol and allow to dry. 2. Puncture finger. 3. Wipe away first drop. 4. Use second drop for repeat testing.
Venous / Arterial Blood Testing You must use venous or arterial specimens within 30 minutes of collection. If not used immediately, use only anti-coagulated samples. Specimen Source Venous Arterial IV start Collect in: Green- or purple- top tube Syringe containing heparin or EDTA Special Instructions Use immediately to avoid specimen clotting. Micro clots interfere with biosensor technology
GHS Blood Glucose Ranges Adults: 70-400 mg/dl Newborn: 40-200 mg/dl Take action for EVERY result outside these ranges. The meter displays the result and an arrow pointing up (if >400) or down (if <70) and prompts you to input a comment code. Enter comment code #1 (repeat test). Repeat test immediately to verify first result. If the repeat test remains outside of the range, enter an appropriate comment code. Examples: Dr/charge nurse notified (code #11), hypoglycemia protocol (code #9).
GHS Blood Glucose Ranges, con t. A STAT lab draw is required for any result remaining >400 mg/dl after a repeat test. A STAT lab draw is recommended for any result: Remaining <70 mg/dl after a repeat test, and Not consistent with physical symptoms, and Technical errors have been ruled out. Click here to review Nursing Policy #6137, Diabetes and Blood Glucose Management. Click here to review Laboratory Policy #701-007, Precision Glucose Systems.
Use Proper Test Strip Only use the test strip from the package you scan. Scanning the test strip bar code enters the strip lot number and expiration, control ranges and expiration, and calibration information into the meter. This is important because unique information is associated with each lot number.
Patient Results Possible causes for out-of-range patient results Lower than expected: Water or alcohol remaining on puncture site. Venous or arterial blood sample not tested within 30 minutes of collection. Patient is severely dehydrated, severely hypotensive, or in shock **Hyperglycemic-hyperosmolar state (with or without ketosis). **Hematocrit is higher than the acceptable limit for the test strips, as indicated on the test strip package insert. **Send a Lab draw on patients who meet these manufacturer limitations.
Patient Results, con t Possible causes for out-of-range patient results Higher than expected: Serum or plasma used instead of whole blood. **Hematocrit is lower than the acceptable limit for the test strips, as indicated on the test strip package insert. **Send a Lab draw on patients who meet these manufacturer limitations. Document all patient results in the patient s chart.
Patient Results, con t Laboratory testing is only good as the sample used for testing. Point of care glucose testing relies on capillary punctures. Good peripheral blood flow is critical for an accurate sample. Finger stick or capillary punctures should not be used on patients exhibiting decreased peripheral blood flow. In these cases, venous or arterial blood samples should be obtained for testing.
Patient Test Review 1. Press the On/Off button to turn the monitor on. 2. Press the Menu button. 3. Press 1 to select Data Review. 4. Scan operator ID. 5. Choose the category of data to review.
Unregistered Newborns You can find glucose logs for unregistered babies in both the NICU and Well Nursery. You may use an assigned number for the patient ID along with the patient s last name. Place the patient s label on the log as soon as possible. Fax log to laboratory daily: 678-312-3371
Unregistered ED Patients You can find glucose logs for unregistered ED patients at different locations in the Lawrenceville and Duluth EDs. Please see managers for specific locations. Enter Date and Time (mmdd0000) on log under Number Used as the patient identifier. Example: Enter Jan 8 th at 1400 as: 01081400 Record results and your operator ID on log. Place the patient s label on log ASAP. Fax log to Laboratory daily: 678-312-3371.
Testing Patients in Isolation Before Testing: Prepare all testing materials prior to entering the patients room. Place meter in a biohazard bag and seal the bag. Use any necessary Personal Protective equipment (PPE) to enter the room. Take ONLY your meter and necessary supplies into the room. DO NOT take entire meter case.
Testing Patients in Isolation, cont. Testing: 1. Scan/enter your operator ID. 2. Scan the patients armband. 3. Push the test strip through the bag, making a small hole. 4. Perform test.
Testing Patients in Isolation, cont. After Testing: Remove the meter from the room by sliding it out of the biohazard bag to: An isolation cart, -or- Available counter top, -or- Staff member outside of the room. Dispose of the biohazard bag, your PPE, and all testing materials BEFORE exiting the room. Wash your hands and decontaminate the meter AFTER exiting the room.
Meter Care To reduce meter down time and extend meter life: Avoid dropping the meter. Do not place meter on beds or cluttered tray tables. keep a firm grip on the meter at all times If the meter is accidentally dropped, verify correct date and time on meter screen and do QC testing to be sure it is operating properly before doing patient testing. Avoid getting QC solution or patient blood inside meter. Use small drops of control solution and patient blood. Keep meter in a horizontal (flat) position during testing.
Meter Care, cont. Avoid getting QC solution or patient blood inside meter, cont. Remove test strips before lifting the meter to read the screen. Excessive specimen may run down the strip, into the strip port opening and onto the circuit board. This results in a strip error where the meter will not recognize the test strip once it has been inserted or removed. Wetting the internal circuits repeatedly damages the meter and causes inaccurate test results.
Keeping the Meters Clean Clean the PXP meters with a hospital approved disinfectant wipe after each patient use. Follow directions for use as a disinfectant on back of wipe container. Turn the meter off when cleaning it. Clean the scanner window with an alcohol pad and wipe dry. Soiled or smudged windows do not scan properly DO NOT immerse, flood with any liquid or autoclave the meter. Clean the meter over a counter or desk top to avoid dropping the meter on the ground. Keep a firm grip on the meter at all times.
Replacement Meters Replacement meters are available in the Lab. Bring the defective meter to the Lab for exchange along with a description of the problem. A description of the problem is necessary when the meter is sent back to the company.
Congratulations! You have completed this Computer-Based Learning (CBL) module. Continue on to take the test. Questions? Contact: Lin Gustafson Point of Care Coordinator, Laboratory 678-312-2902