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BLOOD GLUCOSE MEASUREMENT

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Chapter 19 BLOOD GLUCOSE MEASUREMENT Mary Clynes, Colleen O Neill and Sara Raftery Introduction This presentation examines the blood glucose measurement procedure ... – PowerPoint PPT presentation

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Title: BLOOD GLUCOSE MEASUREMENT


1
BLOOD GLUCOSE MEASUREMENT
Chapter 19
  • Mary Clynes,
  • Colleen ONeill
  • and Sara Raftery

2
Introduction
  • This presentation examines the blood glucose
    measurement procedure and the rationale for
    carrying it out
  • Part 1 Blood Glucose Measurement Overview
  • Part 2 Indications and Contraindications for
    Blood Glucose Measurement
  • Part 3 Blood Glucose Measurement Pre-Procedure
    Patient Care Principles
  • Part 4 - Blood Glucose Measurement Procedure
    Patient Care Principles
  • Part 5 - Blood Glucose Measurement Post-Patient
    Care Principles

3
  • PART 1 Blood Glucose Measurement Overview

4
Definition
  • Blood glucose monitoring is a procedure to
    establish the measurement of glucose in the blood.

5
Normal Measurement
  • Blood glucose levels are measured in mmol/l.
  • The normal range for an adult is 4.5-5.6 mmol.l
  • The normal range for a child is 3.4-5.6 mmol/l
    and a neonate is 2.6-5.0 mmol/l (Skinner 2005).

6
  • PART 2 Indications and Contraindications for
    Blood Glucose Measurement

7
Indications
  • In diabetics, take care to monitor blood glucose
    levels. The readings can assist the mdical team
    in adjusting insulin levels (Alexander et al,
    2006).
  • To detect hypoglycaemia (low blood sugar) or
    hyperglycaemia (high blood sugar).
  • To monitor patients on parenteral nutrition to
    ensure that blood glucose levels are within
    acceptable limits. It is important to be aware
    that hyperlipidaemia (raised blood lipids) may
    alter blood glucose reading.
  • To monitor patients who are taking hypogylcaemic
    medications.
  • To eliminate diabetes mellitus as the cause of in
    patients who present in an unconscious.

8
Blood Glucose Monitor
  • There is a variety of blood glucose monitors
    available.
  • They vary depending on size, testing speed,
    amount of blood needed for the test, ability to
    store test results in memory, cost of meter and
    reagent/test strips.
  • It is important to follow manufacturers
    instructions for storage and blood monitoring
    techniques.
  • Compatible test/reagent strips should be used.
  • Ensure that you are familiar with the workings of
    the equipment. Only staff who are specifically
    trained should use the monitor.
  • Before carrying out the procedure, ensure that
    the blood glucose monitor is checked and is in
    working order to ensure accuracy of result.
    Monitors should also be calibrated as per
    manufacturers guidelines to ensure an accurate
    result.

9
Contra-indications
  • Staff need to be aware that certain conditions
    may give false results and in those instances a
    laboratory measurement using a venous blood
    sample is required.
  • Results may be affected by the following
  • Dialysis treatment
  • Hyperlipidaemia
  • Severe dehydration
  • High and low haematocrit values
  • High bilirubin values
  • Peripheral circulatory failure
  • Intravenous infusions of ascorbic acid (Vitamin
    C)
  • Patients receiving intensive oxygen therapy
    (MHRA, 2005)

10
Responsibilities
  • In order to provide safe, competent care to
    patients an understanding of the principles and
    processes related to blood glucose monitoring is
    necessary.
  • HCPs need to be aware of their role in the
    pre-procedure phase, procedure phase and post
    insertion stage. 

11
  • PART 3 Blood Glucose Measurement Pre-procedure
    Patient Care Principles

12
Pre-Procedure Patient Care
  • Wash hands and put on gloves and apron to prevent
    contamination with blood and reduce the risk of
    cross-infection.
  • Explain the procedure to the patient in order to
    gain consent and co-operation. Discuss with the
    patient any concerns or queries to minimise
    patient anxiety.
  • Check that consent has been obtained.
  • Collect and prepare the equipment in order to
    carry out the procedure smoothly and without
    unnecessary stoppages.

13
  • Equipment
  • Blood glucose meter
  • Test/reagent strips
  • A spring-loaded finger pricking device and
    sterile lancets
  • Cotton wool balls
  • Non sterile gloves and apron
  • Sharps bin
  • Record sheet
  • Receptacle for waste material

14
  • PART 4 Blood Glucose Measurement Procedure
    Patient Care Principles

15
Procedure Patient Care
  • Ask patient to wash hands with soap and water
    prior to taking sample, to reduce skin microbial
    load.
  • The warm water dilates the capillaries and
    increases blood flow. Provide assistance as
    appropriate. Alcohol wipes should not be used to
    clean puncture site, as alcohol interferes with
    test/reagent strips and repeated use toughens
    skin.
  • Ask patient to sit or lie down to ensure patient
    safety. Some patients may feel faint when a blood
    sample is taken.
  • Select puncture site. The side of heel or side of
    finger are potential sites. Avoid using back of
    heel and tips of fingers to reduce pain and
    prevent damage to underlying nerves.

16
  • The site should be rotated to reduce the risk of
    infection from recurrent punctures, prevent the
    areas becoming hard and reduce discomfort.
  • Insert the lancet into the spring-loaded device.
  • Remove protective cap from lancet.
  • Place the sterile lancet firmly against selected
    area and press the release button to obtain blood
    sample. The lancet will immediately puncture the
    skin.
  • Gently squeeze finger or heel to produce a
    sufficient sample of blood to ensure accuracy of
    result.
  • Avoid massaging blood from the puncture site.
    This may result in damage to the tissues and the
    subsequent seepage of tissue fluid will give a
    false result. (Skinner, 2005).

17
  • Position finger in downward position to aid the
    flow of blood.
  • Ensure that there is sufficient blood to cover
    the reagent/test strip. Do not smear or spread
    the blood on the strip.
  • Continue as per the manufacturers instruction as
    the procedure may vary depending on the type of
    monitor.
  • Apply cotton wool to puncture site and apply
    pressure to prevent further bleeding and to
    prevent haematoma formation.

18
  • PART 4 Blood Glucose Measurement Post-Procedure
    Patient Care Principles

19
Post-Procedure Patient Care
  • Dispose of lancet in sharps bin to reduce the
    risk of needle stick injury.
  • Dispose of waste appropriate to prevent the
    spread of infection.
  • Ensure bleeding has stopped and patient is
    comfortable.
  • Remove and dispose of gloves.
  • Wash hands or clean with bactericidal solution to
    prevent cross-infection. Read and record result
    as soon as it is displayed on the monitor to
    ensure accuracy.
  • The nurse must know the normal blood glucose
    range so that abnormalities can be recognised and
    treatment provided as appropriate.
  • Careful and thorough documentation is important
    to ensure accurate record of the procedure and
    nursing care provided.
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