# Glucometer Blood...



## BloodNGlory02 (May 20, 2005)

Sorry if this is in the wrong forum, but in WI you can use the glucometer as a basic so I felt Id start here.

So... you get a call for a 56 y/o female feeling weak and "funny". She tells you she hasnt been eating due to dieting. Just from the looks of her you can tell she's very dehydrated. You *if you're licensed to!* go to start an IV. She mentions she is also diabetic. 

Duh Da Dum Duh.... do you use the blood from your IV start for the strip, or do you poke her again, in the finger for the strip?

What kind of machine do you use? typical over the counter or a "special" EMS glucometer?


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## TTLWHKR (May 20, 2005)

As a diabetic, I find it more comfortable to poke my arm. But you should follow your protocols. It's less painful to test on the tip of the thumb, IMO anyway. 

Doesn't matter anyway because if it's below 30, I have to use an injection that goes on my abdomen anyway. That hurts like hell. And I've been known to be conscious, but woozy at 19mg/dl.


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## emtal233 (May 20, 2005)

Usually when obtaining a blood sample using a glucometer, the meters are only calibrated for capillary blood not venous unless it states you can. Also as a good thing never retake your sample post dextrose in the same arm you pushed it...

As far as the type of glucomters, in my vollie as do most round these parts, we use standard type people use at home, like the accuchecks, in my full time job in a health system we can one use meters of the same lineage as the hospitals and must be QA'd every shift and all info downloaded at the end of the tour.

You may wana check your regional medical advisory committe to see what is the meter to use....


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## ma2va92 (May 20, 2005)

if i know i'm going to start a line.. the blood will come from the IV site.... if not then if can respond.. i'll ask what finger .. do you want me to use.. they may tell ya.. use this one here.. it never really hurts there... ok got my target.. ready aim.. got my drop of blood


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## rescuecpt (May 21, 2005)

I do them separately.  IV here, glucose stick there.


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## shorthairedpunk (May 21, 2005)

Im a fan of IV blood, its easy and yer there.

If theyre conscious, alot of times i have them stick themselves, they know wheres best and how deep to go.


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## MMiz (May 21, 2005)

We got a memo about a month ago with several case studies attached.

We are to do separate sticks for the glucometer.  The studies went on to show the disparity between glucose levels from an IV and capillary poke.

Interesting stuff


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## coloradoemt (May 21, 2005)

I do bloods and BGL seperately. I always get my sample from the patient...   It works better that way...


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## cbdemt (May 21, 2005)

If its a non diabetic trauma pt, we get the blood from the IV.  For any diabetic problem or altered LOC of unknown etiology we use the finger.  As its been said before, if they're consious they will more than likely tell you which finger to use.  As a diabetic, I can tell you that in my opinion it hurts much less on the side of the middle or ring finger.  (though that could just be because i've been testing there for the last 10 years and am used to it)  Most ambulances around here use the OneTouch Ultra, but we have some old relic of an accucheck... not even sure what model.

TTLWHKR, how do you get a large enough sample out of your arm?  I've tried before and never had much luck, but you're right... dosent hurt at all!


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## ECC (May 21, 2005)

> _Originally posted by MMiz_@May 20 2005, 11:49 PM
> * We got a memo about a month ago with several case studies attached.
> 
> We are to do separate sticks for the glucometer. The studies went on to show the disparity between glucose levels from an IV and capillary poke.
> ...


That is interesting...considering that the capliiary blood is where the glucose should be most accurate (where exactly the glucose needs to be going). 

I still use the IV stuff though...it is not enough of a difference for me to withold D50 from my patient. 

Remember Glucose is still a diagnostic tool...if it does not work, something else is wrong.


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## vtemti (Jun 8, 2005)

Listen to your patient (LOC permitting) or family members whenever possible. More than likely they have been testing for a while. In fact, many times our diabetic patients or family members have already done a test prior to our arrival which gives us a heads up. In any case, our BLS people will usually do a finger stick while ALS is starting the line.


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## Jon (Jun 9, 2005)

Does anyone have a link to a study on the disparties? I've seen some medics take it from the IV cath, then subtract 20, and I've seen some say "it is better from the IV" and I've seen some that ask "what is that glucometer thigamagig I keep hearing about????"

  

I'm going to be doing a presentation on this for next friday.


Jon


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## Lootsie (Jun 9, 2005)

> _Originally posted by BloodNGlory02_@May 20 2005, 09:34 PM
> * Sorry if this is in the wrong forum, but in WI you can use the glucometer as a basic so I felt Id start here.
> 
> So... you get a call for a 56 y/o female feeling weak and "funny". She tells you she hasnt been eating due to dieting. Just from the looks of her you can tell she's very dehydrated. You *if you're licensed to!* go to start an IV. She mentions she is also diabetic.
> ...


 According my previous exprience, you can use the same blood that come from the IV. Why do you want to prick the pt twice? 

You can make use of over the counter devices, the all do the same thing, it is only the look that is different. The princple stay the same.


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## Jon (Jun 14, 2005)

> _Originally posted by MedicStudentJon_@Jun 9 2005, 07:15 PM
> * Does anyone have a link to a study on the disparties? I've seen some medics take it from the IV cath, then subtract 20, and I've seen some say "it is better from the IV" and I've seen some that ask "what is that glucometer thigamagig I keep hearing about????"
> 
> 
> ...


 Ok... guys.... I  REALLY need studies to back this up.... any suggestions?


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## aristigal (Jun 15, 2005)

Well from my experiance I use the IV blood if I am going to start a line.  It's not enough a difference.  I do these on every patient that I start a line on diabetic or not!  It's something I always check just to CYA.  We use Acuchecks with th capilary strips and they work good.  The ones where you have to hold your pateitn upside down and get the drop of blood in the middle really suck.  But you can get the strips where is goes in from the side and they work easy and great.  The vollies that I run with and the service I used to work for use Bayer Elite's and they are pretty good too.   

Me being fresh out of medic school my professor told us that they are calibrated for capilary blood but he still uses the venous blood.  We generally don't have the luxery that the hospital does.  And poking my patient 2 times in 5mins or less doesn't usually go over well.  And if you have to try more than once for that line FORGET IT!!


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## Stevo (Jun 16, 2005)

> *calibrated for capilary blood *


hmmm, never realized that, having scooped a drop from the stick repetitively....thanks aristigal

still, just like BP's it relevant to the last site and_ gizmo _used, for instance as Vtemti alludes here one can use the patients glucometer to measure against it's own prior reading vs. the one's we carry

more better? 
~S~


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## PArescueEMT (Jun 17, 2005)

well... i'm not sure, but i might go for that large pool of blood under their head...

seriously tho, i would go for the thumb or the "driving finger" on me, those are the 2 least sensitive fingers on my hands


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## CodeSurfer (Jun 17, 2005)

I'm all for poking the PT as many times as you can justify.  "Wheres the lancet?"


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## Jon (Jun 18, 2005)

Everything I could find acknowledges a difference between capilary and venous blood, and most studies and manufacturers show correlation, with the venous blood typically being higher.

If it is REAL high, it is really high
If it is REAL low, it is really low
if it is "normal" it is probably normal
if it is borderline, it might be high or low.


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## CodeSurfer (Jun 18, 2005)

But if it's borderline high, wouldnt it be probably high? And vice versa for borderline low.  It seems like you should be able to get a reading good enough to know if your pt is going to go into a diabetic coma or has DKA.


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## Jon (Jun 19, 2005)

> _Originally posted by CodeSurfer_@Jun 18 2005, 11:47 PM
> * But if it's borderline high, wouldnt it be probably high? And vice versa for borderline low.  It seems like you should be able to get a reading good enough to know if your pt is going to go into a diabetic coma or has DKA. *


 and, if you are getting 80 or below, it is probably 70 or lower..... so hit 'em with the d50.


Jon


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## CodeSurfer (Jun 19, 2005)

Maybe take one from the IV site and if the reading is borderline poke em and do it from capillary blood. Takes an extra step, but it would be good to be sure.


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## 911 DJ (Jul 5, 2005)

> _Originally posted by emtal233_@May 20 2005, 10:38 PM
> *Usually when obtaining a blood sample using a glucometer, the meters are only calibrated for capillary blood not venous unless it states you can.*


*Bravo!*
Most glucometers are not calibrated for venous blood. In fact, a recent study states "While a drop of venus blood may be used to measure blood glucose levels with the glucometer, this practice appears to overestimate the venous plasma glucose levels from the laboratory by about 18 mg/dL."


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## Jon (Jul 6, 2005)

> _Originally posted by 911 DJ+Jul 5 2005, 08:56 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (911 DJ @ Jul 5 2005, 08:56 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-emtal233_@May 20 2005, 10:38 PM
> *Usually when obtaining a blood sample using a glucometer, the meters are only calibrated for capillary blood not venous unless it states you can.*


*Bravo!*
Most glucometers are not calibrated for venous blood. In fact, a recent study states "While a drop of venus blood may be used to measure blood glucose levels with the glucometer, this practice appears to overestimate the venous plasma glucose levels from the laboratory by about 18 mg/dL." [/b][/quote]
 I'd like to see the study....

Because I'd like to back up it when I do that...


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## medic 4-2 (Jul 12, 2005)

use the iv its easier to get the blood. saves the pt a stick


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## CanuckEMT (Aug 6, 2005)

It is very commonplace around here to take the blood out of the angiocath post iv start.
We use Bayer elite glucometers and I have never experianced a large confliction between my reading and the one the nurses take at the hospital.


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## TTLWHKR (Aug 6, 2005)

> _Originally posted by medic 4-2_@Jul 12 2005, 08:17 AM
> * use the iv its easier to get the blood. saves the pt a stick *


 No way, poke em! "This won't hurt (me) a bit"

 :lol: 

I vary from place to place, every week when testing my bgl. Most of the time, I use my left hand, Thumb. I also use my left and right forearm. My doctor said once, that if I was so weak that I was unable to load my lancet pen, that I could just use the lancet and poke the top side of my leg, just above the knee and get the same results, with less pain. Plus it would always be hidden, and no red marks on my arms. I have to wear my diabetic bracelet when I am in public b/c some people thing the lancet marks are something else, if you get my drift. I try to concentrate them in one area, but it gets painful after a while. 

Maybe some day they'll make a meter that acts like a pulse ox, and requires no blood or poking.


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## Jon (Aug 6, 2005)

> _Originally posted by TTLWHKR_@Aug 6 2005, 06:30 PM
> * :lol: Maybe some day they'll make a meter that acts like a pulse ox, and requires no blood or poking. *


 That would be great.

Isn't there a "watch" that works by sampling the sweat, or skin conductivity or something? I've heard they are ourtageously expensive, and like, leased for a day so your doc can measure blood glucose over the whole day.

I'm sure there is technology out there, and if you were a millionare, you might even be able to afford it.

Jon


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## TTLWHKR (Aug 6, 2005)

> _Originally posted by MedicStudentJon+Aug 6 2005, 06:28 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (MedicStudentJon @ Aug 6 2005, 06:28 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-TTLWHKR_@Aug 6 2005, 06:30 PM
> * :lol: Maybe some day they'll make a meter that acts like a pulse ox, and requires no blood or poking. *


That would be great.

Isn't there a "watch" that works by sampling the sweat, or skin conductivity or something? I've heard they are ourtageously expensive, and like, leased for a day so your doc can measure blood glucose over the whole day.

I'm sure there is technology out there, and if you were a millionare, you might even be able to afford it.

Jon [/b][/quote]
 Not that I know of, I get the general idea, like that girl on Panic Room. But I really have no idea.


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