# Blood glucose question...



## EMT-IT753 (Dec 16, 2010)

How many people still use an alcohol wipe when checking sugar on a clean finger?

In one of the systems I work for, we do not use an alcohol wipe unless the finger is soiled. In another system I work for they insist on using the alchohol wipe?

I am curious to see if people are still using this technique.


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## MrBrown (Dec 16, 2010)

No, and we also do not use the needle from an IV cannulae to do a BGL

BTW WTF is an EMT-IT


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## TransportJockey (Dec 16, 2010)

Some people who work in my system do, but I do not after having worked in a hospital. alcohol preps can give you a false high reading.

Brown, why not flash chamber blood for a BGL reading? I can't remember exactly, but from my reading it only is a few points off from a CBG.

And I'm guessing IT might be IV Tech? But I don't know. There are too damned many retarded EMS levels in the US


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## EMT-IT753 (Dec 16, 2010)

EMT-IT is an EMT-Intermediate Technician here in Wisconsin. It is a little higher than an EMT-B and a long ways below an EMT-P 

The main difference between the B and IT is we are IV trained and have D50 and Narcan thrown into our list of approved meds we can administer. In my area we also are trained in phlebotomy. The IT curriculum goes a little deeper into assessments as well. Other than that, we are glorified EMT-B's.

I went rounds with one of my team members this morning at 0330 about me not using an alcohol wipe. He insisted I was dead wrong, but whatever, we just agreed to disagree.

Thanks for the input B)


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## reaper (Dec 16, 2010)

Unless you have super vision. Learn to use them on all BGLs. 

I don't know how many times I get people not cleaning a finger and getting high readings. If pt has sugar on finger, it will mix with blood and give false readings. 

You are dealing with diabetics. Antiseptic cleansing is very important. 

Alcohol will only give high readings, if you do not allow it time to evaporate. 

Had a AMS the other day. Partner checked BGL without a wipe and without telling me. BGL was 187. I just happen to take another BGL off IV cannula and it was 22. Recheck on finger, after wiping was 26. This is why you clean them.


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## DFW333 (Dec 16, 2010)

Theres several systems in North Texas that have actually started the trend of removing BGL checks from EMT-B skill set altogether. They are getting false readings left and right, some were checking D-sticks 2x per transport on all patients regardless of chief complaint, some were not checking it on AMS patients and a few somehow managed to stick themselves.

Of course, in their infinite wisdom these companies still allow basics to give oral glucose to the AMS pt who has low sugar... :wacko:


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## Sasha (Dec 16, 2010)

Of course they move to taking away the option of taking a BGL instead of spending a little time on properly educating them when, how, and why to check a glucose.


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## jjesusfreak01 (Dec 16, 2010)

Sasha said:


> Of course they move to taking away the option of taking a BGL instead of spending a little time on properly educating them when, how, and why to check a glucose.



Which is ridiculous considering its one of the more common calls in EMS that occasionally basics will need to handle themselves.


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## Amber2313 (Dec 16, 2010)

In Indiana, basics don't anyway. "Too invasive" ...:blink:


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## jjesusfreak01 (Dec 16, 2010)

ems.amber911 said:


> In Indiana, basics don't anyway. "Too invasive" ...:blink:



Well, they better take Epi-Pens out of the scope too, since they're slightly more invasive...and painful. Sure, some people in BLS only regions may die, but its for the greater good.


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## Amber2313 (Dec 16, 2010)

jjesusfreak01 said:


> Well, they better take Epi-Pens out of the scope too, since they're slightly more invasive...and painful. Sure, some people in BLS only regions may die, but its for the greater good.



Ha. No kidding. Hellooo, band-aid box...


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## mikie (Dec 16, 2010)

Are regular glucometers calibrated to read venous blood? 

(For those who draw it from the IV chamber? Obviously there wouldn't/shouldn't be a huge difference or anything, just curious)


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## DFW333 (Dec 16, 2010)

mikie said:


> Are regular glucometers calibrated to read venous blood?
> 
> (For those who draw it from the IV chamber? Obviously there wouldn't/shouldn't be a huge difference or anything, just curious)



The service I work for uses glucometers that are calibrated for it. It seems logical to bring patients into the hospital with as few holes poked in them as possible.


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## jjesusfreak01 (Dec 16, 2010)

DFW333 said:


> The service I work for uses glucometers that are calibrated for it. It seems logical to bring patients into the hospital with as few holes poked in them as possible.



Do they actually need to be calibrated for that, or is it just a different scale? You wouldn't be getting a CBG reading, but thats just because you aren't taking capillary blood.


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## DFW333 (Dec 16, 2010)

jjesusfreak01 said:


> Do they actually need to be calibrated for that, or is it just a different scale? You wouldn't be getting a CBG reading, but thats just because you aren't taking capillary blood.



I really dont know. The only difference I notice is when we use it on a finger stick the timer on the meter counts down from five. When we get blood from an IV catheter it counts down from fifteen. How it knows the difference is beyond my paygrade. When we first acquired these meters we did double check with finger sticks on more than 50 patients with an average error of +/-5 points on the reading.


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## Phlipper (Dec 16, 2010)

Interesting read.  I have wondered about this myself when I see EMT-Bs and Ps grab the blood sample when I can see over their shoulder the blood is diluting with the alcohol.  Always wondered how that might affect the reading.  So i started wiping, then blotting with the gauze before sticking.  But that's just me. It prolly doesn't make enough difference in the reading.


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## TransportJockey (Dec 16, 2010)

Phlipper said:


> Interesting read.  I have wondered about this myself when I see EMT-Bs and Ps grab the blood sample when I can see over their shoulder the blood is diluting with the alcohol.  Always wondered how that might affect the reading.  So i started wiping, then blotting with the gauze before sticking.  But that's just me. It prolly doesn't make enough difference in the reading.



From what I was taught is you wipe away the first bit of blood anyways, so doing that sounds right


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## DFW333 (Dec 16, 2010)

jtpaintball70 said:


> From what I was taught is you wipe away the first bit of blood anyways, so doing that sounds right



The problem with wiping away the first bit of blood is you sometimes (albeit very rarely) get a person that doesnt bleed very much. You wipe away the first bit of blood and you dont get enough after that to get a reading.


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## emt_irl (Dec 16, 2010)

my company made an s.o.p that we must wipe finger clean before using lancet, but give it a few seconds to dry before we take sample of blood.

being entirley honest i dont see why in most cases? unless the finger tip is soiled.
My mother has been a diabetic all her life and i have been surround by the medications, bgl checks etc for as long as i remember and ive never seen a noticeable different between a wiped and un-wiped finger, using her as a control.


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## DFW333 (Dec 16, 2010)

emt_irl said:


> my company made an s.o.p that we must wipe finger clean before using lancet, but give it a few seconds to dry before we take sample of blood.
> 
> being entirley honest i dont see why in most cases? unless the finger tip is soiled.
> My mother has been a diabetic all her life and i have been surround by the medications, bgl checks etc for as long as i remember and ive never seen a noticeable different between a wiped and un-wiped finger, using her as a control.



I think the books were written with the understanding that the person has such poor control over their diet that you'd be fetching their hand out of a bag of powdered donuts immediately prior to checking the BGL.


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## Akulahawk (Dec 16, 2010)

I've used blood samples from the IV cath many times. The glucometers were calibrated for venous blood though. When using the ones calibrated only for capillary blood, I've used venous blood, but as a gross check - as in grossly high or grossly low. If something's not right, or if I suspect right off the bat that I'd need an accurate FSBG check with a capillary blood only unit, I'll do a dedicated stick for capillary blood.

In either case, I'm going to ensure that the site is clean and dry after properly swabbing the site with the alcohol pad.


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## Phlipper (Dec 17, 2010)

Akulahawk said:


> I've used blood samples from the IV cath many times. The glucometers were calibrated for venous blood though. When using the ones calibrated only for capillary blood, I've used venous blood, but as a gross check - as in grossly high or grossly low. If something's not right, or if I suspect right off the bat that I'd need an accurate FSBG check with a capillary blood only unit, I'll do a dedicated stick for capillary blood.



One of our medics showed me that trick just this week.  Pretty cool.  One less hole in a pt, and since we're initially looking for gross score anyway, it made sense.  Lotsa good info here.


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## emt_irl (Dec 17, 2010)

DFW333 said:


> I think the books were written with the understanding that the person has such poor control over their diet that you'd be fetching their hand out of a bag of powdered donuts immediately prior to checking the BGL.



in my experence thats the exception not the rule though. most of my glycemic emergencies i come across are hypo though, who usually havent seen anything resembling food for hours at least.


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## Akulahawk (Dec 17, 2010)

Phlipper said:


> One of our medics showed me that trick just this week.  Pretty cool.  One less hole in a pt, and since we're initially looking for gross score anyway, it made sense.  Lotsa good info here.


Since most of the BGL units I've worked with were able to use venous or capillary blood, I normally didn't worry about it. Why? The unit will tell me what the BGL is after making the appropriate adjustments via it's own software. With those units, I get to know what the blood glucose level is fairly precisely, so I don't have to do grossly low/high screening. I know. 

In any event, if you have a BGL machine that can use venous samples, it's a nicer thing to check the BGL when you're doing an IV as you're only having to cause the patient pain once versus twice. Sometimes though, that's unavoidable. Someone who is hypoglycemic will have to be stuck a few times during the course of their care with me so that I can re-evaluate my Tx plan and make changes to it and/or intervene if necessary.


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## PeteBlair (Dec 20, 2010)

I use an alchohol wipe followed by wiping with 2X2 - making sure the stick area is dry before sticking.

I've got another question (or two).

Do you carry your own BGL meter or does it belong to the vehicle (with other EMTs using the strips also)?

Do you often have to throw a bunch of strips away because they are out of date?


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## TransportJockey (Dec 20, 2010)

PeteBlair said:


> I use an alchohol wipe followed by wiping with 2X2 - making sure the stick area is dry before sticking.
> 
> I've got another question (or two).
> 
> ...


Each truck has one as does each jump bag in the trucks. We usually use the strips too fast for them to expire


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## Shishkabob (Dec 20, 2010)

PeteBlair said:


> I use an alchohol wipe followed by wiping with 2X2 - making sure the stick area is dry



Hopefully a sterile 2x2?  Otherwise you just defeated the whole purpose of the wipe...


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## jjesusfreak01 (Dec 20, 2010)

jtpaintball70 said:


> Each truck has one as does each jump bag in the trucks. We usually use the strips too fast for them to expire



Firefighters around here love to take blood glucose, because its like one of three things they can do as EMT/firefighters. When we get on scene where fire has been there for a few minutes, we get pulse, bp, bgl, spo2, and usually as much medical history and demographics as they can get. Its actually quite helpful now that I think about it.


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## firemedic07 (Dec 21, 2010)

if we give them an IV then we always check the sugar, its easier and quite less painfull to use the IV cath.


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## llavero (Dec 21, 2010)

We do not use an alcohol wipe when checking sugar on a clean finger, and we carry our own BGL meter, but sometimes the ambulances have one.


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## emt_irl (Dec 21, 2010)

PeteBlair said:


> I use an alchohol wipe followed by wiping with 2X2 - making sure the stick area is dry before sticking.
> 
> I've got another question (or two).
> 
> ...



our ambulance has its own, as does each medication bag with lancets and test strips..

i use my own jump bag on calls and standby events and re stock from the ambulance, so i carry my own glucose meter, lancets and strips. i keep it qc'd along with the other units and throw away more strips then i use due to expiration dates etc....


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## dudemanguy (Dec 21, 2010)

Just out of curiousity, when they say not letting the alcohol evaporate completely before taking a sample can give you a high reading, how much of a difference are we talking?


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## reaper (Dec 21, 2010)

Easily 150 dl/ml difference!


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## mikie (Dec 21, 2010)

*question*

what's your technique(s) for using the venous blood from the cath. or tubing or what?  i've never actually seen it done but hear about it frequently...

(and it is kinda the purpose of this thread)

thanks


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## TransportJockey (Dec 21, 2010)

mikie said:


> what's your technique(s) for using the venous blood from the cath. or tubing or what?  i've never actually seen it done but hear about it frequently...
> 
> (and it is kinda the purpose of this thread)
> 
> thanks


Since my service uses a safety cath that I hate, I get the glucometer ready and use a little bit of blood from the hub of the catheter once I pull the needle out


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## JohnsFutureWife (Dec 21, 2010)

I always use alcohol wipes before doing a BGL.


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## yotam (Dec 21, 2010)

*Always use the wipes...*

I guess more of a "if it's not broken don't fix it" sorta way (meaning it can't compromise the precision of the test then why not). I've also learned that alcohol dilates the blood vessel hence enabling stronger flow. Haven't really looked into it though...


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## mc400 (Dec 21, 2010)

You use a pen to poke the cotton part on the back of the safety cath and push out blood onto the test strip.


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## jakeparamedic (Dec 22, 2010)

Always, Always, use alcohol wipes, of course give it some time to dry, but I've seen it so many times going on diabetic calls, the EMT-B's get excited and take the sugar without wiping off the individuals finger and it reads 200... because that person just ate an apple. Make sure you always use a wipe, give it some time to dry, then read the BGL.


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## jakeparamedic (Dec 22, 2010)

jjesusfreak01 said:


> Well, they better take Epi-Pens out of the scope too, since they're slightly more invasive...and painful. Sure, some people in BLS only regions may die, but its for the greater good.



Well maybe they should if they can't take a proper BGL.


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## jakeparamedic (Dec 22, 2010)

jtpaintball70 said:


> Since my service uses a safety cath that I hate, I get the glucometer ready and use a little bit of blood from the hub of the catheter once I pull the needle out



Probably not a bad idea!


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## Shishkabob (Dec 22, 2010)

You probably have the push button caths, Nathan?

My current service has those too, and I hate them, though they DO thread a lot easier than the locking-caths...once actually in the vein a ways.


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## TransportJockey (Dec 22, 2010)

Linuss said:


> You probably have the push button caths, Nathan?
> 
> My current service has those too, and I hate them, though they DO thread a lot easier than the locking-caths...once actually in the vein a ways.



Nope, those I like. We have the ones where the needle retracts into the handle. I hate them. The cath stick quite a bit to the handle, and my first two IVs here in town I pulled the cath right out! EDIT: Even after breaking loose the seal between hub and handle


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