Blood sugar?

[RALS504]

I've never seen anyone do that, and I don't do it. Sounds kinda messy to me.

I have started an IV and used the needle (or go strait to the freshly placed cath.) for a venous blood sample for a BGL reading since 2001. This works quite well and is not at all messy. I also had someone show me a new trick while working in the ER. If you are going to draw blood from your IV, take an unprimed NS lock (Heparin lock to some of you), start your IV, then hook up your NS lock, lock it closed, remove the buffalo cap, attach a vaccutainer hub or syringe, open the slide lock, let the NS lock prime with blood rather than NS, draw all the desired test tubes, lock the slide lock, replace the cap, and flush the line. When I drew blood off of my IV in the field I always put the vacutainer hub directly to the newly place IV cath. I find this new way neater because you do not have to tamponade off the vien, you have a control valve. I know we do not draw blood all that often in EMS, but if you switch to the hospital or need to draw blood it is a neat little trick. Also per my hospital BGL policy we may use a capilary, venous, or arterial blood sample with the same range 60-120 mg/dl.

 

[TTLWHKR]

I know we do not draw blood all that often in EMS

Every time I start an IV, I draw four vacutainer tubes of blood for labs.. It's my protocol.

 

[RALS504]

Every time I start an IV, I draw four vacutainer tubes of blood for labs.. It's my protocol.

That sounds like very forward thinking protocols you have. I think we under estimate the value of drawing labs early for the best possible patient outcomes. Your system may have hospitals that do not accept your blood draws, so be it. But draw them anyway, label them (date/time,initials, and agency), and tape them to the IV bag this way they have to decide to get rid of a perfectly drawn labs. I mean how nice is it to roll into your local ER with a level one trauma and have a purple top test tube ready to go to the blood bank to get typed and screened.

 

[TTLWHKR]

The hospital system could care less.. I meant that it's something that I personally do, on every call. Saves the patient from getting stuck twice. If it's a trauma, I try to not only get labs, but both IV's.. again.. so they don't have to go through it while everything else is going on. If the trauma victim doesn't get field labs locally, they draw them from the femoral artery.... which hurts like an SOB.. :unsure:

 

[emtbass]

In my part of the world... we do a d-stick on EVERY patient that gets an IV regardless of hx. When you start the IV... you get the blood from the catheter (you can stick your pen in one end and a drop of blood from your flash chamber comes out the other). alot of transfers we'll get a d-stick as well... I would say 98% of the pts get a d-stick.

 

[EMTI&RESCUE]

I might be labeled a "randy rescue" but if their sick enough or hurt enough to get in the back of my bus then their going to get the full work up. IV, D-stick, and all the vitals. Its "CYA" by doing them I think. It will help keep you out of court, or looney bin if ya dont do them and your patient dies on your bed. That and it gives me something to do on the way to the E.R.

 

[AVParamedic1]

Standard assessment of a Pts for AV includes Blood Glucose so yes we do it on all Pts

 

[joshrunkle35]

Of late I have been subjected to a trend of RN's and doctors asking me if I did a blood sugar on every effing pt I bring through the door, regardless of the nature of the illness/injury. Is this ridiculous practice limited to my corner of the world or is it happening everywhere?

If it could be blood sugar related, or something could be masking a blood sugar issue (like a patient that appears to be clearly dehydrated and "feels like they are going to pass out" and hasn't consumed any fluids while the exercised for several hours on a hot day) then I take a blood sugar. If it might be relevant to treatment later, like if they have the flu, I take a blood sugar. I don't take a blood sugar if it's something like a patient with a broken hand, etc.

 

[9D4]

I've never seen anyone do that, and I don't do it. Sounds kinda messy to me.

That's what I was taught. Every time you start a line, use a drop from the flash chamber for BGL. If it's not normal, get a more accurate one by finger stick (although in my limited experience it's never a noticeable difference).

 

[ABQmedic]

Of late I have been subjected to a trend of RN's and doctors asking me if I did a blood sugar on every effing pt I bring through the door, regardless of the nature of the illness/injury. Is this ridiculous practice limited to my corner of the world or is it happening everywhere?

It's interesting you ask that. Here in NM, I am finding that checking a patient's blood glucose is becoming a clinical expectation, maybe even standard of care. Obviously, we check one on diabetics, AMS patients, and ETOH'ers. Think of this, though... hyperglycemia can occur in up to 50% of all STEMI patients (even with no diagnosis of type II DM).

You can also find patients with sepsis, or who are otherwise critically ill, to have acute hyperglycemia

Anymore, I check BGL's on all patients. That way the both the patient and myself are covered.

Posts linked to studies to follow...Stay tuned

 

[ABQmedic]

STEMI and hyperglycemia link

http://circ.ahajournals.org/content/115/18/e436.full

Sepsis and hyperglycemia link

http://www.medscape.com/viewarticle/507661

 

[usalsfyre]

Elevated BGL is part of inflammatory response.

 

[jwk]

That's what I was taught. Every time you start a line, use a drop from the flash chamber for BGL. If it's not normal, get a more accurate one by finger stick (although in my limited experience it's never a noticeable difference).

Why would it be different?

 

[jwk]

It's interesting you ask that. Here in NM, I am finding that checking a patient's blood glucose is becoming a clinical expectation, maybe even standard of care. Obviously, we check one on diabetics, AMS patients, and ETOH'ers. Think of this, though... hyperglycemia can occur in up to 50% of all STEMI patients (even with no diagnosis of type II DM).

You can also find patients with sepsis, or who are otherwise critically ill, to have acute hyperglycemia

Anymore, I check BGL's on all patients. That way the both the patient and myself are covered.

Posts linked to studies to follow...Stay tuned

ANY lab test should be done for indications, not as a matter of routine, and certainly not for every single patient. You're going backwards with the "evidence based medicine" concept.

Now - you're citing several valid indications, which I have no problem with. It's the "I check BGL's on all patients" that I think is absurd.

 

[tred1956]

If I start a line I check BGL. Why not? I however don't start a line on every patient and only check a BGL if I feel it is warranted. While I have never been told to always check a BGL, now that you mention it, I am asked more often lately if I did?

Doug

 

[jwk]

If I start a line I check BGL. Why not? I however don't start a line on every patient and only check a BGL if I feel it is warranted. While I have never been told to always check a BGL, now that you mention it, I am asked more often lately if I did?

Doug

My point is that "because I started an IV" is not an indication for getting a glucose level.

Curious - do you charge the patient for that test or are your charges all bundled together?

 

[tred1956]

No additional charge. I agree total that starting a line does not indicate the need for BGL. However it being already available (with no further invasive procedure of patient) it does on some rare occasions reveal valuable information.

Doug

 

[Aprz]

Why would it be different?

It depends if the glucometer is calibrated for venous blood samples, capillary blood samples, or both. I would say most modern ones are now calibrated for both.

I think I've read before that if distal circulation is poor, venous blood may be more accurate to use, however, I read that from a blog rather than from a study or something super legit so I am not sure how true that is.

I'm trying to think about this logically. There should be more glucose in the capillary sample versus the venous sample because more glucose should be used by then. Although I guess metabolism isn't super fast anyhow so I guess it wouldn't be significant. More fluids in venous "diluting" the glucose in venous versus capillary because some fluid is in interstitial space while passing through the capillary due to hydrostatic pressure? So I am guessing overall the glucometer that is calibrated for only capilary blood samples would think there is less glucose than there really is? Right?

Damn, just noticed this thread is hecka old thanks to the next poster. I saw this page was all new posts, didn't read the first post, and just posted to answer that question in regard to why should it be any different. My bad.

 

[Underoath87]

Standard assessment of a Pts for AV includes Blood Glucose so yes we do it on all Pts

This thread is 8 years old...

 

[ABQmedic]

ANY lab test should be done for indications, not as a matter of routine, and certainly not for every single patient. You're going backwards with the "evidence based medicine" concept.

Now - you're citing several valid indications, which I have no problem with. It's the "I check BGL's on all patients" that I think is absurd.

I apologize for using the qualifier "all" when I should have used "most." Anecdotally, checking a BGL on patients without the usual "valid indications" as you put it, has revealed abnormal values and subsequent diagnoses of new onset type ll diabetes in patients who "just didn't feel well." We don't charge the patient extra for the test. I hope that's less absurd in your observation.