Glucometer Blood...

[BloodNGlory02]

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?

 

[TTLWHKR]

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.

 

[emtal233]

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....

 

[ma2va92]

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

 

[rescuecpt]

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

 

[shorthairedpunk]

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.

 

[MMiz]

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

 

[coloradoemt]

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

 

[cbdemt]

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!

 

[ECC]

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.

Interesting stuff

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.

 

[vtemti]

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.

 

[Jon]

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

 

[Lootsie]

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.

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?

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.

 

[Jon]

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????"



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


Jon

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

 

[aristigal]

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!!

 

[Stevo]

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~

 

[PArescueEMT]

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

 

[CodeSurfer]

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

 

[Jon]

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.

 

[CodeSurfer]

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.