Thoughts on taking BGL as part of your assessment.

Clare said:
Using the cannula needle for glucometery is now severely frowned upon (at least locally) because the glucometer is not calibrated for venous blood and it increases the risk of a needle stick.
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Sounds like it may time to upgrade to "safety caths," which is probably a good idea anyway. Also I'm that most glucometers are able to read both blood types.
 
I do BGLs on:

- Nearly all diabetics
- Altered conscious state
- post-seizures
- hx of poor oral intake
- suspected sepsis or serious infections
- 'unknown' problems
- head injured & intox/drug affected pt's
 
the_negro_puppy said:
I do BGLs on:

- Nearly all diabetics
- Altered conscious state
- post-seizures
- hx of poor oral intake
- suspected sepsis or serious infections
- 'unknown' problems
- head injured & intox/drug affected pt's
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"Nearly All Diabetics"

I like this. I find that I check BGL far less often on diabetics than a do for any of the other listed categories above.
 
I think it goes without saying that a diabetic patient who is unwell should have a blood sugar checked; but just because a patient is diabetic does not mean they need a blood sugar tested.
 
Clare said:
Using the cannula needle for glucometery is now severely frowned upon (at least locally) because the glucometer is not calibrated for venous blood and it increases the risk of a needle stick.
Click to expand...

The difference between capilary and venous blood isn't that significant. maybe 5-10mg/ml, depending on the machine.

If 5-10 makes or breaks a decision on what to do, then I would wager the providers are not very astute clinicians and require a more extensive FTO period. (or one to begin with)

As for needle sticks, well. Be safe or get a safer device.
 
Veneficus said:
The difference between capilary and venous blood isn't that significant. maybe 5-10mg/ml, depending on the machine.

If 5-10 makes or breaks a decision on what to do, then I would wager the providers are not very astute clinicians and require a more extensive FTO period. (or one to begin with)

As for needle sticks, well. Be safe or get a safer device.
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Good points, and I am not suggesting the difference between the two is so significant as to change the course of treatment, but it is something that has been decreed as unacceptable so be it I guess.

I would also think that if the patient has a glycaemic problem requiring intravenous access for medicine or fluid that a blood sugar has been taken before it is decided necessary to put in an IV. For example many hypoglycaemic patients don't even require IV glucose here, something sweet to eat/drink or some glucagon does the trick most of the time, so that means you must take a normal capillary blood glucose. If the patient is unwell with hyperglycaemic osmotic diuresis then you need to establish they are actually hyperglycaemic before treating them so again, you need to take a BGL before putting in an IV.

But then again I suppose it's not the end of the world if you want to use blood from an IV needle to get a blood sugar ...
 
Clare said:
For example many hypoglycaemic patients don't even require IV glucose here, something sweet to eat/drink or some glucagon does the trick most of the time, so that means you must take a normal capillary blood glucose. If the patient is unwell with hyperglycaemic osmotic diuresis then you need to establish they are actually hyperglycaemic before treating them so again, you need to take a BGL before putting in an IV.
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Your experience with hypoglycemic patients not requiring IV glucose(dextrose) is similar to mine.

However, when I see a person who clinically appears dehydrated, starting an IV is usually one of the first things I do. I do not wait for diagnositcs to begin treating that. (drives the nurses nuts actually)

It is also my experience that most "diabetics" I have seen are actually hyperglycemic. They are often previously undiagnosed with type II diabtetes.
 
Clare said:
Using the cannula needle for glucometery is now severely frowned upon (at least locally) because the glucometer is not calibrated for venous blood...
Click to expand...

The literature supports the claim that "there exists a statistically significant difference between blood glucose measurements from arterial, venous, and interstitial samples".

The literature does not support the claim that "there exists a clinically significant difference between blood glucose measurements from arterial, venous, and interstitial samples".

As with any test you may get a falsely low, falsely normal, or falsely high reading; correlate results of tests with clinical judgement. Our SOP for any "critical value" is to get a second reading (preferably with a second device) from a second location/source.

Clare said:
...and it increases the risk of a needle stick.
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Sounds like crappy catheters to me. It'd take crushing them to open the barrels of our catheters to get to the needle. Some neighboring services use "safety" catheters that basically amount to a small metal tab over the needle tip, which are a needle stick waiting to happen (but cheap, and cheap is good right?).
 
Christopher said:
Sounds like crappy catheters to me. It'd take crushing them to open the barrels of our catheters to get to the needle. Some neighboring services use "safety" catheters that basically amount to a small metal tab over the needle tip, which are a needle stick waiting to happen (but cheap, and cheap is good right?).
Click to expand...

I assume you generally use the BD spring loaded catheters. I use those where I volunteer and use the "safety tip" you described with FDNY.

For actual usage, I prefer the safety tip because those catheters have a removable flash cap and are ultimately shorter allowing for a bit more ambidextrous usage.

Safety though, the spring loaded ones may as well be their own sharps container.

I would have to assume the safety tip is substantially cheaper... I have accidentally on a couple of occasions pressed the release button on the spring loaded ones prior to advancing my cath. What a mess that made...
 
NYMedic828 said:
I assume you generally use the BD spring loaded catheters. I use those where I volunteer and use the "safety tip" you described with FDNY.

For actual usage, I prefer the safety tip because those catheters have a removable flash cap and are ultimately shorter allowing for a bit more ambidextrous usage.

Safety though, the spring loaded ones may as well be their own sharps container.

I would have to assume the safety tip is substantially cheaper... I have accidentally on a couple of occasions pressed the release button on the spring loaded ones prior to advancing my cath. What a mess that made...
Click to expand...

No I hate the spring loaded BD ones, wearing glasses has saved me some blood splatters when those were used (especially large bore).

We use the Protectiv IV safety catheters, you manually advance the catheter by pushing on a tab which pulls the barrel over trochar (you can also pull back on the barrel while advancing to do it all in one fluid motion).
 
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Christopher said:
No I hate the spring loaded BD ones, wearing glasses has saved me some blood splatters when those were used (especially large bore).

We use the Protectiv IV safety catheters, you manually advance the catheter by pushing on a tab which pulls the barrel over trochar (you can also pull back on the barrel while advancing to do it all in one fluid motion).
Click to expand...

Those look pretty cool.

That's another good point on the spring loaded, the splashing. I'm not fond of automatic syringes for that reason either...

Any time I use either I pull the needle before pressing the button. The manufacturer recommends pressing it and having it remove itself...
 
Christopher said:
Sounds like crappy catheters to me. It'd take crushing them to open the barrels of our catheters to get to the needle. Some neighboring services use "safety" catheters that basically amount to a small metal tab over the needle tip, which are a needle stick waiting to happen (but cheap, and cheap is good right?).
Click to expand...

The Braun Introcaths that we use have a pretty large metal cap that ends up over the needle. While I think that the totally enclosed system is better, it would be pretty hard to stick yourself with these.
 
Tigger said:
The Braun Introcaths that we use have a pretty large metal cap that ends up over the needle. While I think that the totally enclosed system is better, it would be pretty hard to stick yourself with these.
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We use those during scope of practice exams because of how easy it is to deactivate the safety feature and not waste catheters. Just takes a little bit of finger nail available.
 
The protect iv ones are great. Need to cut a stylet and push it on the rear to use it on a glucometer though.
 
Veneficus said:
It is also my experience that most "diabetics" I have seen are actually hyperglycemic. They are often previously undiagnosed with type II diabtetes.
Click to expand...

Likewise, in my experience most diabetics are chronically hyperglycaemic, not acutely so from DKA or non ketone hyperglycaemia but just in general from very poor control of their diabetes.

The Maori and Pacific populations have rampant diabetes epidemic and most would only require dietary adjustment and maybe some oral antihypoglycaemics at the severe end of the sale but their control is very suboptimal so most have BGL which chronically high.
 
Fish said:
Round these here parts our Basics can check BGL, give ASA, Albuterol, Nitro, Epi 1:1000 IM(by drawing it up, not an EPI pen) Oral Glucose, and Oxygen. They give a good amount of life saving drugs.
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where is this?
 
EMT B said:
where is this?
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I don't know where he is, but in NC that is pretty standard (excepting IM epi is thru autoinjectors only). They used to refer to it as "expanded scope" but now we just call it "basic life support".
 
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