Purpose

• Blood glucose testing is used for persons with diabetes. The doctor uses the results to regulate the person’s drugs and diet.
• Capillary blood is obtained through a skin puncture. A drop of blood is collected. A fingertip is the most common site for skin punctures. This provides easy access and clothing is not removed.
• Inspect the puncture site for signs of trauma and skin breaks. Do not use swollen, bruised, cyanotic (bluish), scarred, or calloused sites. Such areas have poor blood flow. Because of calluses, the thumbs and index fingers are not good sites.
• Use the side toward the tip of the middle or ring finger. Do not use the center, fleshy part of the fingertip. The site has many nerve endings making punctures painful.
• Use a sterile, disposable lancet (short, pointed blade) to puncture the skin. The person feels a brief, sharp pinch. The lancet punctures but does not cut the skin. It is inside a protective cover. You do not touch the blade. Discard it into the sharps container after use.
• Using a reagent strip, a glucometer (glucose meter) measures blood glucose. You apply a blood drop to a reagent strip. The blood glucose level appears on the screen. Many types of glucometers are available. How fast results are displayed varies. Some take 5 seconds.
• Learn to use your agency’s device. Always follow the manufacturer’s instructions.

Equipment

Roll cursor over items to see labels. For the purposes of clearly depicting the equipment, a barrier is not shown in this photo. When providing care, a barrier should always be placed on the surface before placing the equipment.

Gloves

Warm wash cloth

Glucometer

Sterile lancet

Antiseptic wipes

Reagent strips (use the correct ones for the glucometer. Check the expiration date.)

2x2 gauze squares

Paper towels

Delegation

• Follow delegation guidelines. If blood glucose testing is delegated to you, make sure that:
  • Your state and agency allow you to perform the procedure.
  • The procedure is in your job description.
  • You have the necessary training.
  • You know how to use the agency’s equipment.
  • You review the procedure with the nurse.
  • The nurse is available to answer questions and to supervise you.
• If the conditions above are met, obtain this information from the nurse and care plan:
  • What sites to avoid for a skin puncture
  • When to collect and test the specimen—usually before meals
  • If the person receives drugs that affect blood clotting (Note: If yes, it may take a longer time to stop bleeding. Apply pressure until bleeding stops.)
  • What to report and record
  • When to report observations and the test result
  • What patient or resident concerns to report at once

Preparation

• Observe quality-of-life measures.
• Review the information under Delegation and Safety and Comfort.
• Practice hand hygiene.
• Collect the equipment.
• Read the manufacturer’s instructions for the lancet and glucometer.
• Disinfect the glucometer. Follow the manufacturer’s instructions for the disinfectant.
• Arrange your work area.
• Identify the person. Check the ID bracelet against the assignment sheet. Also call the person by name.
• Provide for privacy.
• Raise the bed for body mechanics. The far bed rail is up if used.

Safety

• Accurate results are key. Inaccurate results can harm the person. Follow these rules:
  • Make sure the glucometer was tested for accuracy. Check the testing log.
  • Enter a code or user ID if required by the glucometer. This is provided by the agency. Do not share your user ID with others.
  • Compare the code number on the reagent strip with the code number on the glucometer. The code numbers should be the same.
  • Scan the bar code on the bottle of reagent strips if needed.
  • Check the color of the reagent strips. Do not use discolored strips.
  • Check the expiration date on the reagent strips. Do not use outdated strips.
  • Report the result to the nurse at once, following agency policy.
• Follow the manufacturer’s instructions for the glucometer and disinfectant. Know how to use the equipment. Request training if needed.
• Use only the type of reagent strip specified by the manufacturer. Otherwise, you will get inaccurate results.
• Disinfect the glucometer after testing a patient or resident. Follow the manufacturer’s instructions for the disinfectant used. Always follow the time set by the manufacturer.
• Contact with blood is likely. Follow Standard Precautions and the Bloodborne Pathogen Standard.

Comfort

• The heel is used for skin punctures in infants who are not walking. The third finger (ring finger) is used for children.
• Older persons often have poor circulation in their fingers. To increase blood flow, apply a warm washcloth or wash the hands in warm water.

Follow-up Care

• Provide for comfort.
• Place the call light within reach.
• Lower the bed to its lowest position. Raise or lower bed rails. Follow the care plan.
• Unscreen the person.
• Discard used supplies.
• Complete a safety check of the room.
• Follow agency policy for soiled linen.
• Disinfect the glucometer. (Wear gloves.) Follow the manufacturer’s instructions. Return the device to its proper place.
• Remove and discard the gloves. Practice hand hygiene.

Reporting/Recording

• Report and record your observations, including:
  • The time the specimen was collected
  • The blood glucose test result
  • The site used for the skin puncture
  • The amount of bleeding at the skin puncture site
  • Any signs of a hematoma (a swelling that contains blood)
  • How the person tolerated the procedure
  • Complaints of pain at the skin puncture site
  • Other observations or patient or resident complaints