critically ill
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Can anyone share with me how you’re handling the use of glucometers with critically ill patients?
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I tried to restrict the usage of the waived glucometers in the ICU and other areas of critical care patients. It was not successful.
The way I saw it there are 3 options:
1. Stop using the glucometer on critical patients entirely. (You will get into a debate on what is "a critical patient".)
2 . Have the staff perform a venipuncture and test that sample using the glucometer.
3. Place a comment on all glucometer results with a disclaimer not to use the glucometer on critical patients and that an alternate methodology is required/recommend. This is what we ended up doing.
Since the definition of "critically ill" patient has proven to be very broad, at our organization we achieved an interdepartmental consensus (lab, nurses, physicians) to apply the definition of perfusion when performing waived glucose meter testing. This practice will encourage operators to use their critical thinking prior to collect blood on patients undergoing different treatment and medical conditions. Basically, we instructed nurses and providers to assess the patient's peripheral perfusion prior to collect the sample and then proceed to collect according to the manufacturer specifications. Capillary samples are not discouraged in any hospital setting as long as the patient's peripheral perfusion is okay.
As shown below, we included these considerations regarding the importance of the peripheral perfusion in our SOP using the recommendations of the manufacturer:
Specimen:
Fresh whole blood-capillary samples as long as oxygen saturation, patient color and temperature do not indicate poor peripheral perfusion, venous or arterial whole blood may be used. Neonates use fresh whole blood-capillary samples as long as oxygen saturation, patient color and temperature do not indicate poor peripheral perfusion or arterial whole blood.
Capillary Perfusion Requirements
Proper perfusion must be determined before capillary testing is initiated. Caution should be exercised with capillary whole blood due to potential pre-analytical variability in capillary specimen collection. A capillary whole blood specimen relies upon adequate, non-compromised capillary blood flow. The capillary whole blood specimen glucose result may not always be the same as an arterial or a venous whole blood glucose result, especially when a patient's condition is rapidly changing.
If a capillary whole blood glucose result is not consistent with a patient's clinical signs and symptoms, glucose testing should be repeated with either an arterial or venous specimen on the glucometer or main lab.
We use the Nova Bio glucometers and they are cleared for use on critically ill patients.
https://www.novabio.us/press/07.16.18.php