This document provides guidelines for pre-hospital blood glucose measurement using glucometers. It describes indications for testing including altered mental status and signs of hypo- or hyperglycemia. The procedures section outlines best practices for universal precautions, using the glucometer and disposal. Steps for performing the finger-stick and troubleshooting potential issues are explained. Normal and abnormal glucose readings are defined, along with maintenance, calibration and documentation requirements.
This document provides guidelines for pre-hospital blood glucose measurement using glucometers. It describes indications for testing including altered mental status and signs of hypo- or hyperglycemia. The procedures section outlines best practices for universal precautions, using the glucometer and disposal. Steps for performing the finger-stick and troubleshooting potential issues are explained. Normal and abnormal glucose readings are defined, along with maintenance, calibration and documentation requirements.
This document provides guidelines for pre-hospital blood glucose measurement using glucometers. It describes indications for testing including altered mental status and signs of hypo- or hyperglycemia. The procedures section outlines best practices for universal precautions, using the glucometer and disposal. Steps for performing the finger-stick and troubleshooting potential issues are explained. Normal and abnormal glucose readings are defined, along with maintenance, calibration and documentation requirements.
Indications for BG Measuring Signs and Symptoms consistent with Acute Stroke Altered Mental Status Hypoglycemia Blood glucose level of 80 or less Most calls for diabetic emergency Signs and symptoms: Hunger Nervousness or shakiness Perspiration Dizziness or light-headedness Sleepiness or weakness Confusion Difficulty speaking Unresponsiveness Hyperglycemia Blood glucose level of 120 or higher Most common but least calls to EMS Signs and symptoms: Frequent urination Increased thirst May lead to Ketoacidosis Procedures Careful attention to BSI & safety Insert Glucometer test strip into device Select Finger Massage blood into distal end Clean finger with alcohol & allow to dry Use lancet or Auto-lancet device Wipe first drop of blood off Apply drop of blood onto test strip and follow individual glucometer instructions Dispose of sharps and soiled supplies Step 1 Step 2 Get out a lancet (prepare the lancet as needed) Locate the place for the finger-stick: Choose a finger… any finger (usually not the thumb) Use the side of the pad of the finger, between the knuckle and the finger tip
If the patient has callused fingers or thick skin it maybe
difficult to get blood, try to find a place with “ thinner” skin As EMT providers we are not authorized to use alternate site testing (IV starts, toes, arms, etc.) if fingers are not available, medical control must be contacted for orders to test an alternate site Step 3 Clean the finger tip that you will be performing the finger-stick on with an alcohol prep pad
Be sure the area dries completely, use a sterile
gauze pad to dry the area if needed Note: un-dried alcohol may skew the reading so make sure it dries completely Step 4 Lance the finger with the lancet Lower the hand and squeeze the finger gently (if needed) to assist with producing a small droplet of blood Step 5 Step 6
When the blood glucose reading appears,
document it immediately on the ePCR Ex: “blood glucose 100 at 13:57” Continue to treat the patient per Maryland Medical Protocol Troubleshooting What could go wrong when using the glucometer? Dead batteries Always carry spare batteries in the ambulance and check the unit regularly “Error” reading appears Insert a new strip, re-test, check batteries Unable to get enough blood from finger-stick Lance a different finger, if skin is cold-try warming with a hot pack wrapped in a towel Inaccurate reading Why do you think it was inaccurate? Was the alcohol dried? Was the strip contaminated? Try re-testing. Results Normal blood glucose range is typically 80-120
If it reads “ LO” = lower than 20 mg/dl
If it reads “ HI” = higher than 500 mg/dl
If it reads “ E-3” = may be too low to read
If it reads “ E-4” = may be too high to read
Any of these readings could also indicate that there is a
problem with the test strip. Remember to treat the patient and not the number on the meter. Maintenance & Calibration Techniques Frequency Batteries Care & Storage Device Test strips Documentation