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Obtaining a Blood Glucose Level by Finger Stick

Overview: To measure the amount of glucose in the blood. A drop of capillary blood is obtained by skin puncture on the finger by a single lancet or a device that holds a lancet and then is applied to a reagent test strip that is placed in a glucose monitor to be read.

Preparation
● Sterile asepsis and standard precautions are used throughout the procedure.
● Make sure enough blood is obtained to ensure accurate test results.
● Assess patient/caregiver understanding about procedure and provide teaching.

Special Considerations
• Patients who have had repeated sticks over time may have calloused fingers.
• Blood sugar level should be checked before meals or as ordered to determine insulin dosages.
• Hold the hand in a dependent position before the stick to increase blood flow to the area.

Elderly Patient
• Possible visual impairment reduces ability to read meter accurately; assistance with sticks may be necessary.
• May be necessary to warm fingertips to produce vasodilation to obtain blood sample.

Pediatric Patient
• Heel and great-toe sticks can be used, especially on infants; warming the area with a warm cloth will increase blood flow.
• Allow children to choose puncture site if feasible, and incorporate use of play therapy.

Expected Outcomes
● Normal blood glucose level
● No tissue damage or infection to puncture site
● Adequate amount of blood obtained to get accurate results
● Patient is educated about proper technique and normal blood glucose level

Equipments
Sterile single lancet or automatic lancet
Capillary tube
Glucose reagent test strip
Antiseptic swab
Cotton ball or gauze pad
Soap and water
Clean gloves
Glucose meter
Biohazard bag
Sharps container

Implementation
1. Check prescriber’s order for frequency of glucose status. Identify patient and explain procedure; provide privacy.
Rationale: Frequency is based on patient’s glucose status; ensures accurate testing; enhances cooperation and understanding; allays embarrassment.

2. Gather equipment, and wash hands.
Rationale: Organization promotes successful and time-efficient collection; decreases spread of microorganisms.

3. Don clean gloves.
Rationale: Provides protective barrier.

4. Assess area for puncture site.
Rationale: The most vascular areas with fewer nerve endings are the outer aspect of heel and toes, sides of fingers. Heels and toes are more frequently used for infants.

5. Choose site for finger stick and massage toward puncture site.
Rationale: Increases blood flow to site.

6. Cleanse with soap and water or alcohol swab; allow to dry.
Rationale: Warm water increases blood flow. Reduces bacteria on skin surface from invading puncture site; drying reduces sting of puncture and supports antimicrobial effect.

7. Uncover lancet or activate the automated lancet twisting.
Rationale: Preparation promotes success

8. Place automated lancet firmly against side of finger, and gently press the activating
button. Hold the single lancet perpendicular to site.
Rationale: Ensures correct position.

9. Wipe away the first drop of blood with gauze or cotton ball.
Rationale: Contains more serum, which can dilute blood specimen and alter results.

10. Stroke from base of finger, toe, or heel to puncture site.Do not squeeze puncture site.
Rationale: Stroking in a massaging motion will increase blood flow; squeezing will increase serum and dilute specimen.

11. Fill capillary tube with blood by placing tip of tube at base of drop of blood; or if using
reagent strip, place next to blood drop, making sure that enough blood is absorbed by the strip for accurate results.
Rationale: Ensures accuracy of testing.

12. Apply pressure to puncture site for 15 to 30 seconds with gauze to stop bleeding.
Rationale: Direct pressure reduces bleeding.

13. If using a glucose meter, allow blood to stay on strip for specified time and then place in meter for digital readout.
Rationale: Ensures accurate testing.

14. Discard used equipment into biohazard bags or sharps container, remove gloves and wash hands.
Rationale: Decreases spread of blood-borne pathogens.

Evaluation and Follow up Activities
● Compare patient’s value with normal lab values, and inform prescriber of abnormal findings
● Inspect puncture site for further bleeding
● Administer drug therapy, if ordered, for abnormal glucose level
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