Blood Glucose Monitoring (Pediatric)
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Do not scrape blood onto the reagent strip or apply blood outside the intended specimen area because doing so may cause inaccurate results.
Hypoglycemia may result in diaphoresis, tremors, shakiness, paresthesia, pallor, dizziness, headache, and other neurologic signs.undefined#ref2">2 Hyperglycemia may result in polyuria, polydipsia, polyphagia, and lethargy.
Point-of-care (POC) blood glucose monitoring can be performed at any time on a portable machine, using a reagent (test) strip. POC measurement of blood glucose requires obtaining a drop of capillary blood by skin puncture using a single-use auto-disabling lancet and applying a drop of blood to a specially prepared chemical reagent strip. After the drop of blood is applied to the reagent strip, a reflectance meter provides a measurement of the blood glucose level.
Care must be taken to calibrate the device properly, use it per the manufacturer’s recommendations, minimize common and avoidable errors, and correlate the blood glucose results with a clinical assessment of the patient.
Blood glucose testing may be indicated for many conditions, including type 1 diabetes, type 2 diabetes, altered mental status, seizures, suspected hypoglycemia or hyperglycemia, and maintenance of tight glycemic control.1 Compared with an adult, a pediatric patient may have increased insulin sensitivity (related to physical growth and sexual maturity), more reliance on others to provide care (e.g., caregiver, teacher, daycare staff), and a limited ability to recognize and respond to hypoglycemic symptoms.1
The American Diabetes Association recommends individualized blood sugar level targets and a stepwise approach to lowering blood sugar to prevent hypoglycemia.1 Blood glucose targets for pediatric patients with type 1 diabetes before exercise are 90 to 250 mg/dl.1 Pediatric patients with diabetes have individualized glycemic targets with recommendations for A1C levels every 3 months with a goal of less than 7%.1
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Rationale: Delays may increase the patient’s anxiety level. Expired test strips may cause inaccurate results; therefore, the date a strip should be opened and the strip’s expiration date should be documented. Strips must be stored in the original packaging and tightly sealed.
Ensure that the device is not soiled. Soiling may affect the results.
Rationale: Data from a POC device may be downloaded to the laboratory for tracking and reporting purposes and entered in the electronic health record. Specimens are tracked with the patient’s unique identifier. Operator-identifying information may be used to reflect quality-control training or as a signature in the electronic health record.
Rationale: Hand hygiene promotes vasodilation at the testing site and helps prevent an inaccurate blood glucose reading resulting from a contaminated puncture site.
Rotate sites to minimize discomfort and ensure that there is adequate subcutaneous tissue at the selected site (the little finger may not have enough subcutaneous tissue). Do not use the heel of an infant who can walk.
Rationale: Poor perfusion increases the likelihood of an inaccurate glucose test result. If needed, consider warming the site.
Rationale: Failure to cleanse the finger and allow it to dry can lead to errors in POC glucose measurements.
Rationale: Use of a single-use auto-disabling lancet reduces the possibility of accidental needlesticks and prevents exposure to blood-borne pathogens.
Rationale: Gently squeezing the finger pools blood to the fingertip and promotes blood flow.
Avoid squeezing the finger excessively, which can force plasma from the tissue into the drop of blood and cause an inaccurate result.
Rationale: The alcohol used earlier to disinfect the skin may have contaminated the first droplet of blood, diluting its glucose level, so using the first droplet for testing may provide a less accurate result than using the second droplet.4 Newer meters do not require the first drop to be wiped away. However, in an emergency, this difference may not be clinically relevant.4
Always follow the manufacturer’s instructions because all meters are slightly different.
Ensure that a sufficient sample is on the test strip to obtain accurate results. The sample must be tested immediately to avoid clotting or glycolysis, which affects the accuracy of the results.
Do not use an adhesive bandage if the patient is likely to insert fingers into the mouth because of the risk of ingestion or choking. Apply firm pressure until the bleeding stops.
Consider drawing blood for glucose to be analyzed by the laboratory if the results are abnormal.
At the completion of the procedure, ensure that all choking hazards (e.g., alcohol wipe, lancet cap) are removed from the patient’s linens and placed in the appropriate receptacle.
Rationale: Changes in the patient’s condition may indicate complications from the procedure.
Reportable conditions: Agitation resulting in an inability to obtain blood, signs of hypoglycemia or hyperglycemia, ongoing bleeding from site
Reportable conditions: Signs and symptoms of local infection at the puncture site (e.g., redness, swelling, drainage)
Rationale: A significant change in results without a correlating change in the patient’s condition may indicate that the device is not functioning correctly.
Reportable condition: Abnormal results that do not correlate with the patient’s clinical condition
Boyce, E. (2020). Knowledge is power? How continuous blood glucose monitoring systems are changing the management of type 1 diabetes mellitus. Pediatric Nursing, 46(4), 179-183, 195.
*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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