Endocrine: Blood glucose testing (for nursing assistant training)

Blood glucose testing is a procedure used to measure a client's blood glucose level using a small portable device called a glucometer. It requires a drop of capillary blood most commonly obtained from a finger and takes a few seconds to show results. This is especially important for people with diabetes mellitus type 1 and type 2 as well as gestational diabetes. Regular blood glucose testing evaluates effects of medications, diet, and exercise to keep blood glucose levels under control. This will prevent future complications like vision impairment, kidney and nerve damage, and cardiovascular disease.

As a nursing assistant, you might be asked to help test a client’s blood glucose, so here are some general considerations. First, check to see if the procedure is within your authorized duties and follow facility policies and/or protocols. Also, make sure to familiarize yourself with the type of glucose meter used at your facility. Next, the clients might have thickened, damaged, edematous, or inflamed areas of skin, so you should ask the nurse to determine the most appropriate site for a puncture. Some need testing only once a day, while others might need it more than once and at specific times, like before meals or drug administration. Clients who have coagulation disorders or take drugs that can alter bleeding time might take longer to stop the bleeding after the procedure. Be sure to check with the nurse and the plan of care to determine how often a client needs their blood glucose checked and what’s the normal range for the client.

Now, before you perform blood glucose testing, gather the necessary supplies including gloves, lancet device, antiseptic swab, washcloth, cotton or gauze, and glucometer and strips; make sure you read the instructions on how to use a glucometer because some steps might differ depending on a manufacturer. For the procedure, make sure your client is comfortably sitting or lying in bed in the semi-Fowler position. If they’re in bed, lock the wheels, raise it to a height that’s comfortable to work with, and lower the side rails. Take a new reagent strip and place it in the glucometer to activate it. Make sure that the reagent strip is not expired or discolored and that it’s the right kind of strip for the glucometer. Next, you have to prepare the lancet device, which could be one use or multi-use. In general, you’ll need to remove the cap of the device and adjust the depth of the puncture depending on the thickness of the client’s skin. Put on gloves before looking for the best place to puncture. You should avoid the fingertips because they usually have thicker skin. Also avoid any calloused or bruised areas and puncture sites of previous tests. An ideal spot would be the sides of a finger. Warm up the finger with a warm washcloth and hold it below the client’s heart level to increase blood flow to the finger. Clean the area with an antiseptic swab, and let it dry before you place the tip of the lancet device on the chosen site, hold it steady, and press the button to release the lancet and puncture the skin. After you remove the device, you should see a drop of blood forming. Press gently on the skin next to the puncture site to squeeze out more blood if you need to. Now, take the glucometer with a strip and place the tip of the strip to the blood drop. The blood should be automatically drawn in and the glucometer will inform you when enough sample is collected. While you wait for the results to appear on the screen, you should put a cotton ball or gauze square on the punctured site and keep pressure until the bleeding stops. Read the result and share it with the client. After you’re done, turn off the glucometer; discard the strip, cotton or gauze, gloves; and throw away the lancet in the sharps container. Return the other equipment for proper storage. Finally, assist the client into a comfortable position, raise the side rails, and lower the bed.