Glucometry

[EpiEMS]

What kind of method do you typically use to sanitize a site prior to obtaining a capillary blood sample for glucometry? Alcohol swab?

 

[E tank]

Unless visibly soiled, nothing most times.

 

[EpiEMS]

Unless visibly soiled, nothing most times.

I think that's the most common practice, myself - I just wanted to vet this by some folks smarter than me (such as yourself!). I have to imagine that there is a relatively low risk of complications for this, right? Except, perhaps, in an immunocompromised patient?

 

[EpiEMS]

@Brandon O Any thoughts? Would be curious to hear your opinion.

 

[E tank]

I think that's the most common practice, myself - I just wanted to vet this by some folks smarter than me (such as yourself!). I have to imagine that there is a relatively low risk of complications for this, right? Except, perhaps, in an immunocompromised patient?

Don't confuse training and experience with brains, Bro!

That said. sure, more care for that kind of thing isn't a bad idea, but at the end of the day, those folks are far more likely to get a UTI than an infection from a sterile finger prick. We drag tubes through the filthy orifice of the mouth into the lungs without a second thought as well.

 

[DesertMedic66]

I’ve always used an alcohol prep pad and then waited for the area to dry.

 

[Brandon O]

@Brandon O Any thoughts? Would be curious to hear your opinion.

Uhh. I think a quick alcohol swab is probably the standard of care.

I grant that you would probably have to conduct a surveillance study of 100,000s to try and show harm from not doing this, and if in some kind of austere circumstances or in extremis it's probably perfectly okay to skip it (cf. less than entirely sterile practice in accessing central lines during codes). But if you went to the doctor and they didn't wipe before sticking you for your flu shot, wouldn't you be a little wary?

Risk is probably higher in certain folks (neutropenic, etc), and especially certain circumstances. My arm/hand is probably fairly clean except normal skin flora right now. But some dudes, especially in prehospital medicine, are probably walking around with tetanus and dog poop on them.

 

[VentMonkey]

Unless my patient is acutely hypoglycemic, I get my BGL's from the IV site prior to attaching my lock. If they're in need of a BGL right then and there, a swab plain and simple.

What are you getting at, Ep? Why would we need more than what we have? In the grand scheme, a few numbers off seems trivial when your priorities aren't with worrying about an alcohol swap vs. a Betadine etc.

Except, perhaps, in an immunocompromised patient?

I would think most immunocompromised patients are at greater risk on the whole. None of what we're doing to them in the field, on a stretcher, and in the back of the ambulance is sufficient enough to protect them.

Am I saying to completely disregard proper sanitary techniques with these folks? No, I'm just saying that they most likely will not benefit, or be at more risk from anything that we do in the short time that we have with them. Isolation rooms, and the full precautions taken at the hospital may help more.

 

[E tank]

Sure, swab it if it makes you feel better, but if a skin prick for a BG carried any significant risk for an infection, then there'd be a pandemic of infections from kitchen knife accidents and bloody knuckles from changing spark plugs.

 

[DrParasite]

Unless my patient is acutely hypoglycemic, I get my BGL's from the IV site prior to attaching my lock. If they're in need of a BGL right then and there, a swab plain and simple.

normally i would too, but someone told me capillary blood was more accurate...

That said. sure, more care for that kind of thing isn't a bad idea, but at the end of the day, those folks are far more likely to get a UTI than an infection from a sterile finger prick. We drag tubes through the filthy orifice of the mouth into the lungs without a second thought as well.

well, typically when you are tubing someone, infection isn't high on the list of priorities.....

and it is a sterile finger lancet and a semi-sterile bandaid...

 

[VentMonkey]

normally i would too, but someone told me capillary blood was more accurate...

I've heard the same, but outside of what's taught in the classroom, i.e., real life we all know what needs to be done, and when.

Again, practicality leads me to a capillary check for the combative diabetic anyhow, but the rest can almost always wait, and patient care, or an arbitrary number will hardly suffer.

typically when you are tubing someone, infection isn't high on the list of priorities...

Sadly, this could not be closer to the truth. Now, if you want to discuss a high-risk procedure for an at-risk immuncompromised cancer patient on mid-chemo who needs an aggressively protected airway, well...

 

[Summit]

More than the likelihood of pathogens is the likelihood that there is something on the skin that will skew the test result.

Also, worth noting that multi-strip vials are likely to be contaminated, at least in the hospital environment: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3879749/
But I'm not sure about infections resulting from that...

 

[Tigger]

well, typically when you are tubing someone, infection isn't high on the list of priorities.....

It isn't? Yea, I definitely don't care about infection in critically ill patients. Seriously, did you go to paramedic school? That's some pretty basic airway management knowledge. Doesn't need to be a sterile procedure but care does need to be taken.

As to the OP, I think it is worth wiping the finger. A nearby service recently transported a hyperglycemic patient with presumed new onset diabetes following a syncopal event. Turns out he had trace amounts of syrup on his hands.

 

[Brandon O]

Sure, swab it if it makes you feel better, but if a skin prick for a BG carried any significant risk for an infection, then there'd be a pandemic of infections from kitchen knife accidents and bloody knuckles from changing spark plugs.

People do indeed get cellulitis and the like from scrapes and lacerations.

This is a bit of a weird discussion. Are we in a dystopian future without alcohol swabs? Are we bored enough that we're curious how much Zen-like minimalism our care can embody? Lots of the stuff we do has relatively small potential benefit or is a safeguard against relatively small risks. If they're cheap and easy we do them anyway. Should we stop mopping the ICU floors? Stop giving old ladies pillows? Stop putting dressings on people's cuts? What are we trying achieve here?

 

[EpiEMS]

This is a bit of a weird discussion. Are we in a dystopian future without alcohol swabs?

What are you getting at, Ep? Why would we need more than what we have? In the grand scheme, a few numbers off seems trivial when your priorities aren't with worrying about an alcohol swap vs. a Betadine etc.

Nothing too crazy, I promise! Just trying to get a consensus from the folks around here what the standard of care pre-lancet - alcohol swab, benzalkonium chloride wipes, plain ol' gauze. I had noted that there is a lot of variation in what I do and what I see other providers do - some colleagues don't wipe at all, some only wipe if visibly soiled (thanks, @E tank for that phrasing, I like it), etc.

As to the OP, I think it is worth wiping the finger. A nearby service recently transported a hyperglycemic patient with presumed new onset diabetes following a syncopal event. Turns out he had trace amounts of syrup on his hands.

Thought this would be just a Vermont/NH problem - I guess not?

 

[E tank]

People do indeed get cellulitis and the like from scrapes and lacerations.

This is a bit of a weird discussion. Are we in a dystopian future without alcohol swabs? Are we bored enough that we're curious how much Zen-like minimalism our care can embody? Lots of the stuff we do has relatively small potential benefit or is a safeguard against relatively small risks. If they're cheap and easy we do them anyway. Should we stop mopping the ICU floors? Stop giving old ladies pillows? Stop putting dressings on people's cuts? What are we trying achieve here?

Conversations about the most mundane things we do are often some of the most interesting, like this is shaping up to be...but like I say, if not swabbing goes against the grain, swab...but the reality is that the greatest benefit is for removing potential surface contaminates (like syrup ) not to avoid some infection. And wait for a minute or two for the alcohol to dry because the wipe can throw off the reading too. Most of my patients are asleep when I get a BG and I avoid the contaminant issue by taking it from an ear lobe.

I'll bet most diabetics only wash their hands less than half the time, let alone not ever use alcohol. I'm in favor of doing it or not doing it but with a strong rationale either way.

 

[Brandon O]

I'll bet most diabetics only wash their hands less than half the time, let alone not ever use alcohol. I'm in favor of doing it or not doing it with a strong rationale either way.

I mean, a few days ago popped my own ganglion cyst with a needle, but I wouldn't go try it on a patient. (Incidentally: swabbed with alcohol.) Bit of a different standard. The only person who's gonna yell at you for doing dumb stuff to yourself is your mom.

 

[E tank]

I mean, a few days ago popped my own ganglion cyst with a needle, but I wouldn't go try it on a patient. (Incidentally: swabbed with alcohol.) Bit of a different standard. The only person who's gonna yell at you for doing dumb stuff to yourself is your mom.

Should have used a hard cover dictionary...no need for an alcohol swab.

 

[Brandon O]

Should have used a hard cover dictionary

A what?

 

[E tank]

A what?

One common and traditional method of treatment for a ganglion cyst was to strike the lump with a large and heavy book, causing the cyst to rupture and drain into the surrounding tissues. Historically, a Bible was the largest or only book in any given household, and often was employed for this treatment. This led to the former nickname of "Bible bumps" or "Gideon's disease" for these cysts.[2][23]