LESSON 4.

11
Capillary Blood Glucose Test
(CBG)

OVERVIEW

BLOOD GLUCOSE MONITORING is a

cornerstone of diabetes management.
Modern blood glucose meters have now
been developed to also test a blood
sample for ketones. Before undertaking
either a blood or urine test you must
ensure that you have received training
and are competent to use the equipment.

Nurses play a key role in both performing regular and accurate CBG monitoring and
in teaching people about its use.
With a glucometer, lancet and CBG strips in hand, we, nurses may be able to
estimate the amount of glucose the patient has in his blood in seconds. The CBG result
will serve as a basis for adjusting treatment and medications. Like for example, whether
it is advisable to give insulin injections to the patient and on how much (in units) should
be given to the patient. Mostly, CBG results are relayed to the physician assigned or the
resident on duty for management.
For a safe use of blood glucose monitoring equipment, the nurse should be able
to perform the test according to manufacturer’s instructions and guidelines. It is
important to a nurse to familiarize himself/herself with the instructions for using the
blood glucose testing device in their work setting.
 This module will guide you in the proper steps of getting blood sample of your
patients.

OBJECTIVES

At the end of this module, you will be able to:

1. Define Capillary Blood Glucose Test/Monitoring.
2. State the purposes of capillary blood glucose testing.
3. Enumerate the equipment needed.
4. Enumerate steps in CBG testing procedures .
5. Understand the normal reference values of blood glucose.

LEARNING EXPERIENCE

A blood sugar test is a procedure that measures the amount of sugar, or

glucose, in your blood.
Blood glucose monitoring - is the use of a glucose meter for testing the
concentration of glucose in the blood (glycemia). Particularly important in diabetes
management, a blood glucose test is typically performed by piercing the skin (typically,
on the finger) to draw blood, then applying the blood to a chemically active disposable
'test-strip'.

Purposes:
The main purpose of obtaining a capillary blood specimen to measure blood glucose
is:

1. To determine or monitor blood sugar levels of clients at risk for

hyperglycemia or hypoglycemia.
2. To promote blood glucose regulation by the client.
3. To evaluate the effectiveness of insulin administration. Monitor the effect
of diabetes medications on blood sugar levels.
4. Learn how diet and exercise affect blood sugar levels.
5. Understand how other factors, such as illness or stress, affect blood sugar
levels.
• The doctor informs the patient on how often to check their blood sugar levels.
The frequency of testing usually depends on the type of diabetes they have and
their treatment plan.

➢ Blood Glucose Meter- is an electronic device for measuring the blood

glucose level.
➢ Lancet- used to prick the skin
➢ Thin plastic strips -that have a circuit in them which measures one's
blood sugar level with the help of a glucometer. The circuit of the test
strip is made of a very thin layer of gold that is formed into an elaborate
pattern.

• A relatively small drop of blood is placed on a disposable test strip which

interfaces with a digital meter.
• Within several seconds, the level of blood glucose will be shown on the digital
display.
• Needing only a small drop of blood for the meter means that the time and effort
required for testing is reduced and the compliance of diabetic people to their
testing regimens is improved. Although the cost of using blood glucose meters
seems high, it is believed to be a cost benefit relative to the avoi ded medical
costs of the complications of diabetes.

Types of Blood Sugar Tests

You can take a blood sugar test two ways. People who are monitoring or managing
their diabetes prick their finger using a glucometer for daily testing. The other
method is drawing blood.

1. Fasting blood sugar (FBS) test. Measures your blood sugar levels.
2. Glycosylated hemoglobin, also called a HbA1C test. The results of
this test reflect your blood sugar levels over the previous 90 days. The
results will show if you have prediabetes or diabetes and can monitor how
your diabetes is controlled.
3. Oral Glucose Tolerance Test (OGTT)- a standard dose of glucose is
ingested by mouth and blood levels are checked two hours later.

• The patient is instructed not to restrict carbohydrate intake in the

days or weeks before the test.
• Usually the OGTT is performed in the morning as glucose tolerance
can exhibit a diurnal rhythm with a significant decrease in the
 afternoon. The patient is instructed to fast (water is allowed) for 8–
12 hours prior to the tests. Medication such as large doses of
salicylates, diuretics, anticonvulsants, and oral contraceptives affect
the glucose tolerance test.

Blood Glucose Meter

IDEAL BLOOD SUGAR LEVEL

Type of Test Ideal Blood Sugar Level

Simple Blood Sugar Level Test 80-100 mg/dl
Fasting Blood Sugar Level Test 80-100mg/dl
Oral Glucose Tolerance Test <140 mg/dl
HbAIC 4% -6%

BLOOD SUGAR LEVEL CHART

Fasting Just Ate 3 Hours after Eating

Normal 80-100 mg/dl 170-200 mg/dl 120-140 mg/dl
Pre-Diabetic 101-125 mg/dl 190-230 mg/dl 140-160 mg/dl
Diabetic 126+mg/dl 220-300 mg/dl 200+ mg/dl
 STEPS IN CAPILLARY BLOOD GLUCOSE MONITORING

ASSESSMENT
1. Assess the client’s skin at the puncture site
2. Checks the client’s record for medications that might prolong bleeding
3. Determine the client’s self-care abilities that might affect accuracy of test result,
such as visual impairment and finger dexterity.
PLANNING
4. Review doctor’s order & determine if test requires special timing ( pre/post
meal)
5. Review manufacturer’s instruction for meter usage
6. Wash hands
7. Assemble equipment at the bedside:
a. Glucometer
b. Reagent strip compatible with the meter
c. Sterile lancet
d. Lancet holder/injector
e. Antiseptic swab
f. Dry cotton balls
g. Disposable gloves
IMPLEMENTATION
8. Identify the client.
➢ Verify client’s identity
9. Introduce yourself
10. Explain to the patient what you are going to do, why it is necessary and how the
client can cooperate.
11. Perform hand hygiene, and observe other appropriate infection control
procedures.
12. Position client comfortably (semi-Fowler’s or upright in a chair)
13. Calibrate the meter following manufacturer’s instruction
14. Remove a reagent strip from the container
15. Insert the strip into the meter (this usually turns the meter on)
16. Apply disposable gloves
17. Select appropriate puncture site, wipe it with cotton ball w/ alcohol
➢ The side of an adult’s finger. Avoid sites beside bone
➢ (if earlobe is used, rub it gently with a small piece of gauze.
Rationale: These actions will increase the blood flow to the area.
18. Perform skin puncture
19. Wipe away first drop of blood with dry CB
20. Gently squeeze the site to produce large drop of blood
 21. Transfer the drop of blood to the strip & cover the entire test pad without
smearing
22. Set the meter side and wait for the appropriate time for the result to display on
the meter
23. Apply pressure on the puncture site
24. Read the meter for results
25. Remove the strip from the meter (this usually turns the meter off) & properly
dispose of strip, CB and lancet.
26. Remove gloves & place in paper receptacle
27. Wash hands
28. Record test results on the chart
29. Notify physician or qualified practitioner of result.

KEY POINTS

10 Ways to Master Your Blood Glucose Meter

1. Wash your hands.
• Some residue from eating a piece of fruit or perhaps some lotion on your
hands can affect the test.
2. Use alcohol
• Use it in place of hand washing to clean the finger, removing any residue
before you test. Alcohol-drenched swabs or hand sanitizer will work. But
there's no need to use alcohol after washing your hands.
3. Dry your hands.
 • Excess water and rubbing alcohol can dilute your blood sample, affecting
your reading.
4. Use a second drop.
• The second drop of blood, is less likely to be contaminated.
5. Test on your finger.
• The blood circulation to the rest of the arm takes longer than it does to the
fingertips.
6. Don’t squeeze
• It can affect the blood sample. Sometimes you'll get a little more interstitial
fluid [the substance just below the skin] than the capillary blood. Washing
with warm water will increase blood flow to the fingers, making it easier to
get blood
7. Get the code.
• Make sure your meter has the code from your current test strip bottle.
8. Use control solution.
• Test how well the meter is working with its strips by using the meter's
control solution. If you can't find your meter's brand of solution at the
pharmacy, ask your pharmacist to order it.
9. Use the right test strips
• Don’t use strips that are outdated.
10. Protect your supplies.
• Don't store meter and strips where it's too hot, too cold, too humid, or too
high in altitude (meters and strips should perform in pressurized airplanes,
though). Once the meter is returned to a normal temperature, humidity, or
altitude, however, it should be back to normal.

REFERENCES

• Kozier and Erb’s Fundamentals of Nursing, 8th ed., Volume II

• USI -RLE Performance Skills Handbook BSN 1-4
• Brunner & Suddarth’s (14th Edition 2017) Medical-Surgical Nursing
(Management of patient with Gastrointestinal Disease
• [Link]
glucose-monitoring/
• [Link]
THANK YOU!!
CONGRATULATIOS FOR FINISHING THE MODULE!