Glucometer Use

People with diabetes require regular monitoring of their blood glucose to help them achieve
as close to normal blood glucose levels as possible for as much of the time as possible. The
benefits of maintaining a blood glucose level that is consistently within the range of 4-7
mmol/L will reduce the short-term, potentially life-threatening complications
of hypoglycemia as well as the occurrence rate and severity of the long-term complications
of hyperglycemia.

Patients in the hospital setting are likely to have inconsistent blood glucose levels as they are
affected by changes in diet and lifestyle, surgical procedures, and the stress of being in a
hospital. The physician will prescribe how regularly the blood glucose should be monitored.
In acute situations, a sliding-scale treatment for insulin will be individually prescribed per
patient. The medication administration record (MAR) or sliding scale will provide directions
for the amount of medication to be given based on the blood glucose reading.

It is usually the responsibility of the nurse to perform blood glucose readings. As with any
clinical procedure, ensure that you understand the patient’s condition, the reason for the
test, and the possible outcomes of the procedure. Prior to performing a blood glucose test,
ensure that you have read and understood the manufacturer’s instructions and your
agency’s policy for the blood glucose monitoring machines (see Figure 9.1) used in your
clinical setting, as these vary. It is also important that you determine the patient’s
understanding of the procedure and the purpose for monitoring blood glucose level. Before
you begin, you should also determine if there are any conditions present that could
affect the reading. For example, is the patient fasting? Has the patient just had a meal? Is the
patient on any medications that could affect the reading (e.g., anticoagulants)? In these
situations, draw on your knowledge and understanding of diabetes, the medication you are
administering, the uniqueness of your patient, and the clinical context. Use your knowledge
and critical thinking to make a clinical judgment.
Figure 9.1 A blood glucose monitoring machine with cotton balls, lancets, and reagent strips
Inspect the area of skin that will be used as the puncture site and ask the patient if they are
in agreement with the site you have identified to use for the skin puncture. Your patient may
have a preference for the puncture site. For example, some patients prefer not to use a
specific finger for the skin puncture. Or a particular site may be contraindicated. For
example, you shouldn’t use the hand on the same side as a mastectomy.

Patients who do their own blood glucose testing at home may prefer to handle the skin-
puncturing device themselves and continue self-testing while they are in the hospital.

Checklist 77 outlines the steps for taking a skin-puncture blood sample and using a blood
glucose monitor (glucometer) to measure a patient’s blood glucose level.

Checklist 77: Blood Glucose Monitoring

Disclaimer: Always review and follow your hospital policy regarding this specific skill.

Safety considerations:
 Perform hand hygiene.
 Check room for additional precautions.
 Introduce yourself to patient.
 Confirm patient ID using two patient identifiers (e.g., name and date of birth).
 Check allergy band for any allergies.
 Complete necessary focused assessments and/or vital signs and document on MAR.
 Provide patient education as necessary.

Steps Additional Information

1. Review the patient’s medical history for A thorough knowledge of the patient’s medical
diabetes type, medications, and/or history is important even when the test
anticoagulant therapy. performed is a relatively simple procedure.
Anticoagulant therapy may result in prolonged
bleeding at the skin-puncture site and require
pressure to the site.

2. Determine if the test requires special Blood glucose levels are affected by diet, and
timing; for example, before or after meals. the test may be scheduled at very specific
Blood glucose monitoring is usually done intervals.
prior to meals and the administration of
Diet and medication orders are based on the
antidiabetic medications.
assumption that the test results are accurate.

3. Gather equipment needed: Having equipment prepared and available

promotes organization, safety, and timeliness.
 Disposable latex-free gloves
 Alcohol swab
 Lancet or automatic lancing device
 2 x 2 gauze
 Reagent strips
 Blood glucose meter

Gloves, alcohol swab, lancet, gauze, reagent

strips, glucometer

4. Determine if blood glucose meter needs Calibration should be done regularly according
to be calibrated. to agency policy to ensure accuracy of readings.

5. Assess patient’s sites for skin puncture. Skin integrity at the puncture site minimizes
the risk of infection and promotes healing.

6. Perform hand hygiene. Hand hygiene prevents the transfer of

microorganisms.
 Hand hygiene with ABHR

7. Have patient wash hands with soap and Washing reduces transmission of
warm water, and position the microorganisms and increases blood flow to the
patient comfortably in a semi-upright puncture site.
position in bed or upright in a chair.
Encourage patient to keep hands warm.
Hospital policy may require use of an
alcohol swab only, not water, to clean the
puncture site.
Ensure that puncture site is completely dry
prior to skin puncture.
Have patient wash hands with warm water or
clean with an alcohol swab if that is agency
policy

8. Remove a reagent strip from the Tight closure of the container keeps strips from
container and reseal the container cap. Do damage due to environmental factors.
not touch the test pad portion of the
reagent strip.
 Remove reagent strip from container and close
container tightly

9. Follow the manufacturer’s instructions This prepares meter for accurate readings.
to prepare the meter for measurement.
Prepare the glucometer

10. Place the unused reagent strip in

the glucometer or on a clean, dry surface
(e.g., paper towel) with the test pad facing
up. This step is dependent on the
manufacturer’s instructions.

Prepare the reagent strip according to the

manufacturer’s instructions
Moisture may alter the test results.

11. Apply non-sterile gloves.

Apply non-sterile gloves

Gloves protect health care provider from
contamination by blood.

12. Keep area to be punctured in a Dependent position will increase blood flow to
dependent position. Do not milk or the area. Milking or massaging the finger may
massage finger site. introduce excess tissue fluid and hemolyze the
 specimen.
Avoid having the patient stand during the
procedure to reduce the risk of fainting.

13. Select appropriate puncture site and Your patient may have a preference of site used.
perform skin puncture. For example, the patient may prefer not to use a
specific finger for the skin puncture. Or the site
may be contraindicated. For example, do not use
the hand on the same side as a
mastectomy. Avoid fingertip pads; use sides of
finger.

Perform skin puncture using a lancet

14. Gently squeeze above the site to Do not contaminate the site by touching it.
produce a large droplet of blood.
The droplet of blood needs to be large enough
to cover the test pad on the reagent strip.

Gently squeeze site to

produce a large droplet of blood

15. Transfer the first drop of blood (or The test pad must absorb the droplet of blood
second drop if indicated by agency policy for accurate results. Smearing the blood will
or manufacturer’s instructions) to the alter results.
reagent strip and apply following the
manufacturer’s instructions.
 The test pad must absorb the droplet of blood
for accurate results
The timing and specific instructions for
measurement will vary between blood glucose
meters. Be sure to read the instructions carefully
to ensure accurate readings.

16. Immediately press the timer on the Timing is critical to produce accurate results.
meter (unless it starts automatically with
Always check the manufacturer’s instructions
insertion of reagent strip).
because the technique varies between meters.

17. Apply pressure, or ask patient to apply

pressure, to the puncture site using a 2 x 2
gauze pad or clean tissue.

Apply pressure to the

puncture site
This will stop the bleeding at the site.

18. Read the results on the unit display. Each meter has a specified time for the reading
to occur.
 Read the blood glucose results on the
glucometer

19. Turn off the meter and dispose of the This reduces contamination by blood to other
test strip, 2 x 2 gauze, and lancet individuals.
according to agency policy.

20. Remove non-sterile gloves and place This reduces transmission of microorganisms.
them in the appropriate receptacle.

Remove non-sterile gloves

21. Perform hand hygiene. This reduces the transmission of

microorganisms.
 Hand hygiene with ABHR

22. Review test results with the patient. This promotes patient participation in health
care.

23. Document results according to agency Results will be used to determine the
policy. patient’s treatment plan.

Data source: BCIT, 2015; Hortensius et al., 2011; Pagana & Pagana, 2011; Perry, Potter, &
Ostendorf, 2014; VCH & PHC Professional Practice, 2013; Weiss Behrend, Kelley, & Randoloph,
2004