Blood Glucose Meter Training 1
Disclaimer • This information is intended for use by Health Care Professionals • Patients who are self testing, please refer to your meter’s specific operator manual • If you have questions about your meter, testing, or your condition please contact your physician &/or a Vancouver Island Diabetes Education Centres in your area 2 Accu-Chek Performa Operator Training © VIHA 2013
What is changing? Roche ACCU-CHEK® meters will be the meters used by all Health Authorities in British Columbia by March 31, 2013. • The larger VIHA user sites (Acute Care e.g. CRH, St. Joseph’s, TGH, WCGH, NRGH, CDH, SPH, VGH & RJH etc.) will use the Roche Accu-Chek Inform II meter (can be connected to VIHA network for data transfer) • The smaller VIHA user areas (Residential Care etc.
Learning Outcomes These slides should help you understand: • Basic meter features • How to perform a quality control (QC) & a client test • Meter care & cleaning • VIHA Critical Values and appropriate actions • Competencies required to use this device 4 Accu-Chek Performa Operator Training © VIHA 2013
Review of existing BGM practice/policy Client identification must be confirmed using a minimum of two unique identifiers (name, date of birth, ID number) prior to collection of sample Ensure puncture site is cleaned and thoroughly dried before obtaining blood sample Wipe away first drop to prevent specimen contamination with excess tissue fluid Document result as per current practice as soon as possible Use the term Blood Glucose (BG) instead of old terms like “OT” or “BBGM” 5 Accu-Chek Performa
Accu-Chek Performa Meter Features • • • • 5-second test time 0.6 – 33.
Accu-Chek Performa Meter Features Code Chip Slot On/Off/Set Button Display Battery Door (uses 1 - 3 volt Lithium battery) Right and Left Arrow Buttons Test Strip Slot 7 Accu-Chek Performa Operator Training © VIHA 2013
Changing the Battery It is time to change the battery when you see these screen prompts! 1. 2.
Changing the Battery cont’d 3. 4. 5. Insert the new battery with the + side up. Put the battery door back in place and snap it closed. Turn the meter on, confirm that the time and date are correct.
Coding a meter 1. Make sure the meter is OFF 2. Turn the meter over 3.
Coding a meter cont’d 4. Turn the code chip over so the number faces down 5.
Code Chip • Each box of test strips contains a code chip • Ensure this new chip is inserted into the meter 12 Accu-Chek Performa Operator Training © VIHA 2013
Cleaning & Disinfecting the Meter Clean the meter after each client test with a Percept wipe Routinely disinfect every 7 days AND when meter has been: •soiled with blood •used for a client on additional precautions •exposed to an infectious agent Remember: ONE wipe to CLEAN, TWO wipes to DISINFECT 13 Accu-Chek Performa Operator Training © VIHA 2013
Meter Cleaning Steps 1. 2. 3. 4. 5. Put on clean gloves (and gown if required). Make sure meter is off. Use VIHA Percept wipes. Ensure expiry date has not been exceeded. Squeeze out excess moisture from the wipe before use. Place meter on a level surface and gently wipe the meter surface with Percept wipe. 6. Ensure no moisture enters the code chip or test strip slots. 7. Meter must remain wet for the designated contact time. (5 mins for Percept) 8. Discard wipe.
Accu-Chek Performa Test Strips 15 Accu-Chek Performa Operator Training © VIHA 2013
Accu-Chek Performa Test Strip - Features • 0.6 µL sample size • Wipe 1st drop and use 2nd drop • Apply blood to front edge of strip • Up to 2 minutes to apply sample (meter will turn OFF) • No need to write open date on test strip vial • Test strips good till expiry date on vial, open or un-opened • Store test strips at 2-300C. Use at 10-400 C.
Accu-Chek Performa Control Solution • Only use Accu-Chek Performa Control Solutions • Write the date you opened the bottle on the bottle label. The solution is good for 90 days (three months) from that date OR until the expiry date on the bottle label, whichever comes first • Do not use control solution that is past the expiry date • The solution can stain clothing. If you spill it, wash your clothes with soap and water • Close the bottle tightly after each use • Store the bottle at 2 °C to 32 °C.
Why do a Quality Control ? • Performing a Quality Control verifies the reliability of the test system • Quality Control solutions contain known levels of glucose & are used to verify: Test Strip and Control Solution integrity Meter performance Operator technique ALL operators must be able to perform a Quality Control Remember : QCs can be done anytime & are a good way to maintain your skill with the meter! 18 Accu-Chek Performa Operator Training © VIHA 2013
When to do Quality Control A Quality Control should be done: • Immediately prior to client testing if not done within the last 24 h • Upon opening a new vial of test strips or control solutions • If meter dropped • If there is a question about a client’s glucose results – e.g. glucose result is inconsistent with clinical presentation • Minimally - ONCE per week.
Performing a Control Test – for Healthcare Professionals 1. Insert the test strip into the meter in the direction of the arrows. The meter will turn on 2.
Performing a Control Test – cont’d 3. Select the control solution to be used 4. Place the meter on a flat surface 5. Mix Quality Control (QC) solution by gently inverting bottle 5 times. Remove cap and wipe the bottle tip with a tissue to remove any dried residue.
Performing a Control Test – cont’d 6. Touch the second drop to the front yellow edge of the strip 7.
Performing a Control Test – cont’d – The QC result appears on the display, along with a control bottle symbol & flashing “L” – Do not remove the test strip yet 8. Press once to mark the result as Level 1 9.
Performing a Control Test – cont’d 10. Result is in range if “OK” & the result alternate on the display. (The label on the test strip container also shows acceptable ranges) 11.
Troubleshooting - Quality Control is Out of Range Review this list for possible causes: – Were the control solutions or test strips past their expiry date? (Control solutions are good for 90 days ( 3 months) from opening) – Were the test strip container and control solution bottle caps always closed tightly? – Was the test strip wet, bent, scratched, damaged or left out of the container for too long? – Was the correct control solution level selected when the test was performed? – Did the code number on the
Performing a Blood Glucose Test 1. Insert a test strip, the meter turns on 2. Make sure the code number displayed on the meter matches the code number on the test strip container • • • This is critical as lots change at least once a year! If the code does not match, remove old chip and replace it with a new chip from test strip box. Check again to ensure code number match.
Performing a Blood Glucose Test – cont’d 3. A test strip and flashing blood drop appear on the display. 4. When the “Flashing Drop” symbol appears pierce the site • Cleaning the client’s finger with soap and water is adequate, what is important is CLEAN & DRY, with NO skin contaminates, i.e. fruit juice, saliva, lotion etc.
Performing a Blood Glucose Test – cont’d 5. Wipe the first drop away and touch the second drop of blood to the front edge of the yellow window • • • • The first drop of blood has excess tissue fluid and may contains skin contaminates, always use second drop You have up to 2 minutes to apply the sample The ACCU-CHEK Performa meter only requires a very small amount of blood – 0.6 ul Lancets are single-use, discard in sharps container after use 6.
Hi and Low Results Display • Hi Level - greater than 33.3 mmol/L 29 • Low Level – less than 0.
Reference Ranges VIHA Glucose Meter Normal Reference Interval 4.0 - 11.0 mmol/L (The meter will give readings for results ranging from a low of 0.6 mmol/L to a high of 33.
VIHA Critical Values (follow your facilities procedures for appropriate actions) Critical High 31 Critical Low Accu-Chek Performa Operator Training © VIHA 2013
Documenting Results Remember - Always document the result as soon as possible to avoid error Although the meters have a “memory” which displays previous glucose results, NO client ID is attached to the result. It is impossible to connect the correct client with the result. Please do not use the memory function for results as errors may occur.
Viewing Results - Averages The Perform meter has the ability to show 7, 14 or 30 day averages of results. Since this meter is being used with multiple clients using these result “averages” is not appropriate.
Limitations of ACCU-CHEK®Test Strips (Refer to test strip package insert for further information. A test strip package insert comes in each box of test strips) Key Points: If peripheral circulation is impaired, as in severe dehydration, hypotension or shock, capillary blood may not truly reflect glucose level Hematocrit should be between 0.10 – 0.
Maintaining Competency Competency on the blood glucose meter is your professional responsibility Operator competency is maintained by regularly performing client AND quality control testing Quality control can be run at anytime on ANY SHIFT 35 Accu-Chek Performa Operator Training © VIHA 2013
