Policy Number: 4:10
Contents
1. Capillary venous neonatal including cord blood and arterial whole blood specimens may be used for testing on the Accu Chck Advantage meter 2 The capillary sample must be tested immediately after collection 3 Blood glucose determinations using venous and arterial blood specimens should be performed within 30 minutes of specimen collection to avoid glycolysis Mix samples thoroughly 4 For best results with arterial and venous blood the following anticoagulants preservatives are recommended heparin and EDTA 5 Serum separator tubes are acceptable if blood is used immediately 6 Iodoacetate and fluoride oxalate should not be used as preservatives 7 Caution should be taken to clear arterial lines before blood is drawn and dosed on the test strip 8 Sufficient sample size is required to ensure valid results Refer to the test strip package insert for the most current information Reagents The Accu Chek GTS Plus GTS includes an Accu Chek Advantage Meter along with the following 1 Accu Chek Comfort Curve Test Strips Accu Chek Comfort Curve Glucose Control Solutions 2 Accu Chek Comfort Curve Linearity Test Kit Storage and Handling Calibration 1 2 Test strips must be stored at room temperature 14 and 40 C and lt 85 humidity Do not freeze Test strips are stored in the same tightly capped vial in which they are packaged The vial cap is immediately replaced after removal of a test strip Test strips are s2. extremely high and above the meters readable range If this contradicts the patient s condition perform a quality control check with glucose control solution and a new test strip If the control result is within the acceptable range review proper testing procedure and repeat the blood glucose test with a new test strip If mg dL and error still appear on the patient test contact the laboratory to perform a venous blood glucose If LO is displayed the blood glucose result may be lower than the reading range of the meter Refer to the test strip package insert for more information If this contradicts the patient s condition perform a quality control check with glucose control solution and a new test strip If the control result is within the acceptable range review proper testing procedure and repeat the blood glucose test with a new test strip If LO still appears on the patient test contact the laboratory to perform a venous blood glucose If the control result is not within the acceptable range refer to Understanding Control Results in the User s Manual before proceeding with patient testing If code and error appear on the display at the same time the Code Key is faulty or it was removed while the meter was on Turn the GTS Plus GTS off and reinsert the Code Key If this error display still appears contact the Medical Service Center at 1 800 440 3638 Reference 1 Approved If a test strip symbol and error appear on the
3. stable until the expiration date Test strips must be stored in the same capped vial in which they were packaged and the vial cap must be immediately replaced after removal of a test strip Quality Control Procedure The following equipment is needed for quality control testing Accu Data GTS Plus GTS with Accu Chek Advantage meter Accu Chek Comfort Curve test strips Accu Chek Comfort Curve Glucose Control Solutions Level 1 amp 2 1 Press BLUE power ON button 2 Select CTRLS Verify that the code number on the test strip vial corresponds to the code number on the GTS Plus GTS and on the meter 3 Select YES if the code numbers correspond 4 Enter valid operator ID if enabled GTS Plus only 5 Select NO if the code numbers do not correspond Make sure it is the right calibration number pg 3 6 Enter your operator ID Press ENTER 7 Select the desired control level Level 1 Level 2 8 Verify the lot number of control solution displayed on the GTS Plus GTS 9 Select YES if the lot number is correct 10 Select NO if the lot number is incorrect Enter lot number and expiration date from control solution bottle 11 12 13 14 15 16 17 18 19 20 Remove a test strip from the vial and replace vial cap immediately When the flashing strip icon appears on the meter display gently insert test strip with the yellow target area or test window facing up Insert the end with the silver bars NO
4. MARSHALLTOWN MEDICAL amp SURGICAL CENTER Marshalltown Iowa CARE OF PATIENT POLICY amp PROCEDURE Subject Policy competency confirmed Additional Information Glucose Monitoring Accuchek Policy Number 4 10 Nursing department staff and laboratory staff may perform glucose monitor testing after 1 Use 2 patient identifiers prior to obtaining accucheck 2 See Laboratory Policy Attached Originated by Effective date Authorized by Authorized by Revision date Review date Distribution P CAREPT cpt4 10r2 doc Care of Patient 6 88 Lab 8 08 Prof Prac 4 04 COO CNO Date 12 91 10 94 7 98 5 01 3 04 7 98 8 08 All Nursing Units Lab Accucheck Advantage Blood Glucose Meter Principle The enzyme glucose dehydrogenase converts the glucose in the blood sample to gluconolactone This reaction liberates an electron that reacts with a coenzyme electron acceptor the oxidized form of the mediator hexacyanoferrate II The test strip employs the electrochemical principle of biamperometry The meter applies a voltage between two identical electrodes which causes the reduced mediator formed during the incubation period to be reconverted to an oxidized mediator This generates a small current that is read by the meter The Accu Chek Advantage meter with Accu Chek Comfort Curve test strips which are whole blood referenced systems have been calibrated to deliver plasma like values Specimen 1
5. TE Insert test strip BEFORE dosing Touch and hold drop of glucose control solution to the edge of the curve on the test strip The solution is drawn into the test strip automatically A small box will flash on the display In 40 seconds the glucose control value will appear Verify result on both displays Control ranges are on the bottle of strips for the different levels Enter comment code if needed then press ENTER The Accu Chek Advantage will power down at this point Remove the test strip from the Accu Chek Advantage meter Select YES to do another control test Verify the operator ID and continue with step 5 Select NO to turn GTS Plus GTS OFF Discard the used test strip in a biohazard container The quality control value will remain in the instrument and down loaded for record keeping in the laboratory for two years Patient Test Procedure Patient Preparation 1 The following items should be gathered and taken to the patients bedside a AccuData GTS Plus GTS with Accu Chek Advantage meter b Accu Chek Comfort Curve test strips c Lancets d Alcohol swab e Gauze for wiping finger after stick f Disposable latex gloves Explain the purpose of the test and the steps of the testing procedure to reassure the patient Wash your hands and put on disposable latex gloves prior to testing If the patient is able ask the patient to wash his her hands with warm water and soap rinse and dry well prior to testing
6. button on the GTS Plus GTS to help save GTS Plus GTS batteries while the Accu Chek Advantage is removed from GTS Plus GTS Advantage cradle 11 Touch and hold drop of blood to the edge of the curve on the test strip 12 The blood is drawn into the test strip automatically 13 A small box will flash on the display In 40 seconds the blood glucose value will appear Verify result on both displays NOTE The Accu Chek Advantage may be turned off after the result appears and before it is returned to the GTS Plus GTS Advantage cradle to help conserve its batteries Return the meter to the GTS Plus GTS Advantage cradle If the GTS Plus GTS has turned OFF press BLUE power ON button Verify the result on both displays 14 Enter a comment code if necessary and press ENTER 15 The Accu Chek Advantage will power down at this point 16 Remove the test strip from the meter 17 Select YES to do another test verify the operator ID Select NO to turn GTS Plus GTS OFF 18 Discard the used test strip and lancet in a biohazard container 19 Remove gloves and wash hands thoroughly with soap and water 20 Document the blood glucose result according to on the diabetic flow chart or in the computer system Report Results Nursing Staff Record the results of your accuchek blood sugar on the nursing diabetic flow sheet along with your initials time and date of testing Laboratory Staff Enter results into the CPSI computer system using manual
7. capillary samples If the patient is unable cleanse the puncture site with an alcohol swab and allow it to thoroughly dry Alcohol at the puncture site must be dry or an error code inaccurate result may occur Patient Testing 1 2 10 Press BLUE power ON button Select PAT Verify that the code number on the test strip vial corresponds to the code number on the GTS Plus GTS Select YES if the code numbers correspond Select NO if the code numbers do not correspond See Entering Test Strip Codes Enter your operator ID Press ENTER Enter the patient six digit medical record number Press ENTER Remove a test strip from the vial Immediately replace the cap on the vial When the flashing strip icon appears on the meter display gently insert test strip with the yellow target area or test strip window facing up Insert the end with the silver bars NOTE Insert test trip BEFORE dosing When the flashing drop icon appears on the meter display obtain a blood sample Wipe off the first drop of blood and use the next drop for testing You may use a capillary whole blood venous or arterial blood sample Follow the manufacturer s instructions if using a lancet device NOTE You may remove the meter from the GTS Plus GTS to make it easier to insert the test strip or to dose the test strip DO NOT remove the Accu Chek Advantage from the GTS Plus GTS BEFORE the flashing strip icon appears on the meter display Press the OFF
8. day When the test strips have been exposed to extreme heat humidity or cold When test results contradict clinical symptoms After the batteries I the GTS Plus GTS or Accu Chek Advantage have been replaced or the Accu Chek Advantage meter has been recoded If a quality control test result falls within the acceptable control range it is acceptable to proceed with patient testing If a quality control test result falls outside of the acceptable control range enter appropriate comment in the comment code section Rerun controls if still having problems then go to the troubleshooting section of the Accu Chek Advantage User s Manual for help The problem must be corrected before proceeding with patient testing Any quality control result that falls outside of the acceptable control range along with any corrective action to restore that result to acceptable range must be documented In areas where the Accu Chek Advantage meter is not being used daily quality control will be performed each day of patient testing Internal proficiency testing to verify meter accuracy and operator competency will be performed during nursing competency fairs and laboratory annual competency testing The test strip lot number and the acceptable glucose control ranges are found on the label of each vial of test strips This information must be recorded according to facility policy Test strips must be stored at room temperature Do not refrigerate Test strips are
9. display at the same time the test strip may be damaged or the test was not performed correctly If this display appears before blood is placed on the strip remove the test strip and reinsert If the error display remains repeat the test with a new strip If this display appears after blood is applied to the strip there is an incorrect amount of blood on the strip A second drop of blood may be applied to the target area within 15 seconds of the first drop If more than 15 seconds have passed the test result may be erroneous and you should discard the test strip and repeat the test If the temperature symbol and a flashing test strip icon appear on the display at the same time the temperature is above or below operating range of the test strips Move to a testing area that is between 57 and 104 F 14 and 40 C and wait 5 minutes before repeating the test Do not artificially heat or cool the meter If error appears on the display the meter failed its series of electronic checks Turn the meter off then on again If this error display still appears testing cannot take place Call Accu Chek Customer Care at 1 800 440 3638 If the battery icon appears on the Accu Chek Advantage display replace the Accu Chek Advantage meter batteries Accudata GTS Plus GTS with Accuchek Advantage Blood Glucose Meter Roche Diagnostics Cooperation 9115 Hague Road Indianapolis Indiana 46236 2000 Reviewed Medical Director Date Primary Ope
10. ecalibrated and the new code information must be entered in the GTS Plus The test strip code information must be verified and or re entered in the GTS Plus GTS by the operator whenever a patient or quality control test is performed w p moa F G Press BLUE power ON button Select CTRLS The code for the Accu Chek Advantage is automatically read by the GTS Plus GTS Select YES if the code is correct Enter valid Operator ID Select NO to enter new information or check existing information e Enter the expiration date from the test strip vial label Press ENTER e Enter the number of standard deviations you will be using to determine acceptable ranges for control values Three standard deviations will be used unless you enter a different number Press ENTER e Verify enter the minimum and maximum values for each level of control solution Press ENTER after entering each value Enter valid operator ID Proceed with QC testing Quality Control Quality control records will be retained for a minimum of two years The GTS Plus GTS is set up to store the following information about each quality control test Test Result Operator ID Control Level Control Lot Information Test Strip Code Information Test Time and Date Comment Code Control tests are performed at the following times Each time a new vial of test strips is opened When a vial of strips has been left opened If the GTS Plus GTS has been dropped Each
11. entry following policy manual The normal fasting blood glucose range for a non diabetic adult is 74 99 mg dL One to two hours after meals normal blood glucose levels should be less than 140 mg dL Any neonatal blood sugar less than 40 mg dL must be repeated with a venous or capillary sample performed on the chemistry analyzer The nursing staff must be notified if the patient results are below 80 mg dl or above 200 mg dl The instrument will give a reading from 20 to 600 mg dl but he linearity range is between 40 and 500 mg dl Any result below 40 or above 500 must be repeated with a venous or capillary sample performed on the chemistry analyzer Limitations of Procedure 1 If the Accu Chek Advantage meter displays anything other than a numerical blood glucose result refer to the Accu Chek Advantage User s Manual If HI is displayed the blood glucose result may be higher than the reading range of the meter Refer to the test strip package insert for more information If this contradicts the patient s condition perform a quality control check with glucose control solution and a new test strip If the control result is within the acceptable range review proper testing procedure and repeat the blood glucose test with a new test strip If HI still appears on the patient test contact the laboratory to perform a venous blood glucose If mg dL and error appear on the display at the same time the blood glucose result may be
12. rator Date
13. table until the expiration date on the vial Be sure to write the date on the label when you open a new bottle of control solution A bottle is good for three months after opening or until the expiration date printed on the label whichever comes first The Accu Chek Advantage is to be calibrated each time a new lot number of Advantage test strips is opened The Code Key is to remain in the module until the lot of test strips in use is changed Place the new Code Key in the module and discard the old Code Key Gather the following items for calibration AccuData GTS Plus GTS with Accu Chek Advantage meter Test strips with appropriate Code Key 1 2 Remove the Code Key from the test strip box Compare the 3 digit number on the Code Key with the number of the test strip vial Be sure the AccuData GTS Plus GTS is turned OFF Remove old Code Key from Accu Chek Advantage module located on the right side of the module if necessary Snap the new Code Key slots facing towards the meter into the Code Key slot with the printed side facing up Leave the Code Key in the module Press the BLUE power ON button Verify that the code number on the meter display corresponds to the code number on the vial of test strips being used Entering the Test Strip Code The test strip code displayed by the Accu Chek Advantage blood glucose meter and GTS Plus GTS must match the code of the test strips in use If not the meter must be recoded r
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