Pre‐procedure

ActionRationale

1. 1.Show
   Turn the machine on and ensure the correct date and time are presented on screen, and that there is adequate battery life. Where applicable, enter or scan operator number and/or password.
   To ensure accuracy in the record and patient safety (Roche Diagnostics [180], C).
2. 2.Show
   Ensure that the device is reading in mmol/L prior to each use.
   Units of measure may change from mmol/L to mg/dL, which could result in an incorrect result (MHRA [117], C).
3. 3.Show
   Before taking the device to the patient, calibrate the monitor and test strips (where applicable) using the relevant steps below (always follow the manufacturer's instructions in case of any difference):

   • Ensure the testing strips are in date and have not been left exposed to air.
   • Calibrate the monitor and test strips together.
   • Carry out a quality control test using both high and low or level 1 and 2 solutions (in accordance with trust and manufacturer's guidelines). Ensure the LOT number is recorded, either manually or via a bar code scanning system.
   • Record the result (pass or fail) in the equipment log book and sign it.
   • Where an automated device is used, ensure the device is docked in its base unit to enable the centrally held electronic records to be updated.
   • Ensure the meter has been decontaminated per local guidelines and is fit for use.
   • Ensure the meter service record is in date according to local policy.
   • Ensure the screen or display is intact and the ‘screen safety check’ has been completed in accordance with the manufacturer's guidelines (Roche Diagnostics [180]).
   To ensure the device can be used under safe conditions (MHRA [117], E). Some machines will self‐calibrate; check the manufacturer's instructions.
4. 4.Show
   Identify the patient, introduce yourself, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [144], C).
5. 5.Show
   Select a site that is warm, well perfused and free of any skin damage. The ideal site for lancing is the palmar surface of the distal segment of the third or fourth finger (Action figure 14.43) of the non‐dominant hand, avoiding the thumb and the index finger. Also avoid sites that have recently been punctured.
   Fingers on the non‐dominant hand are generally less callused and the index finger is potentially more sensitive to pain due to additional nerve endings (Marini and Dries [112], C). The thumb also may be callused and has a pulse, indicating arterial presence, and the distance between the skin surface and the bone in the fifth finger makes it unsuitable for puncture (WHO [213], C). Tips and pads of fingers should be avoided as they have a denser nerve supply and can be more painful (WHO [213], C).

   Rotating puncture sites avoids fingertip soreness and reduces callus formation (WHO [213], C).

Procedure

1. 6.Show
   Ask the patient to wash their hands with soap and water and dry them thoroughly.
   To avoid sample contamination (Adam et al. [2], C). Not washing hands can lead to inaccurate results, especially with fingers exposed to fruit or a sugar‐containing product (Pickering and Marsden [164], R).
2. 7.Show
   Ask patient to sit or lie down.
   To ensure the patient's safety and minimize the risks if they feel faint when blood is taken (Roche Diagnostics [180], C).
3. 8.Show
   Wash and dry hands and/or use an alcohol‐based handrub and apply personal protective equipment.
   To minimize the risk of cross‐infection and contamination (NHS England and NHSI [124], C).
4. 9.Show
   Turn on the device (where applicable and if not automated) and insert a testing strip.
   Some devices will turn on automatically once the strip has been inserted. The manufacturer's guidelines should be followed to ensure accurate results (MHRA [117], C).
5. 10.Show
   Take a single‐use lancet and set the appropriate depth (if applicable).
   To minimize the risk of cross‐infection and accidental needle stick injury (NICE [128], C; Pickering and Marsden [164], E; Weston [211], E). The correct depth setting will minimise patient pain (Roche Diagnostics [180], C).
6. 11.Show
   Using the lancet, puncture the chosen site (see step 5). If necessary, ‘milk’ the fingertip from the palm of the hand towards the finger to gain a large enough droplet of blood.
   Reusable lancet devices may be used in the patient's own environment; they should never be used for more than one person due to the risk of blood‐borne viruses (Weston [211], C).

   Milking the finger only (and not from the palm) can cause tissue fluid contamination and a false low reading (WHO [213], R).
7. 12.Show
   Dispose of the lancet in a sharps container.
   To minimize the risk of cross‐infection and accidental needle stick injury (Pickering and Marsden [164], E; Weston [211], E).
8. 13.Show
   Apply the drop of blood to the testing strip (some strips are hydrophilic and are dosed/filled from the side, whereas others require a drop of blood to be placed directly onto the strip). Ensure that the window on the test strip is entirely covered with blood (Action figure 14.44).
   To ensure the result is accurate, the window on the test strip needs to be adequately filled as per the manufacturer's guidelines (Roche Diagnostics [180], C).
9. 14.Show
   Immediately read and make note of the result on the display screen (Action figure 14.45). Document the result.
   To interpret the results of the test. Some devices will turn off automatically after the result has been displayed for a short while. E

   To ensure accuracy in record keeping (NMC [144], C).
10. 15.Show
    Dispose of the testing strip in a sharps container.
    To minimize the risk of sharps injury and cross‐infection (Weston [211], E).
11. 16.Show
    Place gauze over the puncture site, apply firm pressure and monitor for excess bleeding.
    To ensure patient safety (Walden et al. [205], E) and to stop the bleeding (WHO [213], C).
12. 17.Show
    Once the bleeding has subsided, the site can be left exposed. It is not necessary to dress the site unless bleeding persists.
    To allow the site to heal effectively. E
13. 18.Show
    Remove gloves, place them in the clinical waste and perform hand hygiene again.
    To prevent cross‐infection (NHS England and NHSI [124], C).

Post‐procedure

1. 19.Show
   Where applicable, dock the machine.
   To ensure centralized records are maintained and the machine is charged (Roche [180], C).
2. 20.Show
   Report and/or act on any unexpected results.
   To ensure appropriate treatment and obtain an optimal blood glucose range (Adam et al. [2], E).