Fingerstick Glucose Determination in Shock

Abstract

Fingerstick glucose testing does not accurately represent venous glucose levels in severely hypotensive patients. If fingerstick glucose testing is relied on for these patients, errors in clinical management may be made. Venous reagent strip glucose testing correlates well with laboratory glucose measurements and should be the preferred method for rapid assessment of glucose level in critically ill patients with severe hypotension.

Evidence‐based sepsis therapy: A hospitalist perspective

“…For example, in critical illness, intravenous insulin is preferable to subcutaneous insulin, and the frequent measurement of whole-blood glucose instead of finger-stick glucose helps to avoid errors. 55,68 And although researchers were unable to prospectively identify patients with long ICU stays, 59 severely septic patients have long ICU stays (generally 7.5-16.6 days), [1][2][3][4] and individual ICUs might observe enough stays of more than 2 days in their patient population to justify intensive insulin for this subgroup. And finally, although no conclusive evidence mandates a specific approach to hyperglycemia outside the ICU, the ICU data provide a physiologic rationale for cautious but tight control of glucose in more moderately ill patients.…”

Differences in Glucose Values Obtained From Point-of-Care Glucose Meters and Laboratory Analysis in Critically Ill Patients

“…Several of the studies had serious methodological problems, including small sample size, 4 poorly described methods, 5,9,10 and inappropriate statistical analysis. 5,6,10 differences occurred between the reference glucose value (laboratory glucose) and the POC glucose values (CVC and fingerstick blood). Differences (bias) and limits of agreement (precision) between the POC glucose meter (CVC and fingerstick) and reference standard glucose values were calculated and graphed by using the Bland-Altman method.…”

“…[4][5][6][7][8]10,[19][20][21][22][23][24][25][26][27] In most of those studies, however, POC glucose testing was done with fingerstick blood; blood was obtained from an existing catheter device (arterial catheters) and appropriate statistical analysis was done in only 2 studies. 7,8 Our study extends the findings of significant differences between POC and laboratory glucose analysis to CVC blood.…”

“…Although POC devices for glucose testing are calibrated for use with capillary fingerstick blood, clinicians often obtain blood for POC testing from indwelling arterial or central venous catheters (CVCs). Despite the frequency of this practice, few clinical studies [4][5][6][7][8][9][10] have been done to evaluate the performance of POC glucose devices with blood from indwelling catheters. Several of the studies had serious methodological problems, including small sample size, 4 poorly described methods, 5,9,10 and inappropriate statistical analysis.…”

“…Despite the frequency of this practice, few clinical studies [4][5][6][7][8][9][10] have been done to evaluate the performance of POC glucose devices with blood from indwelling catheters. Several of the studies had serious methodological problems, including small sample size, 4 poorly described methods, 5,9,10 and inappropriate statistical analysis. 5,6,10 differences occurred between the reference glucose value (laboratory glucose) and the POC glucose values (CVC and fingerstick blood).…”