Hyperglycemia is a warning sign of infection. The methods of
testing for glucose is different in the lab vs the point-of-care
testing with the finger stick. So there is reason to be
concerned.
There is also concern about the technique of drawing the sample
if the nurses do not routinely turn off the infusion of all fluids
through all lumens when drawing a blood sample. This should be
standard practice to increase the chances of getting a true lab
value.
Is there no way to draw a regular blood sample from a peripheral
stick on this patient? If not, I would definitely make sure they turn
off all infusions for one full minute before drawing the sample from
the PICC. Also you have D5 infusing through the lumen where you are
taking the sample. What are the flushing practices before drawing the
sample? Lynn
At 10:26 AM -0500 8/15/06, G.G. Northington wrote:
I have a patient that had a dual lumen power PICC inserted on 8-3-06. TPN was initiated through one lumen and the other lumen utilized for maintaince fluids (D51/2 NS) and lab draws. The last 3-4 days (not consecutive) the patient's glucose has been elevated on the lab results, but a finger stick has had much lower results. The patient's WBC's are elevated, but not a new finding. The physician is concerned with infection. My first thought was that the nurses are pulling the TPN with their lab draw.--It is common practice on this floor to draw the lab work while the TPN is infusing, so I suggested to stop it briefly before the next lab draw to see if there is a difference in the results.
With the background given, what are your thoughts on possible infection vs. the nurses "technique" on obtaining the sample?
Thanks, G.G.
G.G. Northington,RN,BSN
PICC Nurse
Jackson Hospital & Clinic,Inc.
Montgomery,AL 36016
334-293-6858
[EMAIL PROTECTED]
--
Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
