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Glucometer nova StatStrip Xpress 2 procedure

Contents

  1. Aim
  2. Scope
  3. Link to overarching policy
  4. Procedure
  5. Appendices

1 Aim

To provide clear written instructions to colleagues so that they can safely use the glucometer to check blood glucose in the monitoring of diabetes mellitus, and ketone values in the monitoring of ketosis.

2 Scope

All colleagues using glucometers.

3 Link to overarching policy

The overarching policy for this standard operating procedure is the medical devices management policy.

Other associated documents that should be read in conjunction with the procedure are:

4 Procedure

4.1 Blood glucometer use

  1. Decontaminate hands and don personal protective equipment (PPE) appropriate to the procedure.
  2. Insert a test strip into the test strip port on the meter. Verify that all segments of the screen are displayed, including a test strip with blood drop.
  3. Fingertip blood samples only must be used, ensure patient’s hand or hands have been washed with soap and water and dried well before obtaining a blood sample. Massage finger with thumb toward tip to stimulate blood flow. Use a safety lancet to puncture the finger, then milk to form a drop of blood. Wipe away then milk the finger again to form a second drop of blood.
  4. Dispose of safety lancet into sharps container.
  5. Apply the blood sample to the end of the test strip until the test strip fills and the meter beeps. If the test strip does not fill completely, do not touch the test strip to the blood droplet a second time, discard the test strip and repeat with a new strip. The results will appear in 6 seconds. There is one long beep when the results are ready.
  6. The meter shows results in mmol/l, from 0.6 to 33.3 mmol/l.
  7. Never re-use a test strip.
  8. The meter will turn off if it is inactive for 2 minutes.
  9. Discard used test strip into offensive waste stream (tiger stripe) bag.
  10. Clean machine using a Clinell Universal wipe.
  11. Remove PPE and decontaminate hands.

4.2 Ketone use

Same procedure as for blood glucose, but the countdown is 10 seconds for ketones and the reading range is from 0.0 to 8.0 mmol/l.

4.3 Recording on SystmOne

Record the date, device type, batch number, expiry and result.

4.4 Actions following results of tests

The following actions are to be taken following results of tests, including abnormal results:

  • low blood glucose results, this is indicated by LO in red on the display, treat the hypoglycaemic event and repeat the test
  • high blood glucose results, this is indicated by HI in red on the display, undertake ketone testing
  • high ketone results, this is indicated by HI in red on the display, repeat the test dependent upon the test result and as per guidance
  • low ketone results, this is indicated by LO in red on the display, repeat the test dependent upon the test result and as per guidance, Ketone test results
  • Under 0.6mmol/l, a normal blood ketone value
  • 0.6 to 1.5 mmol/l, indicates that more ketones are being produced than normal. Advise patient to increase fluid intake of non-sugary fluids, ideally water, (at least 100ml every hour) and seek medical advice as it may be appropriate to give a correction dose of insulin at this point to help prevent further ketones from developing. Check for typical symptoms of diabetic ketoacidosis, such as abdominal pain, nausea, vomiting, headache, any change from usual physical or mental health state, drowsiness, confusion, increase in rate of respiration or rapid breathing. Repeat blood ketone test in 2 hours and review
  • 1.6 to 3.0 mmol/l, a high level of ketones and presents a high risk of diabetic ketoacidosis if left unmanaged. This needs to be managed as a medical emergency. Advise patient to increase fluid intake of non-sugary fluids, ideally water, (at least 100ml every hour) and contact healthcare team (diabetes specialist nurse (DSN) or general practitioner) for urgent medical advice, as will need a correction dose of insulin at this point to help reduce the level of blood ketones. Check for typical symptoms of diabetic ketoacidosis, such as abdominal pain, nausea, vomiting, headache, any change from usual physical or mental health state, drowsiness, confusion, increase in rate of respiration or rapid breathing. If patient is experiencing any symptoms or feels unwell in any way, ring 999. Repeat blood ketone test in 2 hours and review
  • above 3.0mmol/l, a dangerous level of ketones and a very high risk of diabetic ketoacidosis. This is a medical emergency ring 999. If able to drink, advise non-sugary fluids, such as water immediately. If patient has a plan for correction doses of insulin, please ensure this is followed

4.5 Training requirements

Colleagues must read the operator’s manual, watch the YouTube training video and practice the testing procedures before using the meter.

4.5.1 Training video

4.6 Safety warnings

Do

  • take care to avoid mix up of blood glucose and ketone strips
  • observe caution when using around children as small parts may constitute a choking hazard

Don't

  • do not immerse the meter or hold under running water
  • do not spray the meter with a disinfectant solution

4.7 Control solution test

This should be done daily or if used less frequently, before first use. It should also be done if the machine has been handled roughly for example, dropped, or blood results have been repeated but are higher or lower than expected. There are 2 levels of quality control solution; Level 1 which is green and Level 3 which is red. Both levels of quality control solution must be run.

  1. Decontaminate hands.
  2. Insert a test strip into the meter, a test strip and blood drop will display. If the strip is removed before the test starts or is not used for over 2 minutes, the screen will go blank.
  3. Designate the test sample as a quality control sample QC1.
  4. Mix the Nova StatStrip Glucose and beta-ketone control solution before each use.
  5. Discard the first drop of control solution from the bottle to avoid contamination.
  6. Touch the end of the test strip to a drop of control solution until the test strip fills and the meter beeps.
  7. Recap the control solution.
  8. Quality control test results are available on the screen in 6 seconds for glucose (GLU) and 10 seconds for ketones (KET). There is one long beep when the results are ready.
  9. Repeat the above for QC3.
  10. If the result is out of range, this is indicated by 3 short beeps. Please repeat the test. If it is out of range for a second time, please check the strips and control solution are not past their expiration dates. If dates are okay, carry out a third test using a new vial of control solution. If still out of range stop using the device and email rdash.purchasing-dg@nhs.net.
  11. The QC logbook must be completed at each QC test including lot numbers of the consumables used.

4.8 Control solution lifespan

Discard control solution 3 months after opening or by the expiry date on the bottle, whichever is first. Write the discard date on the bottle when you open it.

4.9 Test strip lifespan, storage and operating temperature

Test strips are not individually wrapped, when you open a new vial of strips, please write the expiry date on the outside of the container. Glucose strips have a 6-month expiry after opening, ketones are 3 months. Please also check the expiry date added by the manufacturer.

Storage temperature: 4C to 30C. Do not leave in a car overnight due to risk of low temperatures.

4.10 Glucometer operating temperature

Operating temperature: 5C to 40C.

4.11 Incident reporting

If there is an incident or fault whilst using a glucometer, this should be reported on an IR1 in accordance with the incident management policy.

4.12 Troubleshooting

If a meter has an error code or doesn’t seem to be working properly, please try the below,

  • low battery is indicated by a red battery icon at the top right of the screen, there is only enough charge left for 10 tests, please change as soon as possible, it is important to set the date and time after replacing the batteries to ensure the meter works correctly
  • there are error codes E0 to E9, please refer to manual if displayed on screen

5 Appendices

5.1 Appendix A Nova StatStrip Xpress 2 instruction manual

Document control

  • Version: 1.
  • Unique reference number: 1061.
  • Date approved: 5 September 2023.
  • Approved by: Clinical policy review and approval group.
  • Name of originator or author: Medical devices and duty of candour officer, senior buyer, purchasing, community practice educators, diabetes specialist nurses.
  • Name of responsible individual: Executive director of nursing and AHP.
  • Date issued: 2 October 2023.
  • Review date: 31 October 2025 (new document).
  • Target audience: Glucometer users.

Page last reviewed: November 29, 2024
Next review due: November 29, 2025

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