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American Journal of Critical Care. 2009;18: 65-72 doi:10.4037/ajcc2009626
Copyright © 2009 by the American Association of Critical-Care Nurses.
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CE Article

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

By Anjannette Cook, RN, BSN, Delyla Laughlin, RN, Margery Moore, RN, BSN, Doreen North, RN, Kathleen Wilkins, RN, BA, BSN, Gay Wong, RN, BSN, Allyson Wallace-Scroggs, RN, MSc and Lisa Halvorsen, RN, PhD, APRN-BC. Anjannette Cook, Delyla Laughlin, Margery Moore, Doreen North, Kathleen Wilkins, and Gay Wongare clinical nurses in the intensive care unit, Allyson Wallace-Scroggsis director of the human simulation laboratory, and Lisa Halvorsenis director of critical, progressive, and dialysis care at Providence Portland Medical Center, Portland, Oregon.

Corresponding author: Lisa Halvorsen, RN, PHD, Providence Portland Medical Center, 4805 NE Glisan St, Portland, OR 97213 (e-mail: Lisa.Halvorsen{at}providence.org).

Background Blood for glucose analysis is often obtained interchangeably from indwelling catheters and fingersticks.

Objectives To determine the level of agreement between glucose values obtained by laboratory analysis and with a point-of-care device for blood from 2 different sources: fingerstick and a central venous catheter.

Methods A method-comparison design was used. Point-of-care values for blood from fingersticks and catheters were compared with laboratory values for blood from catheters in a convenience sample of 67 critically ill patients. The effects of hematocrit level and finger edema on differences in glucose values between the 2 methods were also evaluated. A t test was used to determine differences in glucose values obtained via the 2 methods. Differences and limits of agreement were also calculated.

Results Laboratory glucose values for blood from a catheter differed significantly from point-of-care values for blood from the catheter (t1,66 = –9.18; P < .001) and from a fingerstick (t1,66 = 6.53; P < .001). Glucose values for the 2 methods differed by 20 mg/dL or more for 1 of 6 patients (15%) for catheter samples and for 1 of 5 (21%) for fingerstick samples. Point-of-care glucose values for fingerstick and catheter samples did not differ (P = .98). Hematocrit level significantly explained the difference in glucose values between the 2 methods for both catheter (R2 = 0.288; P < .001) and fingerstick (R2 = 0.280; P = .02) samples.

Conclusions Use of a commonly used point-of-care device when precise glucose values are needed may lead to faulty treatment decisions.

Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Describe the relationship of euglycemic glucose levels to outcomes for critically ill patients.
  2. Understand the importance of differences between point-of-care (POC) glucose testing and laboratory glucose testing used with critically ill patients.
  3. Recognize the relationship between hemoglobin levels and the accuracy of POC test values for blood glucose.
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.


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Copyright © 2009 by the American Association of Critical-Care Nurses.