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American Journal of Critical Care. 2009;18: 224-230 doi:10.4037/ajcc2009448
Copyright © 2009 by the American Association of Critical-Care Nurses.
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Comparison of Glucose Point-of-Care Values With Laboratory Values in Critically Ill Patients

By Anna Shearer, RN, Marilyn Boehmer, RN, BA, CCRN, Melanie Closs, RN, BSN, Rosalina Dela Rosa, RN, BSN, CCRN, Jean Hamilton, RN, CCRN, Karen Horton, RN, BSN, Rose McGrath, RN and Christine Schulman, RN, MS, CNS, CCRN. Anna Shearer, Marilyn Boehmer, Melanie Closs, Rosalina Dela Rosa, Jean Hamilton, Karen Horton, and Rose McGrath are staff nurses in the intensive care unit at Providence St Vincent’s Medical Center, Portland, Oregon. Christine Schulman is a clinical nurse specialist and consultant in Portland, Oregon.

Corresponding author: Anna Shearer, RN, Intensive Care Unit, Providence Saint Vincent’s Medical Center, 9205 SW Barnes Rd, Portland, OR 97225 (e-mail: Anna.Shearer{at}providence.org).

Background Blood from central venous or arterial catheters as well as from fingersticks is often used for point-of-care glucose testing.

Objectives To compare glucose values obtained with a point-of-care device for catheter and fingerstick blood samples with values obtained by clinical laboratory analysis of a catheter blood sample.

Methods A method-comparison design was used. Point-of-care values for fingerstick and catheter blood samples were compared with laboratory values for blood from catheters in a convenience sample of 63 critically ill patients. Device bias and precision were calculated and graphed according to the Bland-Altman method, and a t test was used to determine differences in glucose values for the 2 methods.

Results Laboratory glucose values for blood from a catheter sample differed significantly from point-of-care values for blood from a fingerstick (t1,61 = 5.01; P < .001) and from a catheter (t1,61 = 3.91; P < .001). Bias and precision for the point-of-care device was large (fingerstick, 8.7 and 13.7; catheter, 7.0 and 14.0); 20% of the values differed from the laboratory glucose values by more than 20 mg/dL. Point-of-care glucose values for fingerstick and catheter samples did not differ (P = .41).

Conclusions Glucose values obtained with a point-of-care device differ significantly from those obtained by laboratory analysis. The magnitude of these differences calls into question the widespread practice of using point-of-care glucose testing to guide insulin titration for tight glucose control. Errors in dosing could easily be made because of the large bias and precision associated with a point-of-care device.






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