R>Policy 1.3.43
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Glucose Accu-Chek Advantage, Whole Blood
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Effective:
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Reviewed:
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Glucose Accu-Chek Advantage, Whole Blood





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Purpose
This document provides instruction to ensure safe and accurate bedside blood
glucose monitoring using the Accu-Chek Advantage monitor.

Audience
The information in this document is applicable to all medical, nursing and
laboratory personnel.

Policy
A physicians order is required for this test.

Test
Principle
The Advantage test strip contains the enzyme glucose dehydrogenase which
converts the glucose in a blood sample to gluconolactone. This reaction
liberates an electron that reacts with a mediator. The oxidized form of the
mediator hexacyanoferrate (III) accepts the electron, forming the reduced form
of the mediator, hexacyanoferrate (II). The Advantage test strip employs the
electrochemical principle of biamperometry. The monitor applies a voltage
between two identical electrodes, which causes the reduced mediator formed
during the incubation period to be reconverted to an oxidized mediator. This
generates a small current that is read by the monitor.

Clinical
Significance


??
Management of diabetics
??
Detection of glucose extremes in patients with symptoms of hypoglycemia or severe
hyperglycemia
??
Intra-operative
??
Immediate post-partum care for diabetic mother and infant
??
Glucose determination in coma patient (ER)
??
Inpatient education
??
Monitor suspected spontaneous hypoglycemia
??
Monitor parenteral hyperalimentation


Specimen
??
The Advantage monitors glucose using capillary, venous or arterial whole
blood.
??
Anticoagulants/preservatives recommended are: Heparin (green top tube),
sodium fluoride (gray)/ EDTA (purple)

Specimen
Rejection
??
Specimens in anticoagulants/preservatives other than the following are
rejected: Heparin (green top tube), sodium fluoride (gray)/ EDTA
(purple).
??
Sample of questionable integrity or improperly labeled; clotted sample.
??
Quantity not sufficient on comfort curve strip (yellow reagent pad not
covered with blood)

UTMB POINT OF CARE TESTING PROCEDURES
POLICY -


Policy 1.3.43
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Reviewed:
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Glucose Accu-Chek Advantage, Whole Blood









Equipment
and Supplies


??
Accu-Chek Advantage Monitor and Code Key supplied with strips
??
alcohol swab
??
collection device (lancets, lancet device)
??
cotton balls
??
disposable latex gloves
??
sharps collection container (available at the bedside)

??
2 ea 3Volt lithium batteries (MM#04209)


Reagents
??
Advantage Comfort Curve Test strips ( MM# 32989)

??
Advantage Glucose High Level and Low Level Control Solutions (MM#
32795)

Use of Check
Strip

Use Check Strip to check meter performance; use the Check
Strip:

1.
At least once a day

2.
When meter is dropped

3.
After cleaning the meter

4.
Before adjusting patient medication based on meter readings

5.
Whenever results do not reflect how the patient feels or when results are
suspected to be inaccurate

6.
How to use Check Strip:


??
Remove the Check Strip from the plastic storage bag


??
Do not touch the meter (electrode) end


??
Insert Strip fully into meter


??
Watch for the result on the display, a check mark
?



??
Document on the Daily or cumulative Quality Control log


??
If out of range, inspect Check Strip for damage. If ok, wipe off
Check Strip with a lint-free wipe, and try it again. If out of range,
call manufacturer for help.


Calibration
(Coding) of
the Monitor
The monitor is to be calibrated (coded) at the time a new lot of Comfort Curve
Test Strips is opened.


Step
Action

1.
Insert code key that is supplied with strips. Verify code key
number is the same as the strips in use.

UTMB POINT OF CARE TESTING PROCEDURES
POLICY -


Policy 1.3.43
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Glucose Accu-Chek Advantage, Whole Blood







2.
Press ON/OFF button to turn monitor ON.


Quality
Control,
Daily when
in use
The Accu-Chek Glucose High Level and Low Level control solutions must be
run daily when the meter is in use for each Accu-Chek Advantage Glucose
Monitor.
The controls must also be tested:
??
When using a new lot number of chemstrips
??
When using a new lot number of controls
??
After a battery change
??
After an instrument has been dropped or damaged

UTMB POINT OF CARE TESTING PROCEDURES
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Policy 1.3.43
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Glucose Accu-Chek Advantage, Whole Blood







Quality
Control
Testing



Step
Action

1.
Clean the monitor as needed. Document on Quality Control
log.

2.
Turn on the monitor by pressing the ON/OFF button on the
monitor.

3.
Assure that the chip code number matches the code number
on the test strip vial label.

4.
Remove a test strip from the vial. Replace vial cap
immediately.

5.
Apply one drop of Glucose Control Solution to the test strip.
??
Be sure to completely cover the yellow reagent section of
the pad with solution.
??
Do not allow the tip of the control solution bottle to touch
the test strip.

6.
Write down control result on paper QC log. Document
corrective action if control is out of range for that lot number.
Remove the test strip from the Accu-Chek Advantage Monitor.

7.
Repeat this process with the second level control solution.

8.
Turn the monitor off by pressing the ON/OFF button.

9.
Verify that the results are within established acceptable limits
for both controls. Only when both controls are within range, is
it acceptable to proceed with patient testing.

10.
If either control is not within acceptable range, repeat the
control(s). If the problem is not resolved SEE Quality Control
Corrective Action for further instruction.

Quality
Control
Corrective
Action


If controls do not fall within the acceptable range on repeat:

Step
Action

1.
Do not report the patient results.

UTMB POINT OF CARE TESTING PROCEDURES
POLICY -


Policy 1.3.43
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Glucose Accu-Chek Advantage, Whole Blood






QC, cont.
2.
Review the test policy and procedure.

3.
If feasible for the testing site, find a loaner monitor.

4.
Control testing should be repeated with the borrowed monitor,
and if acceptable, patient testing can be performed and
reported.

5.
If the problem can not be resolved with a borrowed monitor or
another monitor is not available to the testing site, a patient
sample should be collected and sent to the clinical laboratory for
testing.

6.
Roche Diagnostics can be reached 24 hour/day at the technical
services help line 1-800-440-3638.

Patient
Preparation




Step
Action

1.
The patient identification must be verified by the operator by
checking the wristband or another form of identification.

2.
Prior to testing the patient should be informed of the purpose of
the test and the steps involved in the procedure.

3.
If the specimen is going to be obtained from a fingerstick the
patient should wash his/her hands prior to testing, if possible.
Specimen
Collection


Step
Action

1.
Universal Precautions must be followed when collecting and
handling blood specimens.

2.
Fresh capillary whole blood samples are to be taken from the
fingertip or earlobe, or from a heelstick when the patient is a
neonate.

3.
Cleanse the puncture site with an alcohol swab.

4.
Allow the area to dry. Note: The presence of alcohol can
result in an error code/inaccurate results.

5.
Using a collection device obtain the blood sample. Specific
instructions for blood collection can be found in the Laboratory
Survival Guide located at every testing site or the NCCLS

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Policy 1.3.43
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Glucose Accu-Chek Advantage, Whole Blood
CLIA WAIVED

Effective:
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Reviewed:
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Glucose Accu-Chek Advantage, Whole Blood






document H4-A3, Procedures for the Collection of Diagnostic
Blood Specimens by Skin Puncture or NCCLS document H3-
A3 Procedures for the Collection of Diagnostic Blood
Specimens by Venipuncture.

Patient
Testing


Step
Action

1.
Assemble required supplies and equipment at patient's location.

2.
Turn on the Monitor by pressing the ON/OFF button on the
monitor.

3.
Assure the code number on the code chip matches the code
number on the test strip vial label.

4.
Remove a test strip from the vial; immediately replace the cap
on the vial. Insert the test strip into the monitor.

5.
Obtain a blood sample.

6.
Apply blood to the test strip.
Be sure to completely cover yellow reagent pads with
specimen.

7.
Record the patient result; remove the test strip from the monitor

8.
Turn the Accu-Chek Advantage Monitor off by pressing the
ON/OFF button