Does Site Matter? Comparing patient comfort and accuracy of blood glucose samples from the finger and palm of the perioperative patient.

Purpose:
The purpose of this study is to compare pain/discomfort of obtaining blood glucose via fingerstick (standard practice) with that from an alternative site test (AST), palm of the hand. The accuracy of the blood glucose result obtained from the AST was compared to that obtained from standard practice.

Background/Significance:
In our unit, we obtain blood glucose samples via fingerstick as standard practice. Inquiry from patients regarding less pain with AST led us to review literature and question if a less painful method existed. Also of interest was the accuracy of the blood glucose results obtained from AST versus standard practice. Our hypothesis: the patient will experience less pain with blood glucose samples from AST as compared to standard method (fingerstick) and glucose values will not differ significantly.

Methods:
This is a prospective interventional study design. Subjects deemed eligible via medical record review of inclusion/exclusion criteria. Qualifying subjects were verbally consented. Computerized randomization determined which site sampling was performed first. Subjects received both methods of blood glucose sampling to compare comfort and accuracy; however, clinical treatment based on standard site result. Glucose samples required a drop of blood from subjects per point of care testing device manufacturer recommendations (Accucheck Inform II, Safe-T Pro lancets). Subject demographics, diabetic/site sampling history, pain experience (rating 0-10), and both glucose results were documented.

Results:
Preliminary findings: 82 patients enrolled (41 male, 41 female) with mean age of 61. 39 patients randomized to receive standard site testing first and 42 patients randomized to recieve intervention (AST) first. Statistical Analysis revealed a mean pain score of 2.83 for standard fingerstick sample and a mean pain score of 1.65 for the intervention group (AST). Overall perception of pain/discomfort with AST was less as compared to standard method. Mean glucose value for standard site was 150 mg/dl compared to 149 mg/dl with AST. There was no significant difference in glucose measurements between standard care (p=0.159) and intervention (p=0.121).

Conclusions and Implications for Practice:
The findings of this study support alternative site testing as an accurate and less painful method of obtaining blood glucose results on diabetic patients. These findings may be generalized to any practice setting where point of care testing for blood glucose is performed.