This document provides information on haemoglucosetix testing, which is a point-of-care method to test blood glucose levels. It involves pricking the skin, usually the heel, to draw a small amount of blood, which is then applied to a disposable test strip. The test can help monitor blood glucose fluctuations in sick infants and guide interventions if needed. Factors like temperature, sample size, and test strip accuracy can influence readings. Hypoglycemia is defined as a blood glucose level below 45mg/dl in neonates and should be treated by increasing oral feeds or intravenous glucose depending on the severity of symptoms. Nursing considerations include ensuring continuous glucose infusion to prevent rebound hypoglycemia.

1. ● WELCOME
● TO THE CLASS
● OF
● HEMOGLUCOSSTIX TESTING

2. Haemoglucosetix testing
is a point of care method of
testing the concentrate of
glucose in the blood.
It is performed by piercing
the skin (heel) to draw the
blood and then apply the
blood to a disposable test
strip.

3. P
U
R
P
O
S
E
● To monitor the blood glucose levels, its
fluctuations during sickness and to plan
interventions if needed.
● To help in quick response to low blood sugar
(hypoglycaemia) or high blood sugar
(hyperglycaemia).

4. H
o
w
t
o
d
o
it
Test strips
It has glucose
oxidase that
react with
glucose that is
present in the
blood.
01
Coding
Reading is
carried out
Volume of
blood sample
0.3 – 1 µl
Time and
display
02 03 04
Within 60
second

5. PERFORMING DEXTROSTIX
Preparation of site
Make sure heel is not cold, and warm it, if required.
Clean with 70% isopropyl alcohol using a circular motion.
Do not use povidine/betadine, as specimen contamination may elevate some results.
Allow alcohol to dry: failure to allow the spirit to dry may contaminate the specimen may
give false result or may destroy the RBCs.
Make a needle stick puncture on the postero-lateral aspect of the heel.
Avoid middle portion of the heel.
Avoid making deep punctures.
Allow a drop to fall on the strip. Do not rub the strip against the skin.
Wait for few seconds to obtain the reading.
Use cotton ball to apply pressure on the puncture site, till it stops bleeding.

6. Capillary Vs venous sample
Calibration of meter
Ambient temperature
Size and age of blood sample
Hematocrit
Dirt on meter
Humidity
Old/outdated test strip
FACTORS AFFECTING THE READING

7. LIMITATIONS
● If the value is less ˂50 mg/dl it
may be unreliable so the reading
must be confirmed by sending
the sample to the lab for glucose
test.

8. B) HOW FREQUENT- SCHEDULE FOR TESTING
1. At risk infants.
2. Sick infants ( sepsis, asphyxia, shock): every 6 – 8
hours
3. Stable VLBW Infants on parental nutrition.: During
the initial 72 hrs every 6-8 hrs. After 72 hrs in stable
babies: once a day.
4. Infants with signs of hypoglycaemia.
A) WHOME TO SCREEN
1. Low birth weight infant ( ˂2000 gm).
2. Preterm infants ( ˂35 weeks).
3. SGA ( small for gestational age infants.
4. IDM (infants of diabetic mothers).
5. LGA (large for gestational age).
6. Infants with Rh- hemolytic disease.
7. IUGR babies.
8. Perinatal asphyxia, polycythemia, sepsis, shock.
9. Infants receiving total/partial nutrition.
10. Term infants with poor feeding, inadequate
lactation, cold stress.
INDICATIONS FOR HEMOGLUCOSTIX TESTING (SCREENING)

9. Hypoglycaemia is
defined as a measured
blood glucose level of
<45mg/dl in both the
term and preterm
neonate.

10. INTERVENTION STEPS TO BE TAKEN.
Management of infants with asymptomatic hypoglycemia.
1) Blood sugar 20-40 mg/dl: Trial of oral feed (expressed breast milk
or formula) and repeat blood test after 1 hour.
2) If repeated blood sugar is more than 50 mg/dl: 2 hourly feed with 6
hours monitoring for 48 hours.
3) If repeated blood sugar is less than 40 mg/dl, IV Dextrose is
started.
4) Blood sugar level less than 20 mg/dl: IV Dextrose is started at 6
mg/Kg/min of glucose;
5) Further management is done for symptomatic hypoglycaemia.

11. Management of symptomatic hypoglycaemia
1) Seizures: bolus of 2 ml/kg of 10% Dextrose (200mg/kg)
2) Immediately after bolus, a glucose infusion at an initial rate of 6-8 mg/kg/min
should be started.
3) Check blood sugar after 30-60 minute and then every 6 hourly until blood
sugar is more than 50 mg/dl.
4) Repeated subsequent hypoglycaemia episodes may be treated by increasing
the glucose infusion rate by 2 mg/kg/min until a maximum of 12 mg/kg/min.
5) After 24 hours of glucose therapy if two or more blood sugar is more than 50
mg/dl the infusion can be tapered of at 2mg/kg/min. Every 6 hours.
6) Increase the oral feed as the infusion is tapered.

12. Symptomatic hypoglycaemia is an emergency.
Blood glucose is rechecked after 30-60 min of intervention and
then every 6 hour until blood sugar is >50 mg/dl.
Use a syringe infusion or pumps to ensure the continuous infusion
of glucose.
Avoid 12.5% to 15% dextrose infusion through a peripheral vein.
If oral feeds are contraindicated, start glucose infusion.
Note that the extension tube length and extension tube caliber will
affect the glucose infusion rate. Always ensure that the infusate fluid
reach the patient end before the drip is started.
Always ensure un-interrupted glucose infusion. A delay in IV drip
change can cause a hypoglycaemic spell.
NURSING CONSIDERATIONS

13. —NOTE
“Do not stop an IV infusion of
glucose abruptly; severe rebound
hypoglycemia may occur. Avoid
using more than 12.5 % Dextrose
infusion through a peripheral
vein due to thrombophlebitis.”

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