Venous Lactate Monitoring Procedure

Procedure Guidelines

9.33 Venous Lactate Monitoring Procedure

DEFINITION:

• The Venous Lactate Monitoring Procedure is indicated when a patient is suspected of sepsis or other medical condition that causes hypoperfusion of vital organs or there is a concern the patient is suffering from metabolic distress in shock or end-organ failure.
• It helps confirm cryptic shock.

INDICATIONS:

• Patients presenting with signs and symptoms consistent of sepsis, have had a sepsis screening checklist completed with two or more positive major criteria and two or more positive minor criteria identified.

CONTRAINDICATIONS:

• On patients with impending shock, suspected sepsis or end-organ failure, there are no contraindications for this procedure.

COMPLICATIONS:

• Prolonged bleeding from the blood draw site.
• Pain from the lancing procedure.
• Infection.

PROCEDURE:

• Please refer to the device’s USER MANUAL for more detailed procedures specific to the monitor being used by your agency. The procedure below is generic for the Lactate Pro® monitors.
• Do not use alcohol to clean the site unless it is extremely dirty. If alcohol is used allow it to completely dry prior to testing, failure to do so will cause incorrect readings.
• If the patient's hands are sweaty, dry with gauze before testing, sweat will cause incorrect readings.
• Do not use blood from an IV site or if an IV tourniquet is on the patients arm. This will cause a high reading.
• Place a new test strip (green in color) into the Lactate Pro® monitor by opening the foil and inserting the strip into the device. Be careful not to touch the strip.
  • Use the test strip immediately after opening it. If left open to air for a long period of time (greater than 5 minutes) discard and use a new test strip.
• The monitor will display the calibration number (usually an F-0 through F-12 number) before it is ready to accept a sample. This number must match the one of the strip being used. If the strip is inserted and a sample not placed into the strip within three (3) minutes, the monitor will turn off automatically.
• Lance the finger using a safety type lancing device.
• Press to obtain the first drop of blood from the site. DISCARD the first drop.
• Use the second drop obtained to complete the test. Put the tip or end of the strip against the drop of blood.
  • The strip using a wicking effect will draw the blood sample into the strip. When enough blood is drawn, the monitor will make a beep sound.
  • It takes 60 seconds to obtain a reading. The monitor will show a time countdown until the test is completed.
  • If not enough blood is placed in the strip, the machine will not beep and/or run the test. Remove the strip, place a new one and repeat the test making sure enough blood is used and drawn until the beep sound is heard.
  • The monitor will display “LO” if the venous lactate level is below 0.8 mmol/L and “HI” if the level is above 23.3 mmol/L. If this is the case, please repeat the test. Note in the incident record the results for both procedures.
  • Levels equal to or greater than 4 mmol/L are considered positive findings for metabolic distress and hypoperfusion.
• The monitor must be checked with the “check strip” at least monthly or anytime there is a concern regarding the proper operation of the unit. It is suggested the check strip procedure to be completed the first Sunday of each month.