I really need some input here.

To verify a Dstix below 40 at my facility, infant is taken to nursery and a venous stick is done for the glucose test. 
Dstix are not always verified when borderline (38-39). Our policy sets 40 as lower limit. Formula is often given, yes by MD order, (when I am not available to intervene). I improve latch and try to get EBM to supplement breastfeeding for borderline blood sugars and, of course, it almost always increases the glucose as needed. Nurses will not always do this although it is in the policy.

I'm thinking a venous stick is unecessary, when of course, the heelstick can be done in mother's room and infant put right to breast while awaiting results. This was the policy at other hospitals I have worked in.

The ABM policy has these statements: "Bedside glucose monitoring must be confirmed by formal laboratory testing. "Plasma or serum concentrations are 10-15 % higher than in whole blood." Table 2 says for infants with risk factors, "If plasma glucose concentration of <36.....close surveillance should be maintained. Intervention is recommended if below this level and does not increase after a feed or clinical signs develop." 

This sounds to me like heelsticks to get plasma glucose are acceptable and whole blood testing is not necessary.

Thanks!

Kris Nilson, BSN RN IBCLC

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