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.
• The patient’s finger is prepped in the usual fashion (alcohol prep or betadine), cleansed and allowed to dry. The area must be completely dry before lancing.
• 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.