I'm concerned that nurses are using a device in a way that is considered off label by the Food and Drug Administration (FDA), but which is written policy in their ICUs ("Blood Glucose Meters in ICUs," Diabetes Under Control, April). When strict glycemic control of surgical patients via insulin drip began on my unit, which required hourly monitoring using blood glucose monitors, I had concerns about the accuracy in relation to the coverage. Is the error range of the machine small enough to manage strict control? How accurate is a finger-stick sample on a norepinephrine drip or a patient with edema? Is it injurious to stick fingers every hour for many days? Is using blood from arterial lines accurate compared with capillary blood? I never got answers. I honestly did not know the status of the use of these devices in critical care. Before we lobby the FDA and the Centers for Medicare and Medicaid Services to change their policy, we should demand that research be done to guarantee the safety of the devices and strict guidelines be established on how and where they can be safely used.

Betsy M., RN, via ajnoffthecharts.com