Date Published

September 11, 2017

Updated For

ALS PCS Version ALS PCS Version 5.2


Question: In a situation where we are unable to get a blood glucose reading from the patient's finger due to patient being combative/handcuffed, are we allowed to get it from the toes of the patient?


The situation you describe would be an exceedingly rare occurrence where toes of the patient would be accessible, but the fingers were not. If your safety is in jeopardy and a glucose cannot be obtained, then document as such with consideration of a patch to the BHP for some shared decision making on how to proceed. The concern lies with taking a capillary sample from the toes in a patient with diabetes or peripheral vascular disease. These patients often have very poor blood circulation to the distal extremities and impaired wound healing. A cap sample taken in the toes may result in a wound that becomes chronic with the potential for amputation down the road. Many patients with DM and PVD have sustained trivial foot wounds that result in this outcome, so avoiding a capillary sample in the toes is warranted.



blood sugar

Additional Resources

No additional resources are available for this SWORBHP Tip.