Chapter 18: Durable and Nondurable Medical

Equipment, Devices, and Supplies

Learning Outcomes
Describe durable & nondurable medical equipment
Identify types of blood glucose meters & systems
Describe steps in measuring blood glucose
Describe nondurable medical supplies used in
insulin delivery
blood glucose monitoring

Explain insulin delivery

syringes
pumps
pens

Learning Outcomes
Identify various types of blood pressure monitors &

explain methods of measuring blood pressure

Identify commonly used pedometers/heart rate
monitors
List advantages & disadvantages of home diagnostic
products & identify commonly used products
Identify orthopedic support products
Describe purpose of ostomy products

Key Terms
Aneroid blood pressure monitor
CLIA-waived
Colostomy
Continuous subcutaneous insulin infusion
Control solution
Durable medical equipment
Hemoglobin A1c
Insulin pen
Lancet

Key Terms
Nondurable medical equipment
Orthotic
Orthopedic devices
Orthotic devices
Ostomy
Pedometer
Stoma
Test strip
Urostomy

DME Durable Medical Equipment

Medicare defines DME as medical supplies that are
able to withstand repeated use
primarily used to serve medical purpose
generally not useful to person without illness/injury
appropriate for use in the home
Nondurable medical equipment
medical supplies that must be discarded after use

Role of Pharmacy Technician

Assists pharmacist in
maintaining adequate supplies & equipment
billing insurance for these items
Billing & Reimbursement
must be accredited to bill Medicare Part B for DME
Medicare Part B covers 80%

patient must pay 20%,

CLIA
Clinical Laboratory Improvement Amendments Act of

1988
Devices may be classified as CLIA-waived products
some clinical tests waived from certain laboratory

requirements

Certain home diagnostic tests using blood or urine

samples can be used without maintaining

requirements as strict as those for laboratory tests

Blood Glucose Meters

Used to monitor blood glucose (blood sugar)
Self-monitoring
Maintaining blood glucose levels
Diabetes complications
increase risk of

heart disease
stroke
blindness
kidney failure
nerve damage
amputations

Meters and Supplies

Blood glucose meters are DME
Nondurable supplies
test strips
lancets
control solution
Blood glucose meters have similar features
US glucose measurement in mg /dL

Glucometers
Measure whole blood glucose
Vary in features
size of blood sample needed for testing
calibration
testing time
memory of test results
audible blood glucose meters
Lancets

BG Monitoring Process
1.
2.
3.
4.
5.
6.
7.

Gather materials used for test

Wash hands or clean finger/area of skin to be used
Place test strip in meter/obtain test strip from meter
Lance (stick) area of skin to obtain blood sample
Apply blood sample to test strip
Record blood glucose reading in log book
Discard lancet in hard, puncture-resistant container

Insulin Delivery
Insulin is hormone produced in pancreas
promotes utilization of glucose
synthesis of protein
formation & storage of lipids
Different types of insulin vary in their
onsets
peaks
durations of action

Name of insulin

Type of Action

Insulin aspart (Novolog)

Rapid-Acting

Insulin lispro (Humalog)

Rapid-Acting

Insulin glulisine (Apidra)

Rapid-Acting

Regular Human (Humulin R, Novolin R) Short-Acting

NPH (Humulin N, Novolin N)

Intermediate-Acting

Insulin glargine (Lantus)

Long-Acting

Insulin detemir (Levemir)

Long-Acting

Insulin
Injected with or before meals or administered once daily
Concentration most commonly used 100 units/mL
Available in 3-mL or 10-mL sizes
Insulin injected subcutaneously (under skin)
Traditionally, insulin administered using syringe
can also be administered with insulin pens
continuous infusion using pump
Sites: abdomen, back of arm, outer thigh, hip/buttocks

Injection with Syringes

Insulin syringes are available in
30-unit (3/10 mL)
50-unit (0.5 mL)
100-unit (1 mL)
Use syringe size close to # of insulin units injected
allows for more accurate dosing
Needle can vary from 5/16 inch to 1/2 inch
Gauge can range from 28 to 31
higher gauge needles are thinner

Steps of Insulin Injection

1.
2.
3.
4.
5.

Wash hands; gather materials

Clean site of injection with alcohol prep
Draw air into syringe-same volume as insulin units
Inject air into insulin vial
Invert vial, withdraw units, check for air bubbles
while syringe needle remains in vial

Steps of Insulin Injection

6. If air bubbles are present, push insulin back into vial

& withdraw insulin units again

7. Remove syringe from vial
8. Pinch fold of skin, inject at 45- or 90-degree angle
9. Keep needle in skin for few seconds; then release
skin fold & remove needle from skin

Insulin Pens
Portable, discreet, convenient
Components: cartridge, dose indicator, dose knob
Cartridges are available in 1.5-mL or 3-mL sizes for refill
Some are disposable pens
discard entire device no refills

Insulin pens continue to be updated with newer models

Disadvantages of Insulin Pens

Typically more expensive
Limited to commercially available products
Each injection is limited to maximum number of units

(varies per device)

Must not be used for multiple patients

Sharps Disposal
Insulin syringes/pen needles should be used once
Discarded into puncture-resistant container
Products available for sharps disposal
BD Home Sharps Container
BD Safe-Clip
Clip & Stor Insulin Needle Safety System
UltiCare
UltiGuard
Voyager.24-26

Continuous SQ Insulin Infusion

Provided via catheter
attached to insulin reservoir within insulin pump
Infusion administers insulin for 24 hours
Rapid-acting insulin used in insulin pumps
Insulin pump allows for flexibility of meals & physical

activity
Frequent blood glucose monitoring required

Advantages of Insulin Pump

Elimination of individual insulin injections
More accurate insulin delivery than injections
Improvement of hemoglobin A1c level
Fewer variations in blood glucose levels/reduction in

episodes of low blood sugar

Ability to administer additional insulin based upon
carbohydrate intake & blood glucose levels
Flexibility in mealtimes & physical activity

Disadvantages of Insulin Pump

Weight gain
Diabetic ketoacidosis (DKA)
Expense
Device attached to body at all times
Extensive education required
Infection resulting from improper care

Pump Features
Basal rates, battery life, degree of water resistance
Pump provides both basal & bolus delivery
Daily dose:
4050% for basal
5060% for bolus insulin
Education about nutrition, frequent BS monitoring

Blood Pressure Monitoring

Hypertension (high blood pressure) major risk factor

for:
heart disease
stroke
congestive heart failure
kidney disease

Hypertension management
monitoring blood pressure

Blood Pressure
Home blood pressure monitoring
Adjustments in lifestyle and/or medication therapy
Blood pressure measured in millimeters of mercury

(mmHg)
Normal blood pressure is considered to be <120/80
mmHg.
High blood pressure for adults is defined as
systolic blood pressure of 140 mmHg or higher or
diastolic blood pressure of 90 mmHg or higher

Blood Pressure Monitors

Aneroid blood pressure monitors
built-in stethoscope
gauge with dial where numbers are read
cuff manually inflated
less expensive than digital monitors
require adequate hearing, sight, dexterity

Blood Pressure Monitors

Digital blood pressure monitors are
easy to read
manually or automatically inflated
expensive

extra features, such as printout of blood pressure readings

accuracy affected by body movements/irregular heart

rates
accuracy affected by the size of cuff used

Monitoring Process
1.
2.
3.
4.
5.
6.
7.
8.

Avoid food, caffeine, tobacco, alcohol for 30 minutes

Sit quietly for 35 minutes in comfortable position
Rest your arm, at level of your heart, on table
Place arm cuff over brachial artery
Measure blood pressure by following directions
Remain quiet while taking your blood pressure
Write measurements down in your own log
Take repeat reading 23 minutes after 1st one to check
accuracy

Heart Rate Monitoring

Measure heart rate in real time while physically active
Normal heart rate ranges for adults, 60100 beats per min
Heart beat detected radio signal transmitted
Regular physical activity can
improve blood glucose control
reduce cardiovascular risk factors
contribute to weight loss
improve well-being

Pedometers
Records each step-detects motion of the hips
Recommended number of steps per day- 10,000
Microelectromechanical system (MEMS)
inertial sensors & sophisticated software
Pedometer should be worn on belt
Simplest pedometers-only count steps
Complex pedometers
calorie estimates, clocks, timers, stopwatches, speed
estimators, 7-day memory, heart rate

Measuring Cholesterol
High cholesterol-modifiable risk factor for heart disease
60% of all adults have high cholesterol (>200mg/dL)
> 1 of every 5 adults have > 240 mg/dL

Home testing of cholesterol

determine health risk status for heart disease

Cholesterol kits use blood sample from fingerstick

Results within 1015 minutes

Measuring Hemoglobin A1c

Average blood glucose control for past 23 months
Patients may want to monitor their hemoglobin A1c

levels between physician visits

Blood sample obtained from fingertip using lancet
Samples must be mailed to reference laboratory
Results are sent back to the patient by mail, by fax, or
electronically

HIV Testing
Rate of HIV in US rapidly increasing
21% undiagnosed & unaware of their HIV status
Body forms antibodies to virus between 6 weeks & 3

months after infection with HIV virus

HIV test in privacy of home
concern for maintaining confidentiality
results are retrieved by calling toll-free number
kit is considered to be 99.9% accurate

Pregnancy/Ovulation Testing
Home pregnancy test
use drop of urine on test strip
detects human chorionic gonadotropin (hCG)
positive result-color change or symbol appears
false-negative results if tests very early in pregnancy
Ovulation testing-used in family planning
determines when woman is most fertile
ovulation predictor tests detect monthly luteinizing
hormone (LH) surge

Orthopedic Devices
Orthopedic devices are DME
used by patients of all ages
braces, supports, splints
used for rehabilitation & pain management
Orthotic devices
prevent or correct physical deformity or malfunction
Some braces & supports require custom-fitting with

assistance of certified orthotist

Ostomy Products
Ostomy is a surgically created opening in body
Sigmoid or descending colostomy
most common type of ostomy surgery
certain types of cancer of bowel or anus
Stoma
passage through abdominal wall
Patients must learn how to care for stoma & to keep

area clean

Other -ostomies
Ileostomy
involves small intestine
ileoanal reservoir (also known as J-Pouch)

most common alternative to conventional ileostomy

Urostomy
diverts urine from bladder
reservoir or pouch in abdomen
pouch systems include

skin barrier & collection pouch