Accuracy of bedside capillary blood glucose measurements in critically ill patients

Critchell, C. Dana; Savarese, Vincent W.; Callahan, Amy; Aboud, Christine; Jabbour, Serge; Marik, Paul E.

doi:10.1007/s00134-007-0835-4

Cited by 144 publications

(104 citation statements)

References 21 publications

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“…33,[35][36][37][38] Bedside glucometer readings in critically ill patients result in overestimates of blood glucose level [39][40][41][42] and lack precision 2,18,32,34,43 for a variety of reasons: fluid accumulation in the fingertips, poor peripheral perfusion due to shock or administration of vasopressors, anemia, sample volume insufficient for analysis, or sampling method used. 20 In addition, glucometers must be calibrated frequently, but such calibration capillary samples from patients receiving intravenous insulin therapy and the third in a capillary sample from a patient receiving subcutaneous insulin therapy.…”

Section: Resultsmentioning

confidence: 99%

Hypoglycemic Events in Intensive Care Patients: Analysis by Insulin Administration Method and Sample Type

Torredà

Pérez²,

Aragón³

et al. 2011

American Journal of Critical Care

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Background Intensive insulin treatment is associated with an increased risk of hypoglycemia, so strict glycemic monitoring is essential. The best type of sample for identifying hypoglycemia remains under debate. Objectives To establish the number of hypoglycemic events in intensive care patients relative to insulin administration method and the method used to collect the blood sample. Methods Retrospective descriptive study lasting 6 months. Hypoglycemia was defined as a blood glucose level less than 80 mg/dL (mild: 50-79 mg/dL, severe: <50 mg/dL), measured with a bedside glucometer and blood from the arterial catheter or fingerstick, in critically ill patients who require insulin administered subcutaneously (with sliding scales) or via continuous intravenous perfusion (intense infusion protocol with a nurse-managed insulin therapy algorithm). Results Analysis of the 6636 samples from 144 critically ill patients revealed 188 mildly hypoglycemic samples (2.8%) and 3 severely hypoglycemic samples (0.04%). The prevalence of mild hypoglycemia was greater when insulin was administered intravenously (3.2%) rather than subcutaneously (2.3%; P = .04). Among patients receiving insulin intravenously, hypoglycemia was found more often in arterial (4.5%) than in capillary (2.8%) blood (P = .01). The prevalence of hypoglycemia in capillary blood samples did not differ significantly between subcutaneous (2.3%) and intravenous (2.8%) insulin therapies (P = .21). Conclusions With a target blood glucose level of 110 to 140 mg/dL, few hypoglycemic events are detected in critically ill patients, regardless of whether insulin is administered intravenously or subcutaneously. Analysis of solely arterial samples may yield a higher prevalence of hypoglycemia than otherwise.

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Section: Resultsmentioning

confidence: 99%

Hypoglycemic Events in Intensive Care Patients: Analysis by Insulin Administration Method and Sample Type

Torredà

Pérez²,

Aragón³

et al. 2011

American Journal of Critical Care

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“…The sensitivity of these methods is likely to be highest at blood glucose levels in diabetic range and may drop at extreme values. In intensive care units, a number of potential inaccuracies may arise because of presence of metabolic acidosis , hypoxia (Tang et al, 2001), hypoperfusion www.intechopen.com (Atkin et al, 1991) or edema (Critchell et al, 2007). If the devise uses glucose oxidase method, it may give abnormally low glucose values at high blood oxygen levels (Tang et al, 2001).…”

Section: Devices For Screening Of Blood Glucosementioning

confidence: 99%

An Update on Neonatal Hypoglycemia

Kumar¹,

Saini²

2011

Hypoglycemia - Causes and Occurrences

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“…Numerous researchers 50,51 have evaluated the differences between glucose values obtained by analyzing various blood sources and have shown a general disagreement between testing sources; however, no recommendation is available on the optimal method for evaluating a patient's true blood glucose level.…”

Section: Future Directionsmentioning

confidence: 99%