Agreement of blood glucose measured with glucose meter in arterial, central venous, and capillary samples in adult critically ill patients

Abstract

Background: The measurement of blood glucose in critically ill patients is still performed in many ICUs with glucose meters and capillary samples. Several prevalent factors in these patients affect the accuracy of the results and should be interpreted with caution. A weak recommendation from the Surviving Sepsis Campaign (SSC) suggests the use of arterial blood rather than capillary blood for point of care testing using glucose meters. Aims and objectives: To analyse the agreement between arterial, central venous, and capillary blood samples of glucose values measured by glucose meter in critically ill patients and study potential confounding factors. Design: Prospective cross-sectional study in a general intensive care unit (ICU). Patients needing insulin treatment (subcutaneous or intravenous) and blood glucose control were included. Methods: Standardized collection of blood samples and measurement of glucose values with a glucometer. Agreement was studied by the Bland-Altman method and stratified analysis of disagreement-survival plots was used to study the influence of haematocrit, pH range, SOFA score, capillary refilling time, intravenous insulin infusion, and lactic acid.Results: A total of 297 measurements from 54 patients were included. The mean arterial blood glucose was 150.42 (range 31-345 mg/dL). In the graphical analysis, there is a poor agreement both in capillary and venous central to arterial samples, but in opposite direction (underestimation of capillary and overestimation of central venous). Factors associated with a reduction in the agreement between arterial and capillary samples were elevated lactate, poor capillary refilling, and hemodynamic failure. Patients without hemodynamic compromise have an acceptable agreement with values for absolute differences of 16 mg/dL for a disagreement of 10%. Conclusions:In critically ill patients, the measurement of blood glucose with a glucose meter should be performed with arterial samples whenever possible. Capillary samples do not accurately estimate arterial blood glucose values in patients with

Peri‐dialytic hypoglycemia with hemodialysis and online post‐dilutional hemodiafiltration

“…Subcutaneous monitoring devices have reported more episodes of hypoglycemia in diabetic patients during dialysis compared to when not treated by dialysis [2,12,24]. However, as there are changes in the circulation during dialysis, with a reduction of blood supply to the skin and subcutaneous tissues, this could lead to a reduction in subcutaneous glucose concentrations compared to venous blood measurements [25].…”

“…No patient was symptomatic. Peri‐dialytic hypoglycemia has been reported to be associated with increased morbidity and mortality [23], and could potentially be misdiagnosed as hypovolemia, dialysis disequilibrium or electrolyte imbalances. Historically, reports of peri‐dialytic hypoglycemia were first described in nondiabetic patients, but these reports predominantly came from centers using glucose free dialysates [3, 24].…”

American Association for the Surgery of Trauma/American College of Surgeons—Committee on Trauma Clinical Consensus-Driven Protocol for glucose management in the post-resuscitation intensive care unit adult trauma patient

“…Therefore, hypoglycemia measured by fingerstick whole blood or hyperglycemia measured by central venous blood may be erroneous and should be confirmed by arterial blood sampling if there is clinical question of appropriateness of treatment. These differences can be significant and vary based on several patient-related factors, but even in patients without hemodynamic failure, 10% of patients have a difference of 16 mg/dL or greater between arterial and fingerstick measurements, and 10% of patients have a difference of 44 mg/dL or greater between arterial and central venous measurements 21 . The SCCM task force CPG recommends, with a moderate level of evidence, the use of arterial or venous BG measurements instead of fingerstick for patients in shock, on vasopressors, with severe peripheral edema, or on prolonged insulin infusion.…”

Spotlight on the first joint BACCN/IACCN conference

“…A Chinese team evaluated the reliability of acid-base and electrolyte monitoring through circuit lines in patients receiving continuous renal replacement therapy with regional citrate anticoagulation, 7 whereas a team from Spain compared glucose level measurements from arterial, central venous and capillary samples. 8 Respiratory care also features prominently in this issue. Guner and Kutluturkan's randomized controlled trial adds to the growing body of evidence about the optimum angle of the head of bed elevation that is safe and effective in the prevention of ventilator-associated pneumonia, 9 while Burey et al investigated the feasibility of alveolar collapse analysis by measuring lung impedance distribution by nurses caring for patients with acute respiratory distress syndrome.…”

“…This issue features clinical studies assessing the accuracy of two very important sets of biochemical investigations used by critical care nurses. A Chinese team evaluated the reliability of acid–base and electrolyte monitoring through circuit lines in patients receiving continuous renal replacement therapy with regional citrate anticoagulation, 7 whereas a team from Spain compared glucose level measurements from arterial, central venous and capillary samples 8 …”