Is nurse-managed blood glucose control in critical care as safe and effective as the traditional sliding scale method?

Adams, Gary G.; Hunter, Jo; Langley, Jane

doi:10.1016/j.iccn.2009.09.002

Cited by 10 publications

(10 citation statements)

References 40 publications

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“…20,29 In addition, despite having a similar study protocol, different centers in other clinical trials had different routines for sampling and analysis of blood glucose levels 10,17,30,31 or considered capillary and arterial blood samples to be interchangeable for purposes of analysis. 12,13,20,21,31,32 Our study addresses this gap in the literature by comparing blood glucose determinations on the basis of the type of sample analyzed. Differences between the 2 groups were found only when we included arterial samples in the analysis (as in the previous studies).…”

Section: Resultsmentioning

confidence: 99%

“…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%

“…19 Therefore, hypoglycemia was considered as a blood glucose level less than 80 mg/dL, with a value of 50 to 80 mg/dL categorized as mild hypoglycemia and less than 50 mg/dL as severe hypoglycemia 20,21 because our IIP requires intravenous insulin at this value to prevent the neurological complications associated with hypoglycemia, even if the patient is asymptomatic.…”

Section: Methodsmentioning

confidence: 99%

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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%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

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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“…Diese Form des Typ-1-Diabetes ist mit hoher Penetranz vererbbar, tritt sehr selten und überwiegend bei Patienten mit asiatischem oder afrikanischem Hintergrund auf [Imagawa 2000, EK III]. 1…”

Section: Idiopathischer Typ-1-diabetesunclassified

S3-Leitlinie Therapie des Typ-1-Diabetes

2018

Diabetologie und Stoffwechsel

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“…[3][4][5][6] Although the pOC glucometer is of particular concern in patients with anemia, [7][8][9] it has been used in numerous studies. 10 In critically ill patients, pressure-monitoring systems connected to indwelling arterial catheters also allow repeated extraction of blood samples. 11 Although this avoids the discomfort associated with fingersticks, it is not exempt from complications 12 and the daily loss of 40 to 70 mL of blood.…”

Section: Intervention Groupmentioning

confidence: 99%

Arterial Catheter Setup for Glucose Control in Critically Ill Patients: A Randomized Controlled Trial

Torredà

Llano-Serrano

Almirall-Solsona

et al. 2014

American Journal of Critical Care

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Background Use of an arterial catheter to obtain hourly blood samples for intensive insulin therapy monitoring avoids causing patients the discomfort of repeated fingersticks. Returning the clearing volume may decrease procedure-related blood loss by 50% and minimize the risk of anemia. Objectives To compare the feasibility of 2 arterial catheter clearing-volume return setups for hourly blood extractions and to evaluate the related complications and the accuracy of arterial samples in determining glycemia.Methods In an open clinical trial, 90 critical patients undergoing intensive insulin therapy who had a radial arterial catheter were randomized to an intervention group-nonwaste needleless setup or nonwaste syringe setup and compared with the standard setup (control group). Mechanical and infectious complications related to the arterial catheter were evaluated. Blood glucose measurements at point-of-care glucometer (arterial catheter or fingerstick sample) were compared with laboratory results (venous blood). Results No patient had catheter-related infection in the intervention group (an estimated 12 776 manipulations); the control group had 2 infection episodes in 5230 catheter-days (an estimated 13 075 manipulations). The incidence of bacterial colonization was not significantly higher in the needleless group than in the syringe group (22.2% vs 12.2%; relative risk, 0.55; 95% CI, 0.16-1.71), with 1778 (SD, 114) and 1918 (SD, 82) catheter manipulations, respectively. Arterial catheter complications were negligible in all patients. Glycemia was detected from arterial catheter samples as effectively as with laboratory results (venous samples) except when hematocrit was less than 25%. Conclusions Use of blood obtained via an arterial catheter is safe and effective for glucose monitoring in patients undergoing intensive insulin therapy, with no increase in complications of catheterization.

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Is nurse-managed blood glucose control in critical care as safe and effective as the traditional sliding scale method?

Cited by 10 publications

References 40 publications

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

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

S3-Leitlinie Therapie des Typ-1-Diabetes

Arterial Catheter Setup for Glucose Control in Critically Ill Patients: A Randomized Controlled Trial

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