Tale of two sites: capillary versus arterial blood glucose testing in the operating room

Akinbami, Felix O.; Segal, Scott; Schnipper, Jeffrey L.; Stopfkuchen-Evans, Matthias; Mills, Jonathan; Rogers, Selwyn O.

doi:10.1016/j.amjsurg.2011.10.013

Cited by 11 publications

(8 citation statements)

References 19 publications

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“…It is known that capillary testing should be avoided in patients with haematocrit levels <25% or >60%, in shock, with severe dehydration and when vasoactive agents such as norepinephrine are given [38][39][40]. However, for most surgical patients, phlebotomy or arterial access is not routine [41]. In hemodynamically stable patients the capillary glucose meter correlates well with laboratory reference values [7] and is strongly correlated with arterial samples [41].…”

Section: Discussionmentioning

confidence: 99%

“…However, for most surgical patients, phlebotomy or arterial access is not routine [41]. In hemodynamically stable patients the capillary glucose meter correlates well with laboratory reference values [7] and is strongly correlated with arterial samples [41]. Also, the laboratory plasma values generally provide little additional information for non-ICU patients and typically lower the mean glucose [42].…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative Glycaemia Following Paracetamol with and without Glucose: A Randomized-Controlled Trial

Pereira¹,

Gonçalves²,

Costa³

et al. 2013

IJCM

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Background: Hyperglycaemia is conversely a risk factor for perioperative complications. We are currently using a generic 3.3 g glucose containing formula of intravenous 1000 mg paracetamol for perioperative analgesia. Our main goal was to compare the trends of glycaemic values after administration of a generic 3.3 g glucose containing formula with a non-glucose containing branded formula of intravenous 1000 mg paracetamol. Methods: A exploratory proof-of-concept randomized clinical trial was conducted with 150 patients scheduled for elective gynaecologic. Patients were randomly assigned into three groups: control group (saline); active-control group: intraoperative administration of a branded non-glucose containing 1000 mg paracetamol formula; experimental group: intraoperative administration of a generic 3.3 g glucose containing 1000 mg paracetamol formula. The primary outcome was mean change from baseline in glaucoma. In case significant differences were found, the following secondary outcomes were explored: the proportion of patients with high glycaemia values (>150 mg/dL) and the proportion of patients with negative glycaemic variation. Results: Mean glycaemia change was higher after generic 3.3 g glucose containing paracetamol formula both in comparison to placebo (16.3 mg/dL [95% CI: 6.1 to 26.6]) and active-control (19.1 mg/dL [8.2 to 30.0] groups. Similar results were found in the intention-to-treat analysis. In only the experimental group, patients had high glycaemic values (11.3%). Conclusions: This study showed that in non-diabetic, under non-cardiac surgery, administration of a generic glucose-containing formula of intravenous 1000 mg paracetamol was associated with poorer glycaemic control. These results raise the question of a possible increased risk among these patients. Further studies using diabetic patients are recommended.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intraoperative Glycaemia Following Paracetamol with and without Glucose: A Randomized-Controlled Trial

Pereira¹,

Gonçalves²,

Costa³

et al. 2013

IJCM

View full text Add to dashboard Cite

show abstract

“…26,27 In patients undergoing major surgery, arterial and capillary glucose samples are strongly correlated with each other. 28 Intraoperative CGM and capillary glucose trends correlate well with each other, though CGM values may overestimate capillary values by up to 20 mg/dL. 26,29 Intraoperative signal loss from CGMs is also commonly reported, particularly around induction and during use of electrocautery.…”

Section: Automated Insulin Deliverymentioning

confidence: 95%

“…CGM data may be particularly useful in operations in which tight glucose control is necessary, as glucose trends can be detected earlier than with intermittent glucose sampling 26,27 . In patients undergoing major surgery, arterial and capillary glucose samples are strongly correlated with each other 28 . Intraoperative CGM and capillary glucose trends correlate well with each other, though CGM values may overestimate capillary values by up to 20 mg/dL 26,29 .…”

Section: Error 2: Failure To Understand Diabetes Technologymentioning

confidence: 99%

Error traps in the perioperative management of children with type 1 diabetes

Hoagland,

Duggar,

Hamrick

et al. 2023

Pediatric Anesthesia

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Patients with type 1 diabetes mellitus (T1D) require insulin administration at all times to maintain euglycemia and metabolic stability. Insulin administration in the perioperative period is complicated by fasting requirements and perioperative stressors that can change the patient's insulin needs. In addition, many anesthesia providers are not familiar with insulin dosing strategies and technology, such as insulin pumps and continuous glucose monitors (CGMs), that are commonly used by patients with T1D. Errors in perioperative insulin administration can lead to hypoglycemia, hyperglycemia, and diabetic ketoacidosis. This article reviews common errors of associated with the perioperative management of patients with T1D, including failure to assess and coordinate patient care preoperatively; failure to understand diabetes management and technology; failure to monitor blood glucose and recognize dysglycemia; and failure to appropriately administer basal insulin.

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“…One study of 50 postoperative cardiovascular surgery patients demonstrated high correlation in capillary glucose sampling,(6) while others have shown poor correlation in cardiopulmonary resuscitation (CPR),(7) shock states,(5, 8) presence of edema,(9) and following major surgery. (9, 10) The small sample sizes in these studies and the conflicting results support the need for further study in populations with compromised peripheral perfusion.…”

mentioning

confidence: 92%

Suitability of Capillary Blood Glucose Analysis in Patients Receiving Vasopressors

Ellis

Benjamin²,

Cornell³

et al. 2013

American Journal of Critical Care

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Background Glycemic control in critically ill patients decreases infection and mortality. While capillary blood glucose values are accurate in normotensive patients and correlate with arterial samples, patients on vasopressors have altered peripheral perfusion that may affect accuracy of capillary blood glucose values tested using point of care devices. Objectives To compare capillary and arterial blood samples using point of care testing (POCT) with arterial blood samples using the clinical chemistry lab in patients following cardiothoracic surgery, and to determine if vasopressor medications or diminished peripheral perfusion influenced the accuracy of POCT values. Methods In a prospective, convenience sample (n=50) of adult post-operative cardiothoracic patients on insulin and vasopressors, samples (n=162) were obtained simultaneously from capillary and arterial sites during insulin infusion and tested on both POCT and clinical chemistry lab, respectively. Quality of peripheral perfusion was recorded using a standardized scale. Clarke error grid analysis and ISO 15197 were used to analyze the level of agreement between the three samples. Two-way ANOVA was used to analyze differences in blood glucose values with respect to vasopressor use and peripheral perfusion. Results An unacceptable level of agreement was found between the capillary POCT and arterial samples tested in the clinical chemistry lab (only 88.3% of values fell in Zone A, or within the ISO 15197 tolerance bands). Arterial POCT showed 94.4% agreement with the clinical chemistry lab. Vasopressor use demonstrated a statistically significant effect on the accuracy of arterial blood glucose values (F=15.01; p= .0001). Conclusions Capillary POCT is not within acceptable limits of agreement with the clinical chemistry lab. Even when using the more accurate arterial blood with POCT, patients with >2 vasopressors demonstrate significantly less accuracy as compared to patients on fewer vasopressors. Using the clinical chemistry lab may be safer for insulin titration in these patients.

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Tale of two sites: capillary versus arterial blood glucose testing in the operating room

Cited by 11 publications

References 19 publications

Intraoperative Glycaemia Following Paracetamol with and without Glucose: A Randomized-Controlled Trial

Intraoperative Glycaemia Following Paracetamol with and without Glucose: A Randomized-Controlled Trial

Error traps in the perioperative management of children with type 1 diabetes

Suitability of Capillary Blood Glucose Analysis in Patients Receiving Vasopressors

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