The practical management of glucose-insulin infusions in the intensive care patient

McWilliam, David

doi:10.1007/bf01683359

Cited by 6 publications

(2 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the study the dose of insulin was adjusted by intensive care nurses assisted by a study physician. Other published protocols for intravenous insulin infusions have either had a higher target range of blood glucose 4,5 or have not been evaluated in critical illness [6][7][8][9][10][11][12] . To alleviate the need for clinical judgement (and the inherent errors evoked) in deciding insulin doses when using intensive insulin therapy, a simple prescriptive protocol was developed to enable ICU bedside nursing staff alone to control blood glucose between 4 and 7 mmol/l.…”

mentioning

confidence: 99%

Implementing Intensive Insulin Therapy: Development and Audit of the Bath Insulin Protocol

Laver

Preston

Turner

et al. 2004

Anaesth Intensive Care

View full text Add to dashboard Cite

Intensive insulin therapy to control blood glucose has been found to reduce mortality among critically ill patients in a surgical intensive care unit, though a simple prescriptive insulin infusion protocol to achieve this has not been published previously. This study documents the development and routine use of a simple prescriptive intravenous insulin infusion protocol for critically ill patients and compares the results with previous practice. During development the protocol was optimized and practical issues of implementation addressed. The optimized protocol was then used for all ICU admissions, and a prospectively defined retrospective chart audit performed for the first month of use. Results were compared with a similar time period the previous year. In September 2002, 27 admissions were started on the protocol. Blood glucose for the time on the protocol had a median value of 6.2 (IQR 5.9-7.1) mmol/l compared with 9. 2 (IQR 8.1-10.2) mmol/l for those on insulin in 2001. Blood glucose for the whole ICU stay for those on the protocol in 2002 had a median value of 6.6 (IQR 6.0-7.4) mmol/l compared with 8.6 (IQR 8.0-9.4) mmol/l in 2001. Blood glucose for all ICU patients in 2002 ) mmol/l in 2001.Three blood glucose recordings were less than 2.2 mmol/l in September 2002. This study provides initial effectiveness and safety data for the Bath Insulin Protocol. Further audits in a larger patient population are now needed.

show abstract

mentioning

confidence: 99%

Implementing Intensive Insulin Therapy: Development and Audit of the Bath Insulin Protocol

Laver

Preston

Turner

et al. 2004

Anaesth Intensive Care

View full text Add to dashboard Cite

show abstract

“…The Van Den Berghe study protocol (Van Den Berghe et al ., 2001) for IIT provided guidance rather than strict instructions on insulin doses and required clinical judgements to be made while it was used. Other published protocols for intravenous insulin infusions have either had a higher target range of blood glucose (Woolfson, 1980; Brown and Dodek, 2001) or have not been evaluated in critical illness (McWilliam, 1980; George et al ., 1982; Thomas et al ., 1984; Watts et al ., 1987; Hendra and Yudkin, 1992; Malmberg et al ., 1994; Umpierrez et al ., 1997). To remove the need for clinical judgement (and the inherent errors it evokes), we decided to develop a nurse‐lead prescriptive insulin infusion protocol to be used for IIT on all of our critical care patients.…”

Section: Introductionmentioning

confidence: 99%

Introducing intensive insulin therapy: the nursing perspective

Preston

Laver²,

Lloyd³

et al. 2006

Nursing in Critical Care

View full text Add to dashboard Cite

Intensive insulin therapy (IIT) for the management of high blood glucose can reduce mortality and morbidity in the critically ill. However, there is little published literature on how to implement it successfully. The aim of this study is to chronicle the development and difficulties encountered in implementing an IIT protocol in a critical care unit in a district general hospital. A nurse-led protocol was developed. Qualitative audit was undertaken during development and implementation to identify potential problems with using the Bath Insulin Protocol. Regular feedback sessions were introduced to encourage change and further identify problem issues. Qualitative audit led to changes in practice for individual nurses and changes to other unit protocols. The main change for individual nurses was to measure blood glucose hourly using a bedside glucometer. The unit's feeding and drug dilution policies were identified as a potential cause of glucose instability and were modified. To implement IIT successfully, it is necessary to consider changing working practices and to identify other unit protocols which can cause glucose instability. The additional nursing workload must be considered and appropriate means of supporting staff identified.

show abstract

Control of blood glucose during nutritional support in Ill patients

Woolfson

1980

Intensive Care Med

View full text Add to dashboard Cite

The traditional "Sliding Scale" is an inefficient and unreliable way of controlling blood glucose levels in ill patients receiving nutritional support in the Intensive Care Unit. In these patients, it is necessary to reassess insulin requirements frequently in the light of changing clinical circumstances. A significant improvement in control can be achieved by using a dynamic scale of instructions for changing the insulin dose rather than one of arbitrary dose levels. This scale adapts to any changes that occur without needing to be rewritten. It avoids confusion due to a proliferation of prescription charts, and has been readily accepted by nursing staff.

show abstract

The practical management of glucose-insulin infusions in the intensive care patient

Abstract: Intensive Care patients given intravenous infusions of strong glucose often develop hyperglycaemia requiring insulin. A simple method is described for regulating these insulin requirements during infusions of 50% glucose based on beside monitoring of blood glucose.

Cited by 6 publications

References 14 publications

Implementing Intensive Insulin Therapy: Development and Audit of the Bath Insulin Protocol

Implementing Intensive Insulin Therapy: Development and Audit of the Bath Insulin Protocol

Introducing intensive insulin therapy: the nursing perspective

Control of blood glucose during nutritional support in Ill patients

Contact Info

Product

Resources

About