[morta]

Hi, friends.

Do you use insulin perfusions, in recent surgery patients?

We use it, and we take a control q 3 h, by glycemia level between 80 and 110 mg/dl

Now, the infusion tube and bag are ultraviolet opaque and we change iv tube every time the infusion bag is change.

what in your SICU??

HOLA AMIGOS.

¿UTILIZAIS PERFUSIONES DE INSULINA EN PACIENTES QUIRURGICOS?

NOSOTROS HACIEMOS CONTROLES DE GLUCEMIA CADA TRES HORAS PARA CONSEGUIR NIVELES ENTRE 80 Y 110 mg/dl.

AHORA, ADEMAS PROTEGEMOS EL SISTEMA DE PERFUSION Y EL RECIPIENTE DE LA LUZ Y CAMBIAMOS TODO CADA VEZ QUE SE VACIA EL RECIPIENTE.

EN TU UNIDAD ¿TAMBIEN LO HACEIS?

[TraumaNurse]

The most recent research suggests patient outcomes are greatly improved if blood glucose levels are kept within a tight range. Our facility keeps glucose levels between 80 - 120. We use Insulin gtts on almost every patient and check glucose levels every 1-2 hours or more frequently if needed.

[zambezi]

In our CCU we have strict blood sugar controls after heart surgery. If BS >150, pt gets started on an insulin gtt...we have a whole long protocol on how to titrate (by percentages) and how often to do cbs checks, as often and q1hr (q.5 hr is dramatic drop) depending on how frequently we are titrating the insulin gtt. Our goal is to keep cbs 90-120 but anything less than 150 is acceptable. Now that we are used to it, it is not too bad, but can get busy if you have two pts on q1hr cbs checks.

[helix]

That is interesting. We don't have anything like that and could probably use it. Who initiated the protocols for your institutions? Was it nursing or physicians or both? Did you have certain physicians that began doing this and then others followed? Could you refer me to some research so that maybe I could get it started at our facility?

Thanks,
Helix

[morta]

The text that you are looking for is in http://content.nejm.org/cgi/content/...ct/345/19/1359

NEJM Volume 345:1359-1367 November 8, 2001 Number 19

The protocol was initiated by physicians but its a nurse work.

morta

[gwenith]

Thank-you Morta and welcome to the board!!

[pghfoxfan]

When our patients are on Insulin drips, we do blood sugars every 1 hour.

Just a reminder that Insulin will adhere to the IV tubing so remember to waste about 30 or so cc's before starting the drip.

We tried to keep the blood sugars below 150.

[Chttynurs]

All diabetics on our unit go in insulin gtts post op and we have a written protocol, every one hour, half hour when they go too low until they come up again. Big improvement in post op infection and healing rates!

[pghfoxfan]

Ditto with us...but what a freekin pain in the ass!

[Tenesma]

some of the initial studies were done at my institution (MGH) in conjunction w/ the european groups --- and now in our ICU we are moving away from the 80-120 BS parameters towards 110-150 - primarily due to the higher incidence of hypoglycemic episodes with such tight control.... and we find that the infection/comorbidities are just as good with the slightly higher range, minus the worry for hypoglycemia