[Furoffire]

I'm reviewing various gtts and came acrcoss the insulin one.

It says "when changing, flush 50 ml of solution through tubing to saturate binding sites."

Does this mean to flush w/ NS first and every time new tubing and gtt is changed?

Don't completely understand?

Kit

[travelnurse63]

I learned about this working on a Pediatric floor. ALWAYS flush the tubing with NS prior to initiating an insulin drip. In simple terms(freq the books make things complicated- like saturate the binding sites)Using NS prevents the insulin from binding with other solutions ie: D5W. Insulin also sticks to the walls of the tubing and even though you have a drip set @ a certain rate they will only be receiving what is not "stuck" on the tubing..as in a lower dose.
If you are ever in doubt just ask someone..I still do.

[nursepearl]

You flush 50cc of the insulin through the tubing so the insulin will bind to the recpetor sites and when you begin your infusion you will be sure the pt is getting the insulin as opposed to it binding to the tubing.

[BittyBabyGrower]

We have albumin added to our insulin drips so that the insulin won't bind with the tubing. I have never heard of flushing the line first.

[Ann RN]

Originally Posted by BittyBabyGrower

We have albumin added to our insulin drips so that the insulin won't bind with the tubing. I have never heard of flushing the line first.

What concentration do you use for your insulin drips? How much albumin & what percent so you use? How does the albumin prevent binding?

Thanks.

[mrmag]

The following may be more than what you wanted but it does indicate that flushing IV tubing with the insulin solution will have impact on what the patient initially receives providing a more consistent insulin infusion.

Sorption – the absorption of insulin to the surfaces of IV infusion solution containers, glass and plastic, tubing and filters

Absorption of insulin to container surfaces is instantaneous[1],[2],[3],[4]

The effect of absorption on the deliverable amount of insulin varies with time. Initial drop of delivered insulin, most absorption in the first 30-60 minutes, plateau of delivered insulin may be reached earlier with faster flow rates 3,[5],[6],[7],[8],[9],[10],[11]

Flushing IV administration system with the insulin solution to saturate the tubing prior to administration 9,[12]

Adding extra insulin to compensate for absorption[13]

Use syringe pump with short tubing to reduce surface area[14]

Absorption has no effect on success of therapy[15],[16]

May be relevant less than 100-200 units/L 7,8,9,[17]

When the IV dose is used to determine subcutaneous dose can result in wrong dose because the actually dose administered is less than the apparent dose[18]

Patient monitoring and making appropriate adjustments[19]

Potential variations in concentration[20]

[1] Petty C, Cunningham NL: Insulin absorption by glass infusion bottles, polyvinylchloride infusion containers, and intravenous tubing, Anesthesiology 40;400-404 (Apr) 1074.

[2] Weber SS, Wood WA, Jackson EA: Availability of insulin from parenteral nutrient solutions, Am J Hosp Pharm 36;330-337 (Mar) 1079.

[3] Twardowski ZJ, Nolph KD, McGary TJ, et al.: Insulin binding to plastic bags: a methodologic study, Am J Hosp Pharm 40;575-579 (Apr) 1983.

[4] Twardowski ZJ, Nolph KD, McGary TJ, et al.: Nature of insulin binding to plastic bags, Am J Hosp Pharm 40;579-582 (Apr) 1983.

[5] Goldberg NJ, Levin SR: Insulin absorption to an inline filter, N Engl J Med 298;1480 (June 29) 1978.

[6] Hirsch JI, Fratkin MJ, Wood JH, et al.: Clinical significance of insulin absorption by polyvinyl infusion systems, Am J Hosp Pharm 34:583-588 (June) 1977.

[7] Whalen FJ, LeCain WK, Latiolais CJ: Availability of insulin from continuous low-dose insulin infusions, Am J Hosp Pharm 36;330-337 (Mar) 1979.

[8] Peterson L, Caldwell J, Hoffman J: Insulin absorption to polyvinyl chloride surfaces with implications for constant-infusion therapy, Diabetes 25;72-74 (Jan) 1976.

[9] Wingert TD, Levin SR: Insulin absorption to air-eliminating inline filter, Am J Hosp Pharm 38;382-383 (Mar) 1981.

[10] Hirsch JI, Wood JH, Thomas RB: Insulin absorption to polyolefin infusion bottles and polyvinyl administration sets, Am J Hosp Pharm 38;995-997 (July) 1981.

[11] Kerchner J, Cocaluca DM, Juhl RP: Effect of whole blood on insulin absorption onto intravenous infusion systems, Am J Hosp Pharm 37;1323-1325 (Oct) 1980.

[12] Furberg H, Jensen AK, Salbu B: Effect of pretreatment with 0.9% sodium chloride or insulin solutions on the delivery of insulin from an infusion system, Am J Hosp Pharm 43:2209-2213 (Sept) 1986.

[13] Kane M, Jay M, DeLuca PP: Binding of insulin to a continuous ambulatory peritoneal dialysis system, Am J Hosp Pharm 43;81-88 (Jan) 1986.

[14] Allwood MD: Sorption of drugs to intravenous delivery systems, Pharm Int 4;83-85 (Apr) 1983.

[15] Page MM, Alberti KGMM, Greenwood R, et al.: Treatment of diabetic coma with continuous low-dose infusion of insulin, Br Med J 2;687-690 (June 29) 1974.

[16] Clark BF, Campbell IW, Fraser DM: Direct addition of small doses of insulin to intravenous ub\nfusion in severe uncontrolled diabetes, Br Med J 2:1395-1396 (Nov 26) 1977.

[17] Weber SS, Wood WA: Insulin absorption controversy, Drug Intell Clin Pharm 10:232-233 (Apr) 1076.

[18] Butler LD, Munson JM, DeLuca PP: Effect of inline filtration on the potency of low-dose drugs, Am J Hosp Pharm 37:935-941 (July) 1980.

[19] Seres DS: Insulin absorption to parenteral infusion systems: case report and review of the literature, Nutr Clin Pract 5:111-117 (June) 1990.

[20] Bergman N, Vellar ID: Potential life-threatening variations of drug concentrations in intravenous infusion systems-potassium, chloride, insulin, and heparin, Med J Aust 2:270-272 (Sept 18) 1982.

[tridil2000]

Originally Posted by nursepearl

You flush 50cc of the insulin through the tubing so the insulin will bind to the recpetor sites and when you begin your infusion you will be sure the pt is getting the insulin as opposed to it binding to the tubing.

are you saying you flush your line with *50* ccs of insulin prior to running the infusion through. regular insulin?... like a whole vial????

wouldn't there be significant residual in your tubing? do your pts ever bottom out?????

[Gompers]

Originally Posted by tridil2000

are you saying you flush your line with *50* ccs of insulin prior to running the infusion through. regular insulin?... like a whole vial????

wouldn't there be significant residual in your tubing? do your pts ever bottom out?????

You don't use a vial. Pharmacy (or the nurses in some hospitals) prepares an "insulin drip" which is an IV bag full of fluid with insulin added into it. You spike IV tubing with this bag, run the fluid through, clamp it off, and then let it sit for 30 minutes. After that, you unclamp it and let more fluid run through, then you can attach it to your patient's IV. It will be run on an IV pump and you will get orders at what rate to set the insulin at. After getting blood sugars on your patient, either the doctor will order a change in the IV flow rate to provide more or less insulin, or sometimes you might have standing orders to do this.

Our IV pump tubing is 40cc in volume - it will say exactly how much on the tubing package. So we run the insulin drip through, then after 30 minutes, we place the end of the IV tubing inside a sterile container (like a urine collection cup) and run it until it hits the 40cc mark. We used to just fill the buretrol up to measure, but our new tubing doesn't have them.

[LoveTheNICU]

In my unit, we get insulin from pharmacy premixed with a dextrose solution (the concentration is particular to the baby, usually between D5W-D10W), as well as albumin. The albumin greatly reduces, but does not eliminate, the ability of the insulin to adhere to things. It comes in a glass bottle, to prevent the insulin from sticking to the plastic bottle. In order to prevent the insulin from sticking to the plastic tubing, we run 50 mls out into a graduated cylinder prior to initiating the drip. The rationale is that any insulin that was going to stick to the tube would do so in those first 50 mls, and therefore the patient is receiving the proper insulin dose for the rest of the drip. Prior to this, the nurses were seeing sugars actually INCREASE with insulin drips, because all the insulin was sticking to the tubing and we were running straight dextrose solution.

[abrock82]

I learned in nursing school to use the low absorption tubing (the same used for nitroglycerin), and have had good results. Has anyone else tried this?