[dianah]

Just inquiring, for Cath Lab nurses, what is either your department policy or your practice for when you do accuchecks on diabetics undergoing procedures? At the beginning of a case (if one hasn't been done in X amount of time) ? If a case is lengthy, every hour? Every two hours? Prn? Thanks for any input. -- D

[BJNurse]

Our policy is to get an accucheck on admission for all our same day admissions. If the patient is coming to us from the floor they generally have an accucheck prior to us picking them up, if not we do one prior to the case. We don't have a policy for in case accuchecks but rather just use our common sense. If the pt is showing of s/s of hypoglycemia I will check or if it is a long biventricular pacemaker or extensive plasty I might recheck. I must admit I rarely recheck because most of my patients are in and out in 1-2 hours. Hope that helps.

[dianah]

Appreciate your input, BJ. Our practice is the same as yours. Anyone else? There are no "right" answers, just trying to get a feel for what ppl are doing. Thanks. -- D

[ratchit]

I didn't work cath lab but when I worked Interventional Rad (similar patient populations but cases rarely went as long as 3 hours) our Surgical Day Care area did the AM admit and did an accucheck there. If the patient had done something silly like take their glyburide or NPH I would hang D51/2 instead of 1/2 NS during the case and the PACU would check one postop. They usually did one postprocedure anyway, even though most IR patients were able to eat and drink on arrival to PACU. IR didn't even have our own machine. If the patient came from ICU and was on an insulin drip, they would shut it off an hour before the patient came down, check one (hopefully...) before leaving ICU, then on return. checking one mid-procedure was at their discretion depending on prior values and how labile the patient had been.

In the middle of one case, I was looking at the MARs that fortunately came down with the patient. The floor RN had told me the patient wasn't diabetic.. They wouldn't have been for long- AM fingerstick was 72 and they had given the NPH. If you die from hypoglycemia, are you still a diabetic? <g> Added glucose to the IVF and the ER was kind enough to bring their machine over. The patient was OK.

[dianah]

Thanks ratchit. Reminds me: when I worked Radiology I was called stat to one of the exam rooms (non-interventional), where a pt had collapsed during a routine CXR. It was around 2:00 p.m. Seems the pt had taken his insulin and hadn't eaten all day, and his Accucheck didn't even register. 'Course, while we checked his sugar, we were pushing glucose! He recovered. I hope he got a clue sometime, after that!