Insulin protocol---Q 1 hour accu checks - page 2

Is anyone else dealing with q 1 hour accu-checks and running Insulin drips for every patient with a glucose over 110? This has been happening in my ICU for almost a year. The research supports very... Read More

  1. by   stn2003
    on the floor (cardiac) yesterday who probably would have been in the ICU still except she was moved to our unit bc the hospital was at bed alert red.

    she presented to the ER not feeling well and her blood sugar was 1400!! by the time she came to our floor it was still too high for out glucometers to read it (above 550) and she was on an insulin drip and ordered accuchecks q 1 hr until her bs dropped below 250, at which point we were to call the doc and check the blood sugars thereafter q 6. Poor lady, her fingers looked terrible when i left at the end of the day, and her sugar only ever came down in the 300s while I was there so I'm sure she got poked a bunch more every hour.

    so this particular docs protocal was to check every hour until the sugar was below 250, which is obviously still high. I understand the correlation between blood sugar levels and morbidity/mortality but I am surpised that checks would be ordered on a patient until sugars read 110. That is pretty strict-not saying it is a bad thing.
  2. by   KLARN
    In the ICU I work in we just started the q1h accuchecks so we are working out the kinks, however the patient is not required to have a line of any sort to draw from and YES it is cruel. We have a diabetic patient(not in all cases but most in our ICU)who has potential for poor peripheral vascular circulation and we poke their fingers every hour. We have a new Endocrinologist who does seem to have a grasp on getting these blood sugars under control, but his orders are new and he keeps revising them. The staff are already trying to deal with this change and then the orders change. This is leading to multiple errors as well as blood sugars of 400-40 in a matter of an hour. Hopefully we will get a grasp on this because the studies do indicate its benefits bu tcertain protocols must be initiated as well(arterial lines a must).
  3. by   KimberRN1
    Quote from VAC
    Is anyone else dealing with q 1 hour accu-checks and running Insulin drips for every patient with a glucose over 110?
    This has been happening in my ICU for almost a year. The research supports very tight control of glucose in critically ill patients, but this protocol seems excessive to me. The patient's have necrotic looking fingertips after a few days of this. Is this the new trend everywhere?
    Yep....we're getting it too.... I work at a teaching hospital and have to deal with residents on med teams....based on that new research of critical patients...they really got into putting patients on insulin gtts...and protocol is q 1hr accu checks...other patients is 7, 11, 4, & 9 if they're eating... and 6,12,6,12 for TPN and tube feeds.......In some cases I can see the need for an insulin gtt....but it seems to yo yo a lot of patients...some even bottom out... so it makes me wonder how good can it be?....I glucose of 210 one hour...then < 60 the next.....
  4. by   spitfire
    We also use a insulin drip protocol, if the pt has a cell saver -vamp- I'll use that. if not I often use the ear lobe for a drop of blood - almost all say it is less painful.
  5. by   bluesky
    Quote from spitfire
    We also use a insulin drip protocol, if the pt has a cell saver -vamp- I'll use that. if not I often use the ear lobe for a drop of blood - almost all say it is less painful.
    Learn something new everyday! I'll have to try this. Thanks.

    Our hospital starts the gtt for bg>200 and sticks q 2hrs. Guess that's kind of slacking relative to y'all. The VAMP sounds awesome but I doubt our unit has the cash to get them.
  6. by   rngeorge
    We recently started to use the TGC (tight glucose control) protocol. Unfortunately, we cant use an arterial sample as our glucometer POCT will only take capillary blood. Besides using the finger pads, using the sides of the fingers gives more sites to rotate. Still, q1h is pretty frequent.

    We also use the Edwards vamp system and have found it very useful. It eliminates the need for "discard" in art line samples

    RNG
  7. by   NurseFirst
    Quote from KLARN
    In the ICU I work in we just started the q1h accuchecks so we are working out the kinks, however the patient is not required to have a line of any sort to draw from and YES it is cruel. We have a diabetic patient(not in all cases but most in our ICU)who has potential for poor peripheral vascular circulation and we poke their fingers every hour. We have a new Endocrinologist who does seem to have a grasp on getting these blood sugars under control, but his orders are new and he keeps revising them. The staff are already trying to deal with this change and then the orders change. This is leading to multiple errors as well as blood sugars of 400-40 in a matter of an hour. Hopefully we will get a grasp on this because the studies do indicate its benefits bu tcertain protocols must be initiated as well(arterial lines a must).
    So, this sounds like a bit of science gone mad; nobody is thinking about the consequences, ISTM. Great, we have research studies that say X, and I've heard that as well. However, if we are poking people more who already have poor peripheral circulation....um, can anyone see anything wrong with this picture? Plus, if you are a patient, how can you keep a positive attitude if someone is going to come in every hour and cause you pain? And we know that positive attitudes help to improve outcomes as well.

    NurseFirst
  8. by   Morguein
    Just an update:
    We finally got the VAMP system! yay! Love it! It's awesome! I'm so glad to have learned about it here in this thread.
  9. by   begalli
    Wow!! Moonepie, that's very cool! You said that you "finally got it," but it's actually been just over a month since your post saying that you'd introduce it to your hospital. That's lightening fast if you ask me!

    Way to go!

  10. by   barefootlady
    Better control over glucose levels is more common everyday and fairly common even on med/surg units. Its called advancements in medical and nursing practice.
  11. by   kevagonia
    Quote from VAC
    Is anyone else dealing with q 1 hour accu-checks and running Insulin drips for every patient with a glucose over 110?
    This has been happening in my ICU for almost a year. The research supports very tight control of glucose in critically ill patients, but this protocol seems excessive to me. The patient's have necrotic looking fingertips after a few days of this. Is this the new trend everywhere?
    Yes we've started this as well. 110 doesn't sound like a reasonable place to start a drip that could get them potentially stuck in the ICU longer, but I suppose if the data supports it...
    We do it primarily as part of a sepsis protocol, but it does go for all of our new admits, at least ones under a certain intesivist/pulmonologist group's care.
  12. by   kevagonia
    Quote from KimberRN1
    Yep....we're getting it too.... I work at a teaching hospital and have to deal with residents on med teams....based on that new research of critical patients...they really got into putting patients on insulin gtts...and protocol is q 1hr accu checks...other patients is 7, 11, 4, & 9 if they're eating... and 6,12,6,12 for TPN and tube feeds.......In some cases I can see the need for an insulin gtt....but it seems to yo yo a lot of patients...some even bottom out... so it makes me wonder how good can it be?....I glucose of 210 one hour...then < 60 the next.....
    Sounds like an endocrinologist needs to see the patient to adjust the scale? We have two, one has tighter parameters, higher doses for patients to keep their sugars within range quicker. Of course, if a patient is NPO, has tube feeds, TPN, insulin in the TPN, DM, DKA, all of these things have to be adjusted for. I am not the sharpest with endocrinology, but it has worked for me so far. q1hr accuchecks are a hassle! But whatever it takes to get 'em better.
  13. by   NurseFirst
    Quote from barefootlady
    Better control over glucose levels is more common everyday and fairly common even on med/surg units. Its called advancements in medical and nursing practice.
    Maybe I should talk to my biomedical engineer-inventor-entrepreneur cousin and see if there is a better way to do this than sticking somebody every hour.

    NurseFirst

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