Anyone using bloodless glucose monitoring for intensive insulin therapy?

Biffbradford · Jan 22, 2011

Our ICU had everybody on an Insulin drip and a protocol immediately post op for at least 24 hours if not longer, some times on/off multiple times, some times on Insulin drip for weeks. Art line and central line draws were just as valid as finger pokes. I found that if you do it quickly, patients can sleep right through a finger poke in the middle of the night. Just pick up the finger, 1-2-3, and you're done. ZZZZZzzzzzzz ..... :yawn:

If it's a 'central line', then how is that peripheral blood?

icudavis · Jan 23, 2011

Thanks for your reply...let me clarify myself...It is against policy to use any lines, be it central, peripheral, or arterial...However, when questioned about the research to back their policy..no one responds. I do understand some patients can and do sleep through finger pricking, and I have done this many a time believe me...but wouldn't it be wonderful to not have to subject them to this?

Just curious if anyone out there is using or have ever used any type of continuous glucose monitor-invasive or non-invasive..ie sensors...

NtannRN · Jan 25, 2011

Icudavis, I would love to hear about the non-invasive glucose monitoring. I didn't know there was such a thing. At my facility, it does not matter if It's peripheral or not. Central line is preferred when our pt is fluid overloaded. After while, their finger tips look absolutely horrible.

Biffbradford · Jan 26, 2011

Sort of off topic, but I'm curious why you can't draw a blood sugar off an art line? Just askin'! :confused:

icudavis · Jan 26, 2011

NtannRN..thanks for the reply! There is little research on non-invasive monitoring...most are still waiting for approval. A student at baylor university has invented a monitor that uses infrared, but is in the process of downsizing for practicality.

Most studies have been used on less invasive monitoring, such as sensors which do have a needle tip but is placed in the patient and left there for up to 7 days. These sensors have been used in type I DM for a while and are great! So, why not in the ICU.

Findings have shown repetitive finger sticking consequences to include development of massive scarring, callous formations, and loss of sensibility (Heinemann, 2008). In addition, potential for measurement errors, increased risk of infection, and excess workload on nurses were also shown as negative factors to this type of glucose monitoring (Weiss & Lazar, 2007).

Heinemann, L. (2008). Finger pricking and pain: a never ending story. Journal of Diabetes Science and Technology,2(5), 919–921.

Weiss, R. & Lazar I. (2007). The need for continuous blood glucose monitoring in the intensive care unit. Journal of Diabetes Science and Technology,2(3), 412–414.

BiffBradford,

I don't think you are changing the subject at all....At the previous hospital I worked, we had arterial lines all the time and would draw everything from them; however, at my present place of work, we hardly see any arterial lines, and managers want use to prick fingers for q1h checks on all insulin drips...I know... crazy! This is why I am curious to know what others are doing and researching possible alternatives. :)

jbyrd30 · Mar 27, 2011

Hi,

I am a senior nursing student. I am doing a "change" paper for ICU. So, I am looking for the same information for the paper. The one hour sticks seem horrible for the critical care patients who endure this for days. All I have been able to find are articles on alternate sites, continuous monitors, etc.

One interesting monitor I did find is from Echo Therapeutics called the Symphony tCGM. This system will use a biosensor (like a bandaid) that will be scanned. It has been used at Tufts in Boston during surgery to measure glucose. It looks like it is in the final stages of development. There is also a youtube video from Georgetown University that talks about the biosensor that is interesting.

Anyway, that is the most interesting thing I have found. But, I would be interested to hear how hourly glucose is measured elsewhere because this seems pretty barbaric to me, even from a student's perspective.

Thanks.

jazy4ICU · Mar 28, 2011

I think it will be awesome to have such alternatives in measuring blood sugar. Just come to think of how O2 sats monitoring comes so handy and easy. Noninvasive blood surgar monitoring will be a great development in the medical world especially for my DKA and post op pts. Am waiting for that day.

detroitdano · Mar 28, 2011

1. Nothing non-invasive at my facility, level 1 trauma center/large teaching hospital.

2. We use a scale. We actually have a 10+ page protocol for ICU glycemic control, it's too much to explain but basically anyone NPO or on tube feeds with a sugar > 180 gets an insulin drip.

3. As long as needed. If we have a DKA on an insulin drip for 6 hours until the gap closes, that's that. Some patients need an insulin drip for 2 days while in septic shock. Some nursing home/chronic patients come in and end up on a drip for a few days until we started long acting.

4. It's nurses judgment on where you obtain your specimen. We use the VAMP setup on our arterial lines, and you can actually mate them to a central line if you wanna spend the time. You draw 5 mL blood out with the system, close it off, then take blood off the sampling port, then flush it back in. I prefer doing this for anyone with an art line, just grab a heparin syringe and get .1 mL off and don't be a tool and stick yourself. No destroyed fingertips, no dilution thanks to edematous fingertips/poor circulation/etc.

5. Some patients with high bili's secondary to liver failure, usually fulminant, require a lab draw every 2 hours (on drip) or 4 hours (SQ coverage). Our monitors read wrong when they are elevated. It's a huge waste of time and resources, and if they're high or low you don't know for near an hour even when it's marked stat.