Blood glucoses

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Specializes in NICU.

What is your protocol for checking blood glucoses on NICU babies? We do a PCX/onetouch/accucheck q shift when the baby is on TPN. We have to do this even when the baby has an am lab draw for a renal panel. Also, we are expected to do them every shift on a kid with an IV, and at least once a day on any kid in our NICU.

What bothers me, we keep sticking these babies for no purpose. Most of our babies are fine, the kids who have problems have been that way from the beginning, and nothing is ever changed on the others.

We've already had a thread about the lancets etc. that we use. That's part of this project, to work on the protocol and then I'm interested in the equipment.

I'm so tired of seeing babies start to cry when we touch the feet. I know that the lancets cause permanent scarring, just like IV starts all leave their mark.

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Specializes in NICU, PICU, educator.

We do glucose upon admission, at one hour of life and then two hours. For kids on IV or TPN, we only check them when we initiate TPN or when we have a glucose percentage change. We do them with our windows for 24 hours and then after that we don't do them. We also only get glucoses on kids that are acting sick. No routinely everyday ones anymore. We have a protocol for IDM kids or LGA kids.

What is the docs rationale for wanting them all the time? There is no medical reason to get them that often, that is for sure.

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Admission, half hour x 2, one hour x 2. Q shift if on IV fluids or working up on feeds. Less than 1800g and on full feeds, qd. 1800g+ and ad lib,only if acting sick.

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On admission.

Anywhere from once a shift to once a day on babies getting TPN or any type of dextrose solution.

If baby is on full feeds then blood glucose doesn't need to be checked unless acting sick or if the baby is very small like

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I don't know our policy for new admissions cause I haven't had one yet. I have only been in the NICU for a month, but the only time I have seen them done so far is when a kid was changed from d10 to d12 with their tpn. Then a blood sugar is checked 2 hrs after the change. I know they get them on admission but I don't know how frequently. Other than that they are not done routinely on babies on tpn or full feeds or both.

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Specializes in NICU, CVICU.

On admission, then 2 hours after admission. Two hours after a dextrose% change in TPN or other fluid. ac feeds when going off IVF to full feeds. 1hr or so after making a baby NPO and starting IVF.

We don't do "routine" glucose monitoring, just for any changes in fluids, feedings, or admissions.

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:balloons: We do them on admission and for infants on TPN or any iv fluid once per shift. If they get an am chemistry we use that result unless it comes back out of range (low or high). Changes in the dextrose content we do one in two hours, if you are on no iv and full feeds we don't do one unless it is an infant of diabetic mother and they are repeated on an individual basis.

Hope this helps. Also we use the Tenderfoot to get the specimen which do a small slice instead of a puncture, most babies donot seem to mind.

I forgot to mention infants on insulin or insulin drips, those are done 30min after and change. The ELBW infant will get one if they are spilling atleast 1/2 glucose in the urine.

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Specializes in NICU.

We do one q shift if they're on IV fluids. If they're on full feeds, we just do them with any labs that we draw .... we don't poke them unnecessarily. Occasionally we do q shift sugar checks even if they're on full feeds, but only if they've had sugar problems in the past ... but even then some of our docs don't like us to poke them too much, so they'll just tell us to monitor the urine glucose.

I don't use tenderfoots for only accu checks, I think they make too big of a slice. I just use the little button ones that make just a little tiny prick ... enough for a drop of blood.

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Specializes in NICU.

Thank you all for your responses. I'm hoping that we can reduce the number of heelsticks our babies suffer.

I've been looking online for any Evidence Based info, but I have not been very successful. Does anyone have any ideas about which sites I could check? What interests me is that we are for the most part not doing anything with the BS results. The majority of our lab results are fine, and even if they are a little off, we don't make any changes re IV rates or feedings. They have to be a major trend to to that, and usually the kid has had problems from birth.

We used to have the Tenderfoot lancets, and went to Quickheels last year. I'd like to get some that make just a little prick insteard of a slice that we don't need.

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Specializes in Critical Care, Cardiothoracics, VADs.

Regardless of EBM, if they aren't doing anything with the results, then they don't need to be doing them. I'd speak to whoever is in charge of revising protocols, the medical and nursing director of the unit and get it changed.

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Specializes in NICU.
Regardless of EBM, if they aren't doing anything with the results, then they don't need to be doing them. I'd speak to whoever is in charge of revising protocols, the medical and nursing director of the unit and get it changed.

That's where we are right now. It's a Unit Based Council project.

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