Continuous Insulin drip

Our insulin drips are based on a protocol. As long as the patient is stable on the drip (big if) the accuchecks are q2h. q1h if their sugar is too high/too low. q15m if they require dextrose bolus. It's really not that bad unless you're having a hellish night in addition.

Our insulin drips are based on a protocol. As long as the patient is stable on the drip (big if) the accuchecks are q2h. q1h if their sugar is too high/too low. q15m if they require dextrose bolus. It's really not that bad unless you're having a hellish night in addition.

In our hospital, all patients on an insulin drip go to the unit.

We also take insulin drips on our step-down unit. We used to get a lot of them actually. Accuchecks are only q 2 hours but we did have a patient that was really unstable and we had to check sugars more frequently then that.

Insulin gtts on the floor - get lots of them in stem cell transplant land as they are on TPN and often steroids for GVHD. Usually q 1 as on top of the TPN and 'roids they are receiving multiple antibiotics mixed in D5W - biggest PIA is when they are in contact or even worse droplet isolation!

Thank God for hickmans!

This is an example of how quickly things change in acute care. When I last worked the beside 3 years ago, insulin drips on the floor were an absolute no-no, but when I was doing my CNS clinicals this past semester, it was considered almost routine for the floor.

I work in a high risk OB unit with many antepartum patients who are on an insulin drip and have fingersticks as often as 15 minutes and may stretch as far as 2 hours. Each one has a portable computer about twice as big as a checkbook on a tall stand that is called a GLUCOMMANDER!

This computer manages the pt glucose drip by a program with parameters set by the MD. Depending on the fingerstick the drip gets adjusted or turned off and fingerstick frequency is decided by the program.

Most of our nurses call it the "cricket" for the chirruping sound it makes when asking for a new blood glucose. Also most nurses do nothing but complain about it, but it makes a huge difference in fetal outcomes as far as sugars go. Neonates whose moms have had sugars well controlled by the glucommander usually have good sugars in the first day or two. I can't say how they do in the long run though.

The only other units in our hospital that uses them are the critical care units

We do it on our floor. Our critical care beds are reserved for crashing patients or vented patients.

I think one has to look at the patient and their symptoms. DKA is a critical situation. Asymptomatic hyperglycemia on an insulin drip that will more than like be a brief intervention is not "critical" in my opinion.

I think at the very least the patient should be in a safe ratio, preferably in an intermediate unit, not necessarily critical.

In our facility, insulin gtts are only allowed in the critical care setting. They do not allow then even on stepdown. I believe our protocol is q1hr checks and then depending on how stable the patient's BS is, it goes to q2hr checks unless the BS falls outside certain parameters, then it returns to q1hr checks. I've only had one patient on this new protocol so I could be off a bit, but that's how I remember it.

Melanie = )

We have had a couple people on insulin drips. I raise heck, call, call dr,, raise some more H*** because we normally cant staffing wise have the ability to deal with Q1 BS and call DR with results for titration. HAA

So no we dont routinely take insulin gtt patients and shouldnt in acute care setting. They need more attention than we can give them.

Our hospital, insulin gtss goto the units only... ie ICU/CCU/CVICU..... however I think depending on the circumstances they should be able to goto the floors or at least to PCU of which is considered critical care, however they dont take care of any critical pts. ... I never understood that..... I do think q 1 hours accu checks is too much for the floor nurses they are busy enough...... it all depends if they are DKA, whats there anion gap, how symptomatic are they....... if I have time I prefer to watch them in the ER after their boluses, and k and get the suger down enough to start the D5 with the gtt, hopefully their anion gap is much more narrow or even normal and then they can be sent to somewhere other then the units. However at this time the units complain the pt. is too stable even if on insulin gtt for them to accept, and the other floors say they are too unstable or they wouldnt be on an insulin gtt........... but I believe for the most part our gtts goto the units.