insulin drip protocol for mixing/priming: how do you mix it?

Nurses Medications

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I'm a recent new grad to the ER (today was my 7th day) and got my first DKA patient. Here's a quick run down of the story:

Patient brought in by ambulance with DKA secondary to running out of insulin and not eating for 2 days (pt decided to spend the money on meth instead). An insulin drip was ordered.

In our department, we mix our own insulin with 100 units in a 100ml bag of NS. A disagreement arose between nurses in teaching me how to prime the bag.

The old protocol was to mix the insulin in 100ml of NS, and drain the entire bag. Then mix another bag, spike it, and run it. The rationale is insulin sticks to the plastic of the tubing and therefore, the patient does not receive the intended dose of insulin. Coating the tubing with insulin will allow the rest of the insulin to flow through better.

The current protocol is to address wasting insulin and NS. The procedure is to mix the insulin in NS and drain the first 20ml. How do you guys mix it and is there any evidence-based research to substantiate this? I tried searching Pubmed and Google but couldn't find anything. Maybe someone here will have a better idea.

Specializes in Peds, PACU, ICU, ER, OB, MED-Surg,.

Been a nurse for 14 years. Pharmacy now mixes drips but they should be 1:1 normal saline/insulin in glass. I was taught that the tubing does absorb some of the insulin so you should prime the tubing with the mixture before starting. Another mistake that I have seen frequently by ER is bringing down the sugar too quickly, this can cause cerebral edema.

Thanks

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