Insulin drips patients on L&D

jodyangel, RN · May 24, 2020

On 1/31/2019 at 10:37 AM, PeakRN said:
At our medical center mom would be admitted to the ICU, but we would have an L&D nurse come and monitor the fetus if needed. Our policy dictates that insulin drips can only be given in the ED, ICUs, PICU, or NICUs; it cannot be be given in other critical care nursing areas (be it L&D, PACU, BMT, or others).
Off the top of my head I don't know of any L&D units that give IV insulin drips.

We run ENDOTOOL (insulin drips) on our floor! MB/Antepartum

jodyangel, RN · May 26, 2020

So....we use a program called Endotool which tells us, according to what the BS is...what to set the drip to and when to check it next. I have 4 pts. Not allowed to go higher if I’m running ENDOTOOL.

LaborRN · Jul 5, 2020

On ‎2‎/‎3‎/‎2019 at 7:18 PM, ashleyisawesome said:
My unit's protocol is that anyone (with diabetes) in active labor who has 2 blood sugars in a row that are over 100 gets put on an insulin gtt, and yes we titrate them on our unit. The patient is automatically 1:1 and gets hourly blood sugars until they are off the gtt. The gtt is usually d/c'd once they deliver unless they are type 1 DM, then endocrinology is consulted and they decide what to do with it, but they remain on our postpartum unit unless they are in DKA or something and need to move to stepdown or ICU.
I also did insulin gtts when I worked on med/surg, often with a 6 patient assignment.

Anything over 100? Woah, I'm used to two over 120. Running an insulin drip with six patients sounds stressful!

On ‎5‎/‎26‎/‎2020 at 5:41 PM, jodyangel said:
So....we use a program called Endotool which tells us, according to what the BS is...what to set the drip to and when to check it next. I have 4 pts. Not allowed to go higher if I’m running ENDOTOOL.

That sounds nice! We would use a chart and would need a double check from another RN if we maintained, increased or decreased.

jodyangel, RN · Jul 5, 2020

2 hours ago, LaborRN said:
Anything over 100? Woah, I'm used to two over 120. Running an insulin drip with six patients sounds stressful!
That sounds nice! We would use a chart and would need a double check from another RN if we maintained, increased or decreased.

Yes its actually a great program. You type in the blood sugar result and it tells you what to set the pump to and when to retest!

jodyangel, RN · Jul 5, 2020

I do insulin drips with a limit of 4 patients. We use Endotool and BS checks are as short asq15 mins to 2 hrs ( rarely).

LaborRN · Jul 5, 2020

15 hours ago, jodyangel said:
Yes its actually a great program. You type in the blood sugar result and it tells you what to set the pump to and when to retest!

It sounds cool!

jodyangel, RN · Sep 18, 2020

On 7/4/2020 at 8:06 PM, LaborRN said:

Anything over 100? Woah, I'm used to two over 120. Running an insulin drip with six patients sounds stressful!

That sounds nice! We would use a chart and would need a double check from another RN if we maintained, increased or decreased.

That’s impractical with Endotool tho...you’re checking sugars anywhere from q30 mins to q2 hrs. No second check...only a few Antepartum nurses know how to use the program!

maberRN, BSN · Mar 25, 2021

I have enjoyed finding this question stream! I work at a high volume 6,500-6,700 deliveries a year medical center . We absolutely keep our insulin drip patients in labor and Delivery if they are laboring. And we often keep our DKA pts in our high risk antepartum unit. All our new grads and new hires get a 4 hr class on diabetes and pregnancy, and all RN staff attend an OB Emergency Training ( OBERT) class every 2 years that has a DKA section taught by one of our MFM Docs. Sending obstetrical pts to ICU which is centered on lab and blood gas values for non pregnant pts is not best practice. OB pts have different ABG values and normal lab values. It is a one on one assignment if pt is critically ill.