Insulin gtt questions

[nurses4all]

I have questions about insulin gtts.

When you run an insulin gtt through a PICC line, if the rate is very slow (less than 20 cc's an hour), does the line need to be flushed with NS while the drip is running to keep it patent?

If it was flushed, wouldn't that bolus the Pt. with the insulin remaining in the line? How many cc's would the Pt. actually get from what's in the line? And then, after it was flushed, considering how long the interior line is, wouldn't that cause the insulin to take a couple hours, if running at about 20 cc's an hour or less, to actually reach the Pt.?

Thanks for your help. I hope I put this in the right place.

[heartICU]

I work in a CTICU, and we have run insulin gtts as low as 1-2 cc/hour. Our standard concentration for the gtt is 1:1 (1 unit per cc). However, we are usually running them with other meds that are going at a higher rate, i.e. levo, dopa, dobut, etc. I guess if you were running insulin alone and were worried about the line clotting off, you could set up two separate IV pumps, one with normal saline running at 20cc/hr or whatever rate is prescribed for maintenance fluids, and then set up the other pump with the insulin infusion and "Y" them together. That way they would be getting the appropriate insulin dose, while at the same time preventing the line from clotting off.

[shinerchia]

Judging by the question, I'll assume that you don't normally titrate drips.

If you do, you'll find that you always have a backup fluid as your maintenance and even if the pt is on the brink of CHF every minute...you'll backup your drips with a maintenance line. NTG can go slow to prevent spasms after stents and the like (say..3cc/hr)...insulin as mentioned...although...the splenic basal rate is 3 units an hour and other highly concentrated drugs. Integrillin, nipride, levophed, etc can have slow rates. If yo9u lose a lumen on a central line because you ran a fluid too slow or don't flush often and I inherit the pt...you are gonna know about it.

[nurses4all]

If you do, you'll find that you always have a backup fluid as your maintenance

No, I didn't. It wasn't ordered for that patient. In the future, though, I'll make sure to get one.

If yo9u lose a lumen on a central line because you ran a fluid too slow or don't flush often and I inherit the pt...you are gonna know about it.

Your response was inappropriate. The line didn't clog, I never implied that it had, and yet you threatened me.

This is the type of workplace behavior that needs to be changed. Nurses need to learn to nurture each other instead of attacking each other.

I'm glad I don't work with you, Shin.

[J Lynn]

http://www.manuelsweb.com/gttPerMin.htm

Here's a website I tucked away.

[Celia M, ASN, RN]

I insert PICC lines, you need very little to flush the entire length of the PICC, less than 1 cc. PICCs stay patent with a vey low TKO rate. In home Health I've seen it as low as 1 cc/hr. In our ICU we always have a back up IV eg NS when we are infusing a drip such as insulin and run TKO for central lines as low as 5cc/hr if we're worried about CHF. Also as long as one lumen is open I believe a central line can be changed out using a guidewire, I've seen our CRNAs do it.

[begalli]

Hello, this is my first post here at allnurses.

I would like to comment about having a "back up fluid" running behind your drips.

In our ICU (cardiothoracic surgery), we DO NOT rountinely place our maintanence fluid behind our drips especially when there are multiple drips.

The main reason that we do not do this is because when you run something like a piggyback antibiotic through your maintenance it not only dramatically changes and fluctuates the infusion rate of ALL the gtts but there is always that possiblity of piggyback drugs being incompatible with any one of the drips. This could cause you to lose your central line and compromise patient safety.

If you think about it, it only takes 3cc/hr to keep an arterial line patent. The same when you're transducing a cvp. Saline locks are usually flushed just once a shift.

If however an insulin gtt is the only thing I have running (which rarely occurs where I work), I might put a NS carrier behind it running at 3-5cc/hr. And I might not, especially not if my patient is in CHF.

[suzeeq]

http://www.manuelsweb.com/gttPerMin.htm

Here's a website I tucked away.

Thanks for the website. Don't you use iv pumps though?

[trvlngrn]

the line should be fine as per the home infusion nurse stated. the amount the lumen of the catheter holds is frequently printed on the catheter itself. (and it is a small amount.) but as far as the insulin, it should be fine. good thinking though, to consider the "bolus" and the "lack" of infusion. it shows you are thinking about your infusions which is always a good thing to do.