Insulin protocol---Q 1 hour accu checks

[VAC]

Is anyone else dealing with q 1 hour accu-checks and running Insulin drips for every patient with a glucose over 110?

This has been happening in my ICU for almost a year. The research supports very tight control of glucose in critically ill patients, but this protocol seems excessive to me. The patient's have necrotic looking fingertips after a few days of this. Is this the new trend everywhere?

[kevagonia]

Yep....we're getting it too.... I work at a teaching hospital and have to deal with residents on med teams....based on that new research of critical patients...they really got into putting patients on insulin gtts...and protocol is q 1hr accu checks...other patients is 7, 11, 4, & 9 if they're eating... and 6,12,6,12 for TPN and tube feeds.......In some cases I can see the need for an insulin gtt....but it seems to yo yo a lot of patients...some even bottom out... so it makes me wonder how good can it be?....I glucose of 210 one hour...then

Sounds like an endocrinologist needs to see the patient to adjust the scale? We have two, one has tighter parameters, higher doses for patients to keep their sugars within range quicker. Of course, if a patient is NPO, has tube feeds, TPN, insulin in the TPN, DM, DKA, all of these things have to be adjusted for. I am not the sharpest with endocrinology, but it has worked for me so far. q1hr accuchecks are a hassle! But whatever it takes to get 'em better.

[NurseFirst]

Better control over glucose levels is more common everyday and fairly common even on med/surg units. Its called advancements in medical and nursing practice.

Maybe I should talk to my biomedical engineer-inventor-entrepreneur cousin and see if there is a better way to do this than sticking somebody every hour.

NurseFirst

[RNforLongTime]

We started using this protocol about a year ago at my facility. Our goal range is 91-120.

While we do have the VAMP system, which I HATE, I find it easier to poke the finger. I wonder how safe it is to be getting blood from the system every hour. I would think entering the supposed sterile system every hour would increase the risk of the line becoming infected. Plus if your art line isn't connected to the VAMP system, which, in our post-op CABG pt, it's not because the art line is in place for about 18 hrs anyway( cost factor) then you're wasting about 10cc of blood each hour. The policy at my facility states that you're NOT supposed to give back the 10cc of blood that you're wasting. The VAMP system eliminates that waste, which is nice.

Our CV surgeons are just now starting to put all of thier diabetic pts on the insulin protocol. Just the other night, I had two pt's both on q 1 hr blood sugars.

[angelique777]

Please explain what is a vamp again

[RoxanRN]

Please explain what is a vamp again

The system we use has a syringe-like apparatus in-line. It can be attached to an art-line or CVL (even PICC/PILL if needed). When blood is needed for lab or whatever, you fill the syringe with the 'waste,' get your blood sample from the port and then return the 'waste' to the patient. The system is never open so it works for the JW patients and other bloodless therapy patients as well. It eliminates the need to waste 10ish ml of blood with each line draw. In patients with frequent labs, that adds up quickly and they are more apt to require blood products.

Roxan

[ThumbzRN]

Our hospital uses the intesive insulin protocol 80-110 for post OHS patients and we also have VAMPS attached to our A-lines. We just use insulin needles to get a little blood for our accuchecks.