Insulin protocol---Q 1 hour accu checks

  1. 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?
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    About VAC

    Joined: Oct '01; Posts: 163; Likes: 69
    RN

    29 Comments

  3. by   INtoFL_RN
    The hospital I worked at previously in IN began a similar protocol in 2003. They said studies showed that very tight glucose control during critical illness and during recovery from CABG decreased mortality by 50%! In the ICU many of the pts already had a-lines so the glucoses were checked using arterial blood. I think it's pretty crazy to be sticking people's fingers every hour!!
  4. by   zambezi
    We are also doing this...however depending on the stability of the CBSs we are doing checks q 1-2 hours...our population is post cardiac surgery...though we are starting to see it more on our medical patients as well...we usually start the protocol for anyone with a CBS of >140.
  5. by   begalli
    We also have a protocol to keep a tight control on blood sugars (CTICU) based on those studies that came out a bit more than a year ago or so.

    Our protocol starts at bg of 130, a patient on corticosteroids, or a diabetic patient. 80-120 is our goal.

    We check sugars every hour via the art line.

    After we reach the goal bg, if the bg stays at that level for 3 consecutive hours, we check q 2hours, if the sugar is stable q 2 hours for 6 more consecutive hours, we check it q6 then q12 then daily.

    I have NEVER gotten to even the q6 checks and rarely the q4. Our sugars seem to fluctuate a lot. Has mostly to do with changes in meds, drips, and nutrition.

    We complained about have to draw and waste blood every hour on our critically ill paitents. Management responded by providing us with the VAMP blood draw system. I never poke a finger when the patient's on a drip and rarely even when the patient has a scale. There should be some accomodation for those who don't have a line to draw from.

    I think what's excessive is the pokes, not the protocol.
  6. by   my2sons
    I'd like to see tighter glycemic control in my unit. We have only 1 out of 5 CV surgeons who uses an insulin gtt with his patients (Portland Protocol), the rest order Q6H checks with SQ coverage over 200 diabetic or not. I shudder to think what my diabetic CABG with an epi drip's blood sugar is BETWEEN those Q6H checks!
  7. by   Elenaster
    Quote from begalli
    We also have a protocol to keep a tight control on blood sugars (CTICU) based on those studies that came out a bit more than a year ago or so.

    Our protocol starts at bg of 130, a patient on corticosteroids, or a diabetic patient. 80-120 is our goal.

    We check sugars every hour via the art line.

    After we reach the goal bg, if the bg stays at that level for 3 consecutive hours, we check q 2hours, if the sugar is stable q 2 hours for 6 more consecutive hours, we check it q6 then q12 then daily.

    I have NEVER gotten to even the q6 checks and rarely the q4. Our sugars seem to fluctuate a lot. Has mostly to do with changes in meds, drips, and nutrition.

    We complained about have to draw and waste blood every hour on our critically ill paitents. Management responded by providing us with the VAMP blood draw system. I never poke a finger when the patient's on a drip and rarely even when the patient has a scale. There should be some accomodation for those who don't have a line to draw from.

    I think what's excessive is the pokes, not the protocol.
    That's a really good protocol. Ours varies, but we're mostly q1h on an insulin gtt and q4-q6h on sliding scale, which our critical care docs are going more and more towards managing glucose in the chronic patients with NPH and custom sliding scales.

    I have seen patients on insulin gtts with no a-line for excessive amounts of time and I think it's cruel to keep poking their fingers.
  8. by   LindaMarie76
    What's VAMP? I tried to research it but kept finding sites to vampires and Buffy.

    LOL

    Linda
    Quote from begalli
    We also have a protocol to keep a tight control on blood sugars (CTICU) based on those studies that came out a bit more than a year ago or so.

    Our protocol starts at bg of 130, a patient on corticosteroids, or a diabetic patient. 80-120 is our goal.

    We check sugars every hour via the art line.

    After we reach the goal bg, if the bg stays at that level for 3 consecutive hours, we check q 2hours, if the sugar is stable q 2 hours for 6 more consecutive hours, we check it q6 then q12 then daily.

    I have NEVER gotten to even the q6 checks and rarely the q4. Our sugars seem to fluctuate a lot. Has mostly to do with changes in meds, drips, and nutrition.

    We complained about have to draw and waste blood every hour on our critically ill paitents. Management responded by providing us with the VAMP blood draw system. I never poke a finger when the patient's on a drip and rarely even when the patient has a scale. There should be some accomodation for those who don't have a line to draw from.

    I think what's excessive is the pokes, not the protocol.
  9. by   Bekahlynn
    On my unit, they are qh checks if on a drip. They are only placed on a drip if multiple consecutive checks are high. (unsure of exact level) almost every pt is on at least a q4 check, and everyone receives coverage if needed, based on a sliding scale. Thankfully, the docs are good at prescribing an adequate dose of scheduled lantus for pts that are known to be diabetics.
  10. by   begalli
    Quote from LindaMarie76
    What's VAMP?
    VAMP

    It's the second device at that link.

    It's great for our critical patients who require hourly sugars because it's a completely closed system and you are able to return the waste every time taking only the drop you need. We attach it to our art lines, but many also use them on cvc's.
  11. by   bfjworr
    Quote from Bekahlynn
    On my unit, they are qh checks if on a drip. They are only placed on a drip if multiple consecutive checks are high. (unsure of exact level) almost every pt is on at least a q4 check, and everyone receives coverage if needed, based on a sliding scale. Thankfully, the docs are good at prescribing an adequate dose of scheduled lantus for pts that are known to be diabetics.
    On my unit.....we generally only do q 1 hour accuchecks if our patients are on insulin drips....and the nurses do the accuchecks in the ICU....the lab must do them for all other patients in the hospital....

    We do q 6 hours for patients on TPN....

    And our sliding scale protocol....the main one for our hospital starts at 150 for coverage....

    One doctor has his own sliding scale...he doesnt provide coverage unless the glucose is 250....
  12. by   Morguein
    Quote from begalli
    VAMP

    It's the second device at that link.

    It's great for our critical patients who require hourly sugars because it's a completely closed system and you are able to return the waste every time taking only the drop you need. We attach it to our art lines, but many also use them on cvc's.

    Bengali

    I'm so glad you posted this about the VAMP. I sent an email with the link you posted to our NM and she took a look at it and forwarded the email to our intensivist who is VERY interested in this device. He sent all the information down to purchasing and I think we have a very good chance at being able to get this new device for our unit. I'm glad I came across this post. Thanks!
  13. by   begalli
    Oh man! I should get a commission for that!! :chuckle
  14. by   apaisRN
    I hate it. I hate sticking fingers q1 with our brutal devices (I KNOW there are gently ones available) and I hate that chronic ICU patients get stuck on the drip after weeks and weeks. I do believe that mortality is improved - for CRITICALLY ILL patients. Not failure-to-wean in the MICU. If I could draw blood without sticks I wouldn't mind at all, although it is a lot of work.

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