Serum Glucose Testing in the OR.

Hourly CBGs if Type 1 and Type 2 when receiving insulin coverage.

Electrolytes on an as needed basis.

I'm only speaking from the Cardiac OR perspective but anesthesia wouldn't bother treating unless they were well into the 200's, depending on K levels. Their ABG machines pretty much gives them everything they need, ABG values, Lytes, Glucose, Lactic Acid, Hct, etc...For straight forward CABG's they generally get from what i've seen, 4 or so ABG's, intial, closing, couple in between.

Hope this helps a bit....

Chances are you would not be performing serum testing in the operating room, as this would necessitate spinning down a blood sample in order to obtain the serum in the first place. Most point-of-care instruments that are used in ancillary settings (the I-stat by Abbott comes to mind) use whole blood (venous, arterial or capillary) samples. If you have any specific questions about POC testing, please feel free to PM me.

BSNDec06, MT(ASCP)

I'm only speaking from the Cardiac OR perspective but anesthesia wouldn't bother treating unless they were well into the 200's, depending on K levels. Their ABG machines pretty much gives them everything they need, ABG values, Lytes, Glucose, Lactic Acid, Hct, etc...For straight forward CABG's they generally get from what i've seen, 4 or so ABG's, intial, closing, couple in between.

Hope this helps a bit....

Actually, we are pretty aggressive at my facility with glucose levels, at least in the cardiac ORs. Most patients end up on an insulin drip, at least for a few hours, starting with blood sugars over 150. Studies show that tighter control leads to better outcomes, or so I was told when I did my cardiac rotation.

.....insulin drip, at least for a few hours, starting with blood sugars over 150. Studies show that tighter control leads to better outcomes......

Exactly the current thinking as I hear it. Easy to follow with Accuchek finger sticks intra-op.

d

I can say I've only seen a couple open hearts come out on insulin drips. Post-operatively we are very aggressive with tight glucose control with a goal less than 140 for at least the first 48 hours, as I can't speak to how tight control is on the floors.

I really can't speak to the why's of the -ologists in the CVOR and why they are behind the times. The surgeons and clinical educators are aware and are working on it, but have yet to see any results.

i concur with above.

it depends on the clinical situation and patient at hand

at my current clinical site, the techs are called and bring in a portable glucose machine. it's nice, but it would be nice to have a machine that can read glucose quickly similar to an ACT machine or the like.

also, it would be nice if perfusion machines came with a component that continuously read ABG/chem panel, so you can always have numbers and possibly catch things much earlier.

or do they already have that?

i concur with above.

it depends on the clinical situation and patient at hand

at my current clinical site, the techs are called and bring in a portable glucose machine. it's nice, but it would be nice to have a machine that can read glucose quickly similar to an ACT machine or the like.

also, it would be nice if perfusion machines came with a component that continuously read ABG/chem panel, so you can always have numbers and possibly catch things much earlier.

or do they already have that?

My OR has an Istat machine that they use intraoperatively. Much quicker than sending tubes to the lab.

. Many physicians are now ordering glucose checks q am for two days, as they have been finding out that more are diabetics than the patients were aware of pre-op.

Agreed Suzanne.

However Im not sure that the diagnosis of new onset diabetes can always be accurate for an acutely ill patient who is in the hospital. Gluconeogenisis is increased under stress and illness. A patient's blood sugar may return to a lower level once stress and illness is no longer a factor.

I wonder if the CRNAs on this board are seeing hyperglucosemia intraoperatively on patients who had normal glucose levels preop.

Would be nice to know.

G

I can say I've only seen a couple open hearts come out on insulin drips. Post-operatively we are very aggressive with tight glucose control with a goal less than 140 for at least the first 48 hours, as I can't speak to how tight control is on the floors.

I really can't speak to the why's of the -ologists in the CVOR and why they are behind the times. The surgeons and clinical educators are aware and are working on it, but have yet to see any results.

Hmm... all of our hearts come out on insulin gtts. We follow a tight glycemic control protocol starting in the OR all the way to the med-surg unit.