Serum Glucose Testing in the OR.

skipaway · Aug 6, 2007

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

Electrolytes on an as needed basis.

UCDSICURN · Aug 6, 2007

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....

ICRN2008, BSN, RN · Aug 6, 2007

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)

heartICU · Aug 7, 2007

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.

deepz · Aug 8, 2007

.....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

UCDSICURN · Aug 9, 2007

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.

dfk, RN, CRNA · Aug 10, 2007

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?

GmanRN · Aug 15, 2007

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.

suzanne4, RN · Aug 16, 2007

Glucoses can be done in seconds with the same equipment that the use on the floors, and it can be done quite frequently.

Especially in the open heart rooms, you will now find frequent monitoring of blood sugar levels, the new standards that are now in place require tight control of the blood sugars, much tighter than in the past, and these patients usually have insulin drips running during their procedure. This is very well documented in all of the current literature.

And specific protocols in place for those that do not have the diagnosis of diabetes before the surgery. 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. And again, tighter control is required and is considered best of practice and is actually becoming the standard all over the US.

GmanRN · Aug 16, 2007

. 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

suzanne4, RN · Aug 16, 2007

It is not even to make a diagnosis of diabetes, but to make sure that the glucose levels are kept to the normal levels. Stress plays a big part in elevating glucoses, even the surgery alone can do it, and they find better recovery when sugars are kept under control.

Every heart surgeon that I have worked with in the OR in the past few years is doing this. It is actually becoming a standard of practice, there is much in the literature already on this.