Insulin infusion scale
This study supports the adoption of a protocol-directed insulin infusion sliding scale as a standard of care for post-cardiac surgery patients.
Patients with type 1 diabetes and most patients with type 2 diabetes who were treated with insulin before hospitalization will require such a transition. Key components of a hypoglycemia protocol include specific instructions regarding temporarily turning off or reducing the infusion rate, treating with dextrose or other glucose sources, and monitoring more frequently, as well as when the insulin infusion, if temporarily stopped, should be restarted and at what rate.
Insulin infusion preparation
Crit Care R, A hypoglycemia protocol allows bedside nurses to immediately implement treatment without additional orders. Table 1 provides additional potential indications for IV insulin infusion. However, education is a key component of successful insulin infusion protocols in all settings. We recommend that all healthcare professionals complete the e-learning module on the use of intravenous insulin,3 or equivalent training. Ideally, the transition occurs when patients begin an oral diet and their blood glucose levels are stable within the target range. For patients starting parenteral or enteral nutrition, the use of IV insulin infusion with appropriate monitoring may allow for more rapid titration and determination of patients' insulin requirements than one could expect from either a subcutaneous insulin regimen or from the practice of including insulin in the parenteral nutrition solution. Management of adults with diabetes undergoing surgery and elective procedures: improving standards. Key words: variable rate intravenous insulin infusion, medical Inpatient, sliding scale Rationale for the guideline Most studies on the use of intravenous insulin infusions in hospital have been in the critical care setting or in patients who have undergone surgery. Target blood glucose levels have not been established in trials but there is a consensus for a range between 6. Selecting an Insulin Infusion Protocol Numerous insulin infusion protocols have been published. Evaluation metrics can be as simple as tracking 1 mean or median blood glucose with standard deviations or interquartile ranges by unit or patient population and 2 incidence of hypoglycemia. Such evaluation facilitates continuous improvement and staff education and builds momentum to support expansion of the protocol into additional patient populations or additional settings within the institution. Table 2 lists characteristics to consider when selecting an insulin infusion protocol. Continuous glucose sensors are available for ambulatory patients and have demonstrated benefits in select patients over intermittent POC testing.
Seven research studies met the inclusion criteria. October A systematic review was conducted to determine whether a protocol-directed insulin infusion sliding scale is as safe and effective as a conventional practitioner-directed insulin infusion sliding scale, within target blood glucose ranges.
Guidelines from national and international societies are also discussed.
Insulin drip protocol for dka
Several authors have published protocols for the transition from IV to subcutaneous insulin. Open in a separate window Insulin infusion may be an alternative to a basal-bolus insulin regimen outside of the critical care setting for perioperative and other patients who are not eating NPO status and patients whose glycemia is poorly controlled with subcutaneous insulin. Endocr Pract 12 Suppl. Incorrect use of VRIII can result in hypoglycaemia, rebound hyperglycaemia, excess length of stay and even DKA; a safe and effective step down to other agents should occur as soon as possible. This article has been cited by other articles in PMC. Inpatient Glycemic Targets After publication of the initial van den Berghe trial in surgical intensive care patients, 1 several professional organizations published guidelines supporting near-normal glycemic targets. Management of adults with diabetes undergoing surgery and elective procedures: improving standards.
However, optimal glycemic targets remain controversial, and significant barriers to optimal glycemic control persist. However, normoglycaemia after cardiac surgery is usually difficult to maintain and requirements for insulin after cardiac surgery with cardiopulmonary bypass are much higher than after other operations.
Variable rate insulin infusion
Staff Education The safety of any insulin infusion protocol is tied to the ability of staff members to understand and follow the protocol; thus, ongoing education and competence assessment are crucial. However, data are mixed regarding the performance of these U. The VRIII should only be discontinued 30 minutes after subcutaneous insulin has been given, ideally be at meal time, after administration of short- acting or mixed insulin see below for details of how to identify an appropriate initial dosage of insulin. How interested is the staff in optimizing glycemic control, and do they have the support they need to achieve this goal? Open in a separate window Successful implementation of an insulin infusion protocol requires multidisciplinary interaction and ongoing staff education to ensure optimal patient outcomes. We recommend that all healthcare professionals complete the e-learning module on the use of intravenous insulin,3 or equivalent training. Although hypoglycemia was more common among patients in the intensive treatment group, the association of hypoglycemia with an increased hazard ratio for death was similar in the two groups, suggesting that hypoglycemia contributed to the excess mortality in the intensively treated group. Insulin infusion can be safely administered outside of the critical care setting provided staff education, nurse-to-patient ratios, and blood glucose monitoring are adequate. Treating hyperglycaemia in hospitalized patients has proven to be beneficial [ 9 ].
However, a range of 4. Selecting an Insulin Infusion Protocol Numerous insulin infusion protocols have been published.
We recommend that all healthcare professionals complete the e-learning module on the use of intravenous insulin,3 or equivalent training. Use of the guideline will help to harmonise the use of VRIII, with added benefits of facilitating collection of outcomes data from at multiple sites and allowing continual refinement in the therapeutic use of VRIII.
based on 34 review