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Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Practical aspects of implementing tight glucose control in the ICU
Mathijs Vogelzang1, Jack Jm Ligtenberg
1Surgical ICU, Department of Surgery, University Medical Center Groningen, University of Groningen, the Netherlands.
Current Opinion in Clinical Nutrition and Metabolic Care
|February 8, 2007
Summary
Implementing intensive insulin therapy for tight glucose control (TGC) requires careful patient selection and safe protocols. Nurse-driven dynamic scale protocols using point-of-care analyzers ensure efficacy and safety in intensive care units.
Area of Science:
- Critical Care Medicine
- Endocrinology
- Clinical Practice Guidelines
Background:
- Outcomes of intensive insulin therapy for tight glucose control (TGC) remain inconclusive.
- Hypoglycemia is a significant concern with intensive insulin therapy.
- Achieving normoglycemia in intensive care unit (ICU) settings presents practical challenges.
Purpose of the Study:
- To review the practical aspects of implementing tight glucose control (TGC).
- To provide guidance for safe and effective TGC in real-life ICU settings.
Main Methods:
- Review of intervention studies on intensive insulin therapy for TGC.
- Evaluation of practical implementation strategies, including monitoring methods and protocols.
- Assessment of current and emerging technologies for glucose management.
Main Results:
- Point-of-care blood gas/glucose analyzers offer the best balance of accuracy and speed for glucose monitoring.
- Nurse-driven dynamic scale protocols are most effective and safe for TGC implementation.
- Computerized protocols are emerging, while closed-loop systems are not yet clinically available.
Conclusions:
- Careful patient selection and target blood glucose level are crucial for TGC.
- Safe TGC implementation involves nurse-driven protocols with point-of-care arterial blood gas/glucose analyzers.
- Continuous insulin administration guided by dynamic scale protocols, with performance monitoring and adjustments, yields optimal results.
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