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Should Continuous Subcutaneous Insulin Infusion (CSII) Pumps Be Used During the Perioperative Period? Development of
Lcdr Shannan Rotruck1, Lcdr Lauren Suszan2, Robert Vigersky3
1is a staff anesthetist at Walter Reed National Military Medical Center in Bethesda, Maryland.
AANA Journal
|October 4, 2019
Summary
Continuous subcutaneous insulin infusion (CSII) pumps can be safely used in surgical patients with diabetes mellitus (DM) when a protocol is followed. This approach mimics natural insulin delivery, improving glycemic control during the perioperative period.
Area of Science:
- Endocrinology
- Anesthesiology
- Metabolic Disorders
Background:
- Diabetes Mellitus (DM) affects 30.3 million Americans.
- Over 400,000 individuals with DM use Continuous Subcutaneous Insulin Infusion (CSII) pumps for blood glucose control.
- CSII more closely mimics physiologic insulin delivery compared to daily injections.
Purpose of the Study:
- To examine the literature on the use of CSII pumps in surgical patients with DM during the perioperative period.
- To assess the safety and efficacy of CSII pumps for maintaining glycemic control in this population.
- To develop a decision-making algorithm for anesthesia providers caring for patients with CSII pumps.
Main Methods:
- A literature search strategy was formulated to identify studies on CSII pump use in the perioperative period.
- Seven sources were identified, including one case study and three retrospective cohort studies.
- Methodologic limitations of the identified studies were noted.
Main Results:
- Evidence suggests that CSII pumps can be safely utilized during the perioperative period.
- The safe use of CSII pumps is contingent upon the implementation of an established protocol.
- A multidisciplinary team developed a decision-making algorithm for anesthesia providers.
Conclusions:
- CSII pumps can be safely managed in surgical patients with DM when a protocol is in place.
- A structured approach is essential to minimize risks associated with CSII pump use in the perioperative setting.
- The developed algorithm aims to assist anesthesia providers in managing these patients effectively.
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