Sunday, November 13, 2005
Evaluating a Continuous Insulin Infusion Protocol in Cardiac Surgery Patients to Reduce the Risks of Hyperglycemia
Paulette Gallant, RNC, BSN, Nursing, R1, Maine Medical Center, Portland, ME, USA and Alyce A. Schultz, RN, PhD, FAAN, University of California, Davis Medical Center, University of California, Davis Medical Center, Sacramento, CA, USA.
|Learning Objective #1: Identify that a blood glucose greater than 150 after cardiac surgery increases the patient's risk of developing mediastinitis, mortality and an increased length of stay |
|Learning Objective #2: Understand the necessity to evaluate blood glucose levels intraoperatively and 96 hours postoperatively in cardiac surgery patients on a continuous insulin infusion|
Hyperglycemia is a significant risk for mortality, infection and increased length of hospital stay in intensive care (Van den Berghe et. al, 2000) and in cardiac surgery patients (Furnary et. al., 2001). Furnary and colleagues reported blood glucose levels of less than 150mg./dl. for 72 hours post-operatively in cardiac surgery patients reduced the mortality by half, deep sternal wound infection rate from 1.75 to 0.6% and length of stay by one day. Continuous insulin infusions are a routine practice in cardiac surgery patients. Our protocol for continuous insulin infusion had never been evaluated for compliance with the protocol or evaluation of blood glucose levels. A prospective chart review of 161 cardiac surgery patients on the continuous insulin infusion revealed that blood glucose levels were consistently above 150 in the operating room and for 96 hours post-operatively. The continuous insulin infusion protocol was not followed by nurses in intensive care and the step down unit. In patients who were not a known diabetic and the insulin infusion was discontinued, blood glucose level was not done for the reminder of their hospitalization. The mediastinitis rate for the 161 patients was 3.3% , three times the normal rate for cardiac surgery patients .Based on these results a interdisciplinary team convened to review the findings and implement a change in the insulin infusion protocol as well as a education plan for nurses in intensive care and the step down unit. Follow-up blood glucose levels and compliance with the new insulin protocol will be collected on 150 cardiac surgery patients.