Implementing a Continuous Insulin Infusion Protocol After Cardiac Surgery to Reduce the Risks of Hyperglycemia

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Wednesday, July 21, 2004
9:30 AM - 10:00 AM
Wednesday, July 21, 2004
2:30 PM - 3:00 PM

This presentation is part of : Posters

Paulette Gallant, RNC, BSN and Alyce A. Schultz, RN, PhD. Nursing, R1, Maine Medical Center, Portland, ME, USA

Learning Objective #1: Identify causes and risks of hyperglycemia following cardiac surgery
Learning Objective #2: Explain rationale for continuous insulin infusion for aggressive control of hyperglycemia following cardiac surgery

Diabetes is a known risk factor for mortality and mediastinitis in the cardiac surgery patient.Studies done by Dr. Furnary have shown that hyperglycemia rather than diabetes is the factor that increases a patients' risk for mortality, atrial fibrillation, mediastinitis and increased length of stay. Dr. Furnary has shown by implementing a continuous insulin infusion in all cardiac surgery patients the first 72 hours after cardiac surgery to keep the glucose less than 150 reduces mortality risk by 3-5%, sternal wound infections by 1%, and length of stay by 1 day. What processes need to be put in place to implement a continuous insulin infusion protocol to keep the blood glucose level below 150 in the cardiac surgery patient? A literature search was conducted using the library OVID which includes the databases of MEDLINE, CINAHL, and EBMR.The evidence in seven studies conducted on glycemic control using continuous insulin infusion confirmed a reduction in risk for mortality and medistinitis. In two seperate studies conducted by Dr. Furnary and Dr. Berghe concluded that by keeping glucose levels below 150 reduced mortality, mediastinitis, atrial fibrillation and length of stay. A literature review revealed studies conducted on glycemic control or randomized control trials comparing subcutaneous insulin with a continuous infusion protocol. The original studies were conducted on diabetic patients while the more recent studies from 2000 to the present were conducted on all hyperglycemic surgical and cardiac surgery patients. Based on the published studies, the best practice for all cardiac surgery patients is the implementation of a continuous insulin infusion protocol to control hyperglycemia for a minimum of 72 hours post cardiac surgery.

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July 21, 2004