Atiyeh, Tanya M., BSN, RN

Joson, William F., BSN, RN

Passaro, Cassandra E., BSN, RN

Trinchere, Kevin W., BSN, RN

English

Trinchere, Kevin, RN

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksPatient Care Services / NursingBlood Glucose Point of Care Testing for Patients onVasoconstrictors in the ICUTanya M. Atiyeh BSN, RNLehigh Valley Health Network, tanya_m.atiyeh@lvhn.orgWilliam F. Joson BSN, RNLehigh Valley Health Network, william_f.joson@lvhn.orgCassandra E. Passaro BSN, RNLehigh Valley Health Network, cassandra_e.passaro@lvhn.orgKevin W. Trinchere BSN, RNLehigh Valley Health Network, kevin_w.trinchere@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/patient-care-services-nursingPart of the Nursing CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtAtiyeh, T., Joson, W., Passaro, C., & Trinchere ,K. (2016, February 9). Blood Glucose Point of Care Testing for Patients on Vasoconstrictorsin the ICU. Poster presented at LVHN Vizient/AACN Nurse Residency Program Graduation, Lehigh Valley Health Network,Allentown, PA.© 2016 Lehigh Valley Health Network Lehigh Valley Health Network, Allentown, Pennsylvania Blood Glucose Point of Care Testing for Patients on Vasoconstrictors in the ICU • Point of Care (POC) glucometers, testing capillary blood from finger sticks, are frequently relied on for measuring blood glucose (BG) levels in patients. For patients receiving blood pressure support via vasopressors, capillary POC BG testing can be inaccurate. • PICO Question: “In adult critically ill patients on two or more vasopressors, does POC testing of arterial blood lead to safer and more effective glycemic management than POC testing of capillary blood?” • Inoue, Egi, Kotani, and Morita (2013) conducted a systematic review of studies, revealing that the accuracy of arterial POC measurements was significantly higher than that of capillary POC measurements.   • Ellis et.al (2013) conducted a study on critically ill patients, comparing capillary and arterial POC testing, and found that arterial samples were more accurate than capillary samples. This study also found that the accuracy of arterial blood samples for POC testing was not affected by peripheral perfusion.  It was specifically noted that patients on two or more vasopressors showed decreased accuracy of capillary POCT BG values. • Juneja, Pandey, and Singh (2013) concluded that the accuracy of capillary blood samples did not conform to the ISO standards in the patients on vasopressors.  • Raurell-Torredà, Del Llano-Serrano, Almirall-Solsona, and Nicolás-Arfelis (2014) determined that use of blood obtained via an arterial catheter is safe and effective for glucose monitoring in patients undergoing intensive insulin therapy.  • Periera et al. (2015) evaluated the accuracy of bedside POC BG measurements using arterial, capillary and catheter venous blood samples in ICU patients and concluded that “arterial samples seem to be the only source sufficiently accurate to be used with point-of-care glucometers” (p. 10).      • Ellis, M., Benjamin, K., Cornell, M., Decker, K., Farrell, D., McGugan, L., … Granger, B. (2013). Suitability of capillary blood glucose analysis in patients receiving vasopressors. American Journal of Critical Care, 22(5), 423-429. doi:10.4037/ajcc2013692 • Inoue, S., Egi, M., Kotani, J., & Morita, K. (2013). Accuracy of blood-glucose measurements using glucose meters and arterial blood gas analyzers in critically ill adult patients: systematic review. Critical Care, 17(2), R48. doi:10.1186/cc12567 • Juneja, D., Pandey, R., & Singh, O. (2013). Comparison between arterial and capillary blood glucose monitoring in patients with shock. European Journal of Internal Medicine, 22(3), 241-244. doi:10.1016/j.ejim.2011.01.004 • Pereira, A. J., Corrêa, T. D., de Almeida, F. P., Deliberato, R. O., Lobato, M. d. S., Akamine, N., … Cavalcanti, A. B. (2015). Inaccuracy of venous point-of-care glucose measurements in critically ill patients: a cross-sectional study. PLoS One, 10(6), e0129568. doi:10.1371/journal.pone.0129568 • Raurell-Torredà, M., Del Llano-Serrano, C., Almirall-Solsona, D., & Nicolás-Arfelis, J. M. (2014). Arterial catheter setup for glucose control in critically ill patients: a randomized controlled trial. American Journal of Critical Care, 23(2), 150-159. doi:10.4037/ajcc2014536    • The data obtained suggests a greater than 20% difference between arterial POC BG values and capillary POC BG values in the majority of comparisons.  • Capillary BG values were higher than arterial BG values, potentially leading to unnecessary insulin treatment and hypoglycemic episodes (Figure 2). 196 94 98 138 225 147 99 153 0501001502002501200 1400 1500 1800Arterial BGCapillary BG• Inclusion Criteria: patients on two or more vasopressors  with  arterial access. • At prescribed time for POC BG testing, a nurse collected both capillary and arterial samples to compare results (Figure 1). • Using arterial blood for POC BG testing in patients being treated with two or more vasopressors will provide a more accurate value compared to using capillary blood. • Accurate  BG measurement is essential in preventing the risk of hypoglycemia in these critically ill patients. • Limitations: Decreased acuity in the ICU during the timeframe allocated to data collection produced a very small sample size.  • Future studies include allowing more time to do the research presented in this study, as well as including venous samples and the usage of a blood gas analyzer.   Tanya Atiyeh, BSN, RN; William Joson, BSN, RN; Cassandra Passaro, BSN, RN; Kevin Trinchere, BSN, RN BACKGROUND / INTRODUCTION METHODS OUTCOMES RESULTS CONCLUSIONS/REFERENCES • One patient met the inclusion for this study.  • 3 out of the 4 BG comparisons had a significant difference, which would have altered treatment (Figure 2). • All capillary POC BG values were higher than arterial POC BG values (Figure 2).  Figure 2. A comparison between capillary and arterial POC BG samples.  Blood Glucose (mg/dl) Time of Day Figure 1. Flow sheet provided to staff for data collection • Nurses noted whether or not treatments for BG levels were indicated. Treatments were based on arterial BG value (Figure 1). • A barcode was created to scan for the capillary POC testing, so the patient was not charged for an extra test, and the results of this test did not transfer onto the patient’s medical record.  

Blood Glucose Point of Care Testing for Patients on Vasoconstrictors in the ICU

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Blood Glucose Point of Care Testing for Patients on Vasoconstrictors in the ICU

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