SUGAR: Assessing the SUitability of Capillary Blood Glucose Analysis in Patients Receiving Vasopressors

2.50
Hdl Handle:
http://hdl.handle.net/10755/157100
Category:
Abstract
Type:
Presentation
Title:
SUGAR: Assessing the SUitability of Capillary Blood Glucose Analysis in Patients Receiving Vasopressors
Author(s):
Ellis, Myra; Knouse, Whitney; Cadavero, Allen; Webber, Faresha; Farrell, Debra; Benjamin, Kesi; Macmang, Josephine; Libutan, Joseph; Shearin, Helen; Thomas, Tonda
Author Details:
Myra Ellis, Duke University Hospital, Durham, North Carolina, USA, email: ellis030@mc.duke.edu; Whitney Knouse; Allen Cadavero; Faresha Webber; Debra Farrell; Kesi Benjamin; Josephine Macmang; Joseph Libutan; Helen Shearin; Tonda Thomas
Abstract:
PURPOSE: The purpose of this study is to determine the relationship between vasopressor use in critically ill post operative patients and the accuracy of capillary blood glucose (CBG) analysis. BACKGROUND: Tight glycemic control in critically ill patients decreases infection and mortality. Studies have shown that CBG measurements are accurate in normotensive patients and correlate with arterial samples. However, patients receiving vasopressors may be normotensive by arterial blood pressure, but have altered peripheral perfusion. Since altered peripheral perfusion may affect the accuracy of CBG measurements, actual best practice for this patient population is not known. METHODS: A convenience sample (n=50) of adult post-operative cardiothoracic patients on insulin and vasopressors were prospectively enrolled. Demographics and significant medical history were abstracted from the medical record. Prospective data collection occurred every six hours while on insulin drip and included: pharmacotherapy, vital signs and three blood samples obtained simultaneously from arterial and peripheral sites. Samples were tested using point of care technology and the central lab. The quality of peripheral perfusion was recorded using a standardized scale. One-way repeated-measures ANOVA was used to analyze differences in sets of blood glucose values within each time-point. RESULTS: We found a statistically significant difference in blood glucose levels drawn from both capillary sticks and arterial/venous sites (central lines) using a point of care testing device as compared to the clinical lab blood glucose levels (p<.0001 and p<.001, respectively). However, no difference was found in the point of care glucose measure from the capillary sites as compared to central ports (p=.883). In addition, we found that vasopressive medications (e.g., dopamine, epinephrine, norepinephrine) were significantly correlated with differences in glucose values (p<.001), and that patients on fewer vasopressive medications has less variance in glucose measures. CONCLUSIONS: Our findings suggest that while point of care testing offers valid and reliable trends in glucose measures for both arterial, venous and capillary blood samples, point of care testing does differ significantly from clinical lab testing, and the two methods should not be used interchangeably for IV insulin titration. In addition, patients on vasopressive medication are more likely to have variances in blood glucose testing.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.
Conference Date:
2009
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
New Orleans, Louisiana, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleSUGAR: Assessing the SUitability of Capillary Blood Glucose Analysis in Patients Receiving Vasopressorsen_GB
dc.contributor.authorEllis, Myraen_GB
dc.contributor.authorKnouse, Whitneyen_GB
dc.contributor.authorCadavero, Allenen_GB
dc.contributor.authorWebber, Fareshaen_GB
dc.contributor.authorFarrell, Debraen_GB
dc.contributor.authorBenjamin, Kesien_GB
dc.contributor.authorMacmang, Josephineen_GB
dc.contributor.authorLibutan, Josephen_GB
dc.contributor.authorShearin, Helenen_GB
dc.contributor.authorThomas, Tondaen_GB
dc.author.detailsMyra Ellis, Duke University Hospital, Durham, North Carolina, USA, email: ellis030@mc.duke.edu; Whitney Knouse; Allen Cadavero; Faresha Webber; Debra Farrell; Kesi Benjamin; Josephine Macmang; Joseph Libutan; Helen Shearin; Tonda Thomasen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157100-
dc.description.abstractPURPOSE: The purpose of this study is to determine the relationship between vasopressor use in critically ill post operative patients and the accuracy of capillary blood glucose (CBG) analysis. BACKGROUND: Tight glycemic control in critically ill patients decreases infection and mortality. Studies have shown that CBG measurements are accurate in normotensive patients and correlate with arterial samples. However, patients receiving vasopressors may be normotensive by arterial blood pressure, but have altered peripheral perfusion. Since altered peripheral perfusion may affect the accuracy of CBG measurements, actual best practice for this patient population is not known. METHODS: A convenience sample (n=50) of adult post-operative cardiothoracic patients on insulin and vasopressors were prospectively enrolled. Demographics and significant medical history were abstracted from the medical record. Prospective data collection occurred every six hours while on insulin drip and included: pharmacotherapy, vital signs and three blood samples obtained simultaneously from arterial and peripheral sites. Samples were tested using point of care technology and the central lab. The quality of peripheral perfusion was recorded using a standardized scale. One-way repeated-measures ANOVA was used to analyze differences in sets of blood glucose values within each time-point. RESULTS: We found a statistically significant difference in blood glucose levels drawn from both capillary sticks and arterial/venous sites (central lines) using a point of care testing device as compared to the clinical lab blood glucose levels (p<.0001 and p<.001, respectively). However, no difference was found in the point of care glucose measure from the capillary sites as compared to central ports (p=.883). In addition, we found that vasopressive medications (e.g., dopamine, epinephrine, norepinephrine) were significantly correlated with differences in glucose values (p<.001), and that patients on fewer vasopressive medications has less variance in glucose measures. CONCLUSIONS: Our findings suggest that while point of care testing offers valid and reliable trends in glucose measures for both arterial, venous and capillary blood samples, point of care testing does differ significantly from clinical lab testing, and the two methods should not be used interchangeably for IV insulin titration. In addition, patients on vasopressive medication are more likely to have variances in blood glucose testing.en_GB
dc.date.available2011-10-26T19:25:15Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:25:15Z-
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.conference.date2009en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationNew Orleans, Louisiana, USAen_GB
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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