2.50
Hdl Handle:
http://hdl.handle.net/10755/157510
Type:
Presentation
Title:
CLINICAL IMPLICATIONS OF TIGHT GLYCEMIC CONTROL IN INTENSIVE CARE
Abstract:
CLINICAL IMPLICATIONS OF TIGHT GLYCEMIC CONTROL IN INTENSIVE CARE
Conference Sponsor:Western Institute of Nursing
Conference Year:2010
Author:Goodell, Teresa Tarnowski, RN, CNS, PhD, CCRN, ACNS-BC
P.I. Institution Name:Or Health & Sci Univ
Title:Assistant Professor
Contact Address:3455 SW US Veterans Hospital Rd. SN6S, Portland, OR, 97239, USA
Co-Authors:Quin Denfeld; Kelly Stafford
PURPOSES/AIMS:
The purpose of this study was to determine the difference in blood glucose values obtained at the bedside with a point-of-care (POC) device and in the hospital laboratory. We were interested in the degree of error in glucose measures and their IMPLICATIONS: for hypoglycemia in the context of tight glycemic control.
RATIONALE/CONCEPTUAL BASIS/BACKGROUND:
In the 1990s, clinical trials showed decreased mortality and shorter LOS with tight glycemic control in intensive care units. More recent studies have raised concern about increased risk of hypoglycemia as a result of these protocols. Intensive care nurses may spend over 4 hours per day on glycemic management alone, which may draw the nurse away from other aspects of nursing care. Glycemic management issues such as measurement error with different devices and nursing time have garnered little attention by researchers.
Method
The sample consisted of post-op day #0 cardiac surgery patients. All had an arterial line in place and had orders for a renal function set and a complete blood count. IRB approval was obtained. A single sample of arterial blood was drawn and analyzed both by the RN at the bedside with the Precision XCeedPro glucometer (to obtain the POC glucose value) and in the hospital laboratory with the Beckman Coulter DXC 800 or LH 780 machines. The POC glucose value, the laboratory glucose value, hematocrit and the demographic data were recorded by the RN caring for the patient.
RESULTS:
Data were collected from 46 adults; of these, mean age of the sample was 60.8 years (SD 13.3), 44 (96%) were White, 29 (63%) were male, and 29 (63%) had undergone coronary artery bypass grafting. Thirteen (28%) had a diagnosis of diabetes mellitus. Mean Hct was 27.7 (SD 4.8), mean POC glucose 110.2 mg/dL (SD 28) and mean lab glucose was 97.8 mg/dL (SD 24.7). The mean difference between POC and lab glucose was 12.3 mg/dL (SD 9.8), with POC glucose the higher value. Difference scores ranged from 33 mg/dL to -7 mg/dL. A paired t-test revealed t = 8.5, p <.001. Non-parametric correlation was used because hematocrit and difference scores were not normally distributed; Spearman's rho correlation between the difference scores and hematocrit was -.43, p = .003.
IMPLICATIONS:
Much research on tight glycemic control has been done in the context of controlled clinical trials with dedicated staff. Our study, conducted in usual clinical practice on day 0 post-operative cardiothoracic patients, demonstrates considerable error in bedside glucose testing that may be accounted for by device limitations and by variable techniques used by intensive care registered nurses. We recommend reconsideration of insulin titration protocols with consideration of both nursing time and the degree of error inherent in bedside glucose testing devices. Hypoglycemia, a contributor to poor ICU outcomes, may go undetected in intensive care patients when POC values exceed those typically obtained by the "gold standard" laboratory devices.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleCLINICAL IMPLICATIONS OF TIGHT GLYCEMIC CONTROL IN INTENSIVE CAREen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157510-
dc.description.abstract<table><tr><td colspan="2" class="item-title">CLINICAL IMPLICATIONS OF TIGHT GLYCEMIC CONTROL IN INTENSIVE CARE</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Goodell, Teresa Tarnowski, RN, CNS, PhD, CCRN, ACNS-BC</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Or Health &amp; Sci Univ</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">3455 SW US Veterans Hospital Rd. SN6S, Portland, OR, 97239, USA</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">goodellt@ohsu.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Quin Denfeld; Kelly Stafford</td></tr><tr><td colspan="2" class="item-abstract">PURPOSES/AIMS: <br/>The purpose of this study was to determine the difference in blood glucose values obtained at the bedside with a point-of-care (POC) device and in the hospital laboratory. We were interested in the degree of error in glucose measures and their IMPLICATIONS: for hypoglycemia in the context of tight glycemic control. <br/>RATIONALE/CONCEPTUAL BASIS/BACKGROUND: <br/>In the 1990s, clinical trials showed decreased mortality and shorter LOS with tight glycemic control in intensive care units. More recent studies have raised concern about increased risk of hypoglycemia as a result of these protocols. Intensive care nurses may spend over 4 hours per day on glycemic management alone, which may draw the nurse away from other aspects of nursing care. Glycemic management issues such as measurement error with different devices and nursing time have garnered little attention by researchers.<br/>Method<br/>The sample consisted of post-op day #0 cardiac surgery patients. All had an arterial line in place and had orders for a renal function set and a complete blood count. IRB approval was obtained. A single sample of arterial blood was drawn and analyzed both by the RN at the bedside with the Precision XCeedPro glucometer (to obtain the POC glucose value) and in the hospital laboratory with the Beckman Coulter DXC 800 or LH 780 machines. The POC glucose value, the laboratory glucose value, hematocrit and the demographic data were recorded by the RN caring for the patient. <br/>RESULTS:<br/>Data were collected from 46 adults; of these, mean age of the sample was 60.8 years (SD 13.3), 44 (96%) were White, 29 (63%) were male, and 29 (63%) had undergone coronary artery bypass grafting. Thirteen (28%) had a diagnosis of diabetes mellitus. Mean Hct was 27.7 (SD 4.8), mean POC glucose 110.2 mg/dL (SD 28) and mean lab glucose was 97.8 mg/dL (SD 24.7). The mean difference between POC and lab glucose was 12.3 mg/dL (SD 9.8), with POC glucose the higher value. Difference scores ranged from 33 mg/dL to -7 mg/dL. A paired t-test revealed t = 8.5, p &lt;.001. Non-parametric correlation was used because hematocrit and difference scores were not normally distributed; Spearman's rho correlation between the difference scores and hematocrit was -.43, p = .003.<br/>IMPLICATIONS: <br/>Much research on tight glycemic control has been done in the context of controlled clinical trials with dedicated staff. Our study, conducted in usual clinical practice on day 0 post-operative cardiothoracic patients, demonstrates considerable error in bedside glucose testing that may be accounted for by device limitations and by variable techniques used by intensive care registered nurses. We recommend reconsideration of insulin titration protocols with consideration of both nursing time and the degree of error inherent in bedside glucose testing devices. Hypoglycemia, a contributor to poor ICU outcomes, may go undetected in intensive care patients when POC values exceed those typically obtained by the &quot;gold standard&quot; laboratory devices.<br/></td></tr></table>en_GB
dc.date.available2011-10-26T19:56:19Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T19:56:19Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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