Suitability of Capillary Blood Glucose Analysis in Patients Receiving Vasopressors
| Autor: | Lynn McGugan, Kesi Benjamin, Bradi B. Granger, Debra Farrell, Gloria P Porter, Helen Shearin, Morgan Cornell, Myra F Ellis, Yanfang Zhao, Kelsey Decker |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Blood Glucose Male medicine.medical_specialty Point-of-Care Systems Hypoglycemia Critical Care Nursing Article Nursing care Reference Values medicine Humans Insulin Vasoconstrictor Agents Postoperative Period Prospective Studies Blood Glucose Measurement Aged Glycemic Blood glucose monitoring Academic Medical Centers Analysis of Variance medicine.diagnostic_test business.industry Reproducibility of Results Arteries General Medicine Middle Aged medicine.disease Capillaries Surgery Intensive Care Units Blood pressure Case-Control Studies Anesthesia Arterial blood Female business Blood Chemical Analysis Blood sampling |
| Zdroj: | American Journal of Critical Care. 22:423-429 |
| ISSN: | 1937-710X 1062-3264 |
| DOI: | 10.4037/ajcc2013692 |
| Popis: | Glycemic control is an essential part of caring for critically ill patients and has been shown to improve outcomes.(1) Hyperglycemia is associated with increased morbidity and mortality in diabetic and non-diabetics following cardiac surgery and maintaining glucose < 180 mg/dl has been shown to reduce mortality and morbidity, decrease the incidence of wound infections, reduce hospital length of stay and enhance long-term survival. The use of intravenous insulin infusion to maintain an early postoperative glucose < 180 mg/dl while avoiding hypoglycemia is a class 1b recommendation for patients following cardiac surgery in the 2011 American College of Cardiology Foundation/American Heart Association (ACCF/AHA) Guideline for Coronary Artery Bypass Surgery.(2, 3) The accuracy of blood glucose measurements is paramount to nurses’ ability to manage and control blood glucose. Patients on insulin infusions require frequent blood glucose measurements for glycemic control. These measurements are performed every two hours minimum and generally every hour due to frequent changes in blood glucose values and to achieve the benefits of glycemic control. Blood glucose measurement using a finger-stick to obtain capillary samples is one way to minimize blood sampling from arterial lines in patients on insulin infusions. Additionally, the capillary glucose check is beneficial as it is a task that can be safely delegated to a nursing care assistant. Studies have shown that capillary blood glucose measurements are accurate in normotensive patients and provide good correlation with samples tested in a clinical chemistry lab.(4) However, patients receiving vasopressor agents may be normotensive by arterial blood pressure measurement, but have altered peripheral perfusion due to the vasoconstrictor effects of the medication.(5) Altered peripheral perfusion may affect the accuracy of capillary blood glucose measurements, however actual best practice for this patient population is not known. One study of 50 postoperative cardiovascular surgery patients demonstrated high correlation in capillary glucose sampling,(6) while others have shown poor correlation in cardiopulmonary resuscitation (CPR),(7) shock states,(5, 8) presence of edema,(9) and following major surgery.(9, 10) The small sample sizes in these studies and the conflicting results support the need for further study in populations with compromised peripheral perfusion. The standard of practice for continuous insulin infusions in many intensive care unit settings is hourly blood glucose monitoring, particularly in the acute post-operative phase. Standard procedure however does not dictate method, and as a result either or both arterial and capillary blood samples are collected. Both finger sticks and arterial samples may be drawn concomitantly for purposes of validation; however, this is not required and is a nurse-dependent variation in care. Patients are typically admitted to the cardiothoracic intensive care unit from the operating room on insulin infusions and vasoactive medications. During early post-operative recovery frequent titration of both insulin and vasopressor drips occurs,(2) however, studies to date do not consistently support the accuracy of capillary blood glucose in this setting or the correlation of arterial versus capillary blood glucose values in this critically ill patient population. In order to answer the research question regarding accuracy and correlation in the setting of high doses of vasopressor drugs, early access to temporally related samples is required. The purpose of this study was to compare capillary and arterial blood samples using point of care testing (POCT) with arterial blood samples using the clinical chemistry lab in patients following cardiothoracic surgery, and to determine if vasopressor medications or peripheral perfusion influenced the POCT values. |
| Databáze: | OpenAIRE |
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