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Continuous Insulin Infusion Protocol

Development Of A Cross-disciplinary Continuous Insulin Infusion Protocol For Non-critically Ill Patients In A French University Hospital

Development Of A Cross-disciplinary Continuous Insulin Infusion Protocol For Non-critically Ill Patients In A French University Hospital

Abstract Rationale, aims and objectives In non-critically ill patients, the use of an insulin syringe pump allows the management of temporary situations during which other therapies cannot be used (failure of subcutaneous injections, awaiting advice from the diabetes team, emergency situations, prolonged corticosteroid therapy, initiation of an artificial nutrition, need for a fasting status, etc.). To manage the risks related to this «never event», the use of a standard validated protocol for insulin administration and monitoring is an essential prerequisite. To this end, a multidisciplinary approach is recommended. With the support of our subcommission «Endocrinology-Diabetology», we proceeded with a «step-by-step process» to create such a standardized protocol: (1) review of all existing protocols in our hospital; (2) overview of the literature data concerning insulin infusion protocols developed by multidisciplinary teams in France and abroad; (3) development of a standardized protocol for non-intensive care unit patients, respecting the current recommendations and adapting it to the working habits of health teams; and (4) validation of the protocol Two protocols based on the same structure but adapted to the health status of the patient have been developed. The protocols are divided in to three parts: (1) golden rules to make the use of the protocol appropriate and safe; (2) the algorithm (a double entry table) corresponding to a dynamic adaptation of insulin doses, clearly defining the target and the ‘at risk situations’; and (3) practical aspects of the protocol: preparation of the syringe, treatment initiation and traceability. The protocols have been validated by the institution. Our standardized insulin infusion protocol is simple, easy to implement, Continue reading >>

Program Anestesiologi & Cawangan Kualiti Penjagaan Kesihatan Bpp, Kkm

Program Anestesiologi & Cawangan Kualiti Penjagaan Kesihatan Bpp, Kkm

Program Anestesiologi & Cawangan Kualiti Penjagaan Kesihatan BPP, KKM NAICU / ICU Management Protocol / Intensive Insulin Infusion / August 2006 ICU Management Protocol No. 6 INTENSIVE INSULIN INFUSION Introduction • The role of intensive insulin treatment is to maintain tight control of blood glucose in critically ill patients. • In a prospective, randomised, controlled study of mechanically ventilated adults, intensive insulin therapy reduced mortality to 4.6% compared with a conventional treatment group which had a mortality rate of 8%. The greatest reduction in mortality involved deaths due to multi-organ failure with a proven septic focus. • You may choose to use either Protocol A or Protocol B Protocol A 1. This protocol is not suitable for patients with diabetic ketoacidosis or children under the age of 16 years old. 2. The aim of blood glucose level (BGL) is between 5.1 – 8.0 mmol/l. 3. Start protocol when BGL exceeds 8.0 mmol/l after 2 consecutive readings in 2 hours. 4. Insulin Infusion: Use Soluble Insulin 50 units in 50 ml 0.9%NaCl infused through a dedicated cannula or central line lumen. 5. Blood glucose monitoring: Initially hourly monitoring, then 2-4 hourly when there is no rate change in 2 consecutive hours. 6. Patients who develop symptoms of severe hypoglycaemia should be treated as if BGL < 3.5 mmol/l. Symptoms include tremors, tachycardia, sweating, confusion and agitation leading to fitting and coma. 7. Feeding: Continuous feeding is recommended. Give IV dextrose 10% at 25ml/h until EN is tolerated or TPN is started. If EN is discontinued for any reason, recommence IV Dextrose 10% infusion at 25ml/h and continue insulin infusion. 8. Stop protocol when patient is taking food orally. 9. Other infusions (especially antibiotic Continue reading >>

Continuous Insulin Infusion Therapy: It’s Not Just For The Icu Anymore

Continuous Insulin Infusion Therapy: It’s Not Just For The Icu Anymore

We all know the benefits of tight glycemic control, especially in critically ill patients—fewer infections, less renal failure, fewer transfusions, and short hospital stays—to name a few. And, of course, the best method for achieving tight control is a continuous insulin infusion. Unfortunately, in most hospitals, the only units where a patient could receive such an infusion have been critical-care units. But that’s begun to change. In 2003, more than 10 organizations, including the American College of Endocrinology, set standards identifying target blood glucose levels for both critical-care and non-critical-care patients, treatment methods, and recommendations for a multidisciplinary approach to manage inpatient hyperglycemia. At my facility, studies showed that patients who were candidates for transfer to a less acute level of care were experiencing longer stays in the intensive care unit (ICU), solely because they needed insulin infusions. That led to a decision to make all adult medical-surgical nursing units able to manage patients receiving continuous insulin infusion therapy. The insulin infusion protocol (IIP) already being used in the ICU, the Beckett protocol, would now be used in all units. Using the Beckett protocol What sets the Beckett protocol apart from other protocols is its dosing plan. The Beckett IIP incorporates an engineering control method known as the proportional-integrative method. Most protocols use a proportional insulin dosing plan—simply put, the number of insulin units is a proportional response to the measurement of the blood glucose level. The Beckett IIP adds a second component, the integral or basal insulin dose, which provides cumulative hourly adjustments. The combined proportional and cumulative integral doses then determin Continue reading >>

A Comparison Of Two Insulin Infusion Protocols In The Medical Intensive Care Unit By Continuous Glucose Monitoring

A Comparison Of Two Insulin Infusion Protocols In The Medical Intensive Care Unit By Continuous Glucose Monitoring

Abstract Background Achieving good glycemic control in intensive care units (ICU) requires a safe and efficient insulin infusion protocol (IIP). We aimed to compare the clinical performance of two IIPs (Leuven versus modified Yale protocol) in patients admitted to medical ICU, by using continuous glucose monitoring (CGM). This is a pooled data analysis of two published prospective randomized controlled trials. CGM monitoring was performed in 57 MICU patients (age 64 ± 12 years, APACHE-II score 28 ± 7, non-diabetic/diabetic: 36/21). The main outcome measures were percentage of time in normoglycemia (80–110 mg/dl) and in hypoglycemia (<60 mg/dl), and glycemic variability (standard deviation, coefficient of variation, mean amplitude of glucose excursions, mean of daily differences). Twenty-two subjects were treated using the Leuven protocol and 35 by the Yale protocol; >63,000 CGM measurements were available. The percentage of time in normoglycemia (80–110 mg/dl) was higher (37 ± 15 vs. 26 ± 11%, p = 0.001) and percentage of time spent in hypoglycemia was lower (0[0–2] vs. 5[1–8]%, p = 0.001) in the Yale group. Median glycemia did not differ between groups (118[108–128] vs. 128[106–154] mg/dl). Glycemic variability was less pronounced in the Yale group (median SD 28[21–37] vs. 47[31–71] mg/dl, p = 0.001; CV 23[19–31] vs. 36[26–50]%, p = 0.001; MODD 35[26–41] vs. 60[33–94] mg/dl, p = 0.001). However, logistic regression could not identify type of IIP, diabetes status, age, BMI, or APACHE-II score as independent parameters for strict glucose control. The Yale protocol provided better average glycemia, more time spent in normoglycemia, less time in hypoglycemia, and less glycemic variability than the Leuven protocol, but was not independently assoc Continue reading >>

Sccm Unveils Insulin Infusion Guidelines For Glycemic Control

Sccm Unveils Insulin Infusion Guidelines For Glycemic Control

The Society of Critical Care Medicine assembled the Glycemic Control Task Force, a multiprofessional group of experts charged with summarizing the information available in a practical way. ​ In 2001, a landmark publication from Leuven changed the intensive care unit (ICU) practice of hyperglycemia management around the world.(1) The reported reduction in morbidity and mortality made the critical care community quasi-instinctively follow an aggressive management approach to hyperglycemia with intensive insulin therapy (IIT). The initial optimism was followed by concerns regarding the universal applicability of this treatment given the heterogeneity of the ICU case mix, severity of illness and resource environments. Difficulties regarding the morbidity and mortality rates of hypoglycemia, appropriateness of measurement devices and need for frequent monitoring (e.g., nursing care time, opportunity, cost) were appreciated early. Furthermore, new trials, including one from the original Leuven group,(2) did not corroborate the initial findings. Subsequently, the medical community was surrounded by a series of contradictory results. Confusion, uncertainties and questions regarding “external validity” of the results flourished. Given these circumstances, the medical community at large felt the need for guidelines from professional societies. The Society of Critical Care Medicine (SCCM), under the leadership of its former president Judith Jacobi, BCPS, PharmD, FCCM, assembled the Glycemic Control Task Force, a multiprofessional group of experts charged with summarizing the information available in a practical way. This group, which included intensivists from adult and pediatric medical and surgical ICUs, pharmacists, nurses, endocrinologists, and outcomes researchers, publ Continue reading >>

Guidelines For The Use Of An Insulin Infusion For The Management Of Hyperglycemia In Critically Ill Patients.

Guidelines For The Use Of An Insulin Infusion For The Management Of Hyperglycemia In Critically Ill Patients.

The grades of evidence (High, Moderate, Low, Very Low) and levels of recommendations (Strong, Weak) are defined at the end of the "Major Recommendations" field. Strong recommendations are listed as "recommendations" and weak recommendations as "suggestions." Note: While the initial goal was to suggest glycemic targets for critically ill patients, the limited available literature has narrowed the scope of this article and the ability to make recommendations for specific populations. An overriding focus is on the safe use of insulin infusions. The glycemic goal range of 100–150 mg/dL is a consensus goal, and while it differs slightly from the more stringent goal of 110–140 mg/dL for selected populations, recently published by the American Diabetes Association, and the overall glucose goal of 140–180 mg/dL, this difference is not likely to be clinically significant. In adult critically ill patients, does achievement of a blood glucose (BG) <150 mg/dL with an insulin infusion reduce mortality, compared with the use of an insulin infusion targeting higher BG ranges? The task force suggests that a BG ≥150 mg/dL should trigger initiation of insulin therapy, titrated to keep BG <150 mg/dL for most adult intensive care unit (ICU) patients and to maintain BG values absolutely <180 mg/dL using a protocol that achieves a low rate of hypoglycemia (BG ≤70 mg/dL) despite limited impact on patient mortality. [Quality of evidence: very low] In adult critically ill patients, what are the morbidity benefits of maintaining BG <150 mg/dL? The task force suggests that there is no consistently demonstrated difference in several morbidity measures (renal failure, transfusion, bacteremia, polyneuropathy, and ICU length of stay [LOS]) when evaluated in the general adult ICU population. Continue reading >>

Newborn Services Drug Protocol

Newborn Services Drug Protocol

Note: The electronic version of this guideline is the version currently in use. The general disclaimer regarding use of Newborn Services Guidelines and Protocols applies to this guideline. INSULIN (Neutral) Actrapid Penfill Reviewed by Dr Carl Kuschel, Robyn Wilkinson, and Brenda Hughes February 2002 Administration details updated July 2002 Description Clear colourless solution 100IU/ml in 1.5 ml cartridges. Discard if discoloured or shows precipitate. Prescription Continuous Infusions: Charted on fluid chart giving: rate in ml/hr dose in units/kg/hr Also charted on drug chart under continuous infusions Instructions for 1st and 2nd dilution: Base fluid, type and volume Insulin to be added Units/kg/ml SC/IM Injection: Charted on the prescription chart: dose in units dosing interval rate of administration Continuous IV Infusion: Note: Insulin infusion is not to be filtered. First dilution (1 unit/ml): Dilute 50 units (0.5 ml) of insulin into 49.5 ml D5W to make a solution of 1 unit/ml. Mix well. Using a 5 ml syringe draw up required amount of insulin (1 unit/ml) as charted. Discard the remainder of the 50ml syringe of insulin (1 unit/ml). Second dilution With another 50ml syringe draw up D5W at an amount to make the solution to a total of 50ml. Add the insulin dose (1 unit/ml from the 5ml syringe. Mix well. Prime the BC 566 (no filter is required). Leave syringe and extension for 1 hour to saturate the plastic binding sites. Flush a further 20ml of the prepared solution into a gallipot. Connect to a continuous infusion pump and then to infant. Change solution and tubing every 24 hours. SC/IM Injection: No dilution required. Monitor blood glucose frequently (initially 1-2 hourly until stable). Check urine for glucose at least 4-hourly. Monitor for signs of hypoglycaemia. N Continue reading >>

Assessment Of Nursing Perceptions Of Three Insulin Protocols For Blood Glucose Control In Critically Ill Patients

Assessment Of Nursing Perceptions Of Three Insulin Protocols For Blood Glucose Control In Critically Ill Patients

ORIGINAL ARTICLE Thiago Domingos Corrêa; Francisca Pereira de Almeida; Alexandre Biasi Cavalcanti; Adriano José Pereira; Eliézer Silva Intensive Care Unit, Hospital Israelita Albert Einstein - HIAE, São Paulo (SP), Brazil ABSTRACT OBJECTIVE: To evaluate nurses' perception regarding three different blood glucose control protocols for critically ill patients. METHODS: As part of a randomized trial comparing three blood glucose control protocols in critically ill patients (Computer-Assisted Insulin Protocol, Leuven Protocol, and conventional treatment), all nurses participating in the study were asked to fill in a questionnaire to assess their perceptions of efficacy, complexity, feasibility, and safety (as to the occurrence of hypoglycemic episodes), an to indicate which protocol they would like to see adopted as the standard one in the Intensive Care Unit they worked. RESULTS: Sixty nurses answered the questionnaires. Computer-Assisted Insulin Protocol was considered the most efficient protocol to maintain blood glucose levels within the target range by 58% of the nurses, compared to 22% for Leuven Protocol (p<0.001) and 40% for conventional treatment (p=0.04). Computer-Assisted Insulin Protocol was considered easier to use than Leuven Protocol (p<0.001) and as easy as conventional treatment (p=0.78). Out of the nurses, 37% considered Computer-Assisted Insulin Protocol more feasible than Leuven Protocol and conventional treatment. A total of 51% of nurses chose Leuven Protocol as the protocol more often associated with hypoglycemia, while 27% chose Computer-Assisted Insulin Protocol and 8% conventional treatment. Finally, 56% of the nurses selected Computer-Assisted Insulin Protocol as the protocol they would like to see adopted as the standard one in the Intensive C Continue reading >>

Tight Glucose Control From A Nurse-driven Continuous Insulin Infusion Protocol In The Intensive Care Unit: 455

Tight Glucose Control From A Nurse-driven Continuous Insulin Infusion Protocol In The Intensive Care Unit: 455

Prescribing Information Important Safety Information Patients being treated with Vitamin K antagonist therapy have underlying disease states that predispose them to thromboembolic events. Potential benefits of reversing VKA should be weighed against the risk of thromboembolic events, especially in patients with history of such events. Resumption of anticoagulation therapy should be carefully considered once the risk of thromboembolic events outweighs the risk of acute bleeding. Both fatal and nonfatal arterial and venous thromboembolic complications have been reported in clinical trials and postmarketing surveillance. Monitor patients receiving Kcentra, and inform them of signs and symptoms of thromboembolic events. Kcentra was not studied in subjects who had a thromboembolic event, myocardial infarction, disseminated intravascular coagulation, cerebral vascular accident, transient ischemic attack, unstable angina pectoris, or severe peripheral vascular disease within the prior 3 months. Kcentra might not be suitable for patients with thromboembolic events in the prior 3 months. Kcentra is contraindicated in patients with known anaphylactic or severe systemic reactions to Kcentra or any of its components (including heparin, Factors II, VII, IX, X, Proteins C and S, Antithrombin III and human albumin). Kcentra is also contraindicated in patients with disseminated intravascular coagulation. Because Kcentra contains heparin, it is contraindicated in patients with heparin-induced thrombocytopenia (HIT). Indications Kcentra®, Prothrombin Complex Concentrate (Human), is a blood coagulation factor replacement product indicated for the urgent reversal of acquired coagulation factor deficiency induced by Vitamin K antagonist (VKA—eg, warfarin) therapy in adult patients with a Continue reading >>

Implementing An Intravenous Insulin Infusion Protocol In The Intensive Care Unit

Implementing An Intravenous Insulin Infusion Protocol In The Intensive Care Unit

Purpose. The implementation of three different insulin protocols in intensive care unit (ICU) settings in two community hospitals and one academic hospital is described. Summary. Each institution possessed a commitment to improve the existing insulin protocols in order to achieve tighter glycemic control for ICU patients. Studies have shown that the maintenance of tight glycemic control provides improved patient outcomes. Obstacles to implementation of the insulin protocols at the institutions were increased staff workload, difficulties in interpreting algorithms, and lack of perceived benefit. In comparing details of the insulin protocols at the academic and community hospitals, it was found that differences were influenced by the type of institution. The differences among the institutions in the implementation of the protocols included the initial physician response to the protocol, the details of each protocol, nursing staff autonomy, and the involvement of the nursing staff in early protocol development. All three institutions had a dedicated pharmacist in the ICU who committed time toward insulin protocol implementation. For an increased likelihood of successful insulin protocol implementation, a full-time dedicated ICU pharmacist should be assigned to participate on multidisciplinary rounds, provide nursing support and education, and collect process measures to monitor and improve the protocol. Conclusion. The i.v. insulin infusion protocols developed and implemented in the ICUs at three institutions successfully achieved acceptance and compliance by physicians and nurses. The factors attributed to the success were multidisciplinary involvement, the continuous education of nursing staff, the vigilant involvement of a pharmacist, and flexibility in revising the pro Continue reading >>

Approach To The Hospitalized Patient With Severe Insulin Resistance

Approach To The Hospitalized Patient With Severe Insulin Resistance

The Journal of Clinical Endocrinology & Metabolism Approach to the Hospitalized Patient with Severe Insulin Resistance University of Nebraska Medical Center, Department of Internal Medicine, Division of Diabetes, Endocrinology, and Metabolism, Omaha, Nebraska 68198-3020 Address all correspondence and requests for reprints to: Jennifer Larsen, M.D., Department of Internal Medicine, 983020 Nebraska Medical Center, Omaha, Nebraska 68198-3020. Search for other works by this author on: University of Nebraska Medical Center, Department of Internal Medicine, Division of Diabetes, Endocrinology, and Metabolism, Omaha, Nebraska 68198-3020 Search for other works by this author on: The Journal of Clinical Endocrinology & Metabolism, Volume 96, Issue 9, 1 September 2011, Pages 26522662, Jennifer Larsen, Whitney Goldner; Approach to the Hospitalized Patient with Severe Insulin Resistance, The Journal of Clinical Endocrinology & Metabolism, Volume 96, Issue 9, 1 September 2011, Pages 26522662, Glucose control improves outcomes in the hospitalized patient, particularly patients on prolonged ventilator support, after acute myocardial infarction or after coronary artery bypass surgery. An iv insulin algorithm is the standard of care for initial treatment of significant hyperglycemia in the hospitalized patient, and it can be transitioned to periodic sc insulin once the patient is more stable. However, illness, medications, the endocrine and inflammatory response to stress, and pain can all contribute to insulin resistance and further aggravate preexisting insulin resistance caused by obesity. Glucose treatment goals have been established to guide the rapy, but achieving those goals can be more challenging in the presence of severe insulin resistance. When target glucose values are not Continue reading >>

Iv Insulin On The Floor: Not So Scary After All

Iv Insulin On The Floor: Not So Scary After All

Published in the October 2010 issue of Today’s Hospitalist When it comes to transitioning patients with severe hyperglycemia away from sliding scale insulin, physicians are often blamed for refusing to embrace a better way of doing things. But many hospitalists who are moving to standardize subcutaneous insulin protocols won’t even consider using an insulin drip outside of the ICU. The reason they often shy away from insulin infusion on the floor, even for patients about to receive a procedure, is that nurses simply don’t have the time to do the monitoring (and math) necessary to safely keep ward patients on a drip for a day or two. And if nurses don’t have enough time to monitor patients, an insulin drip protocol could be disastrous. But there’s now some evidence that continuous insulin infusion protocols outside the ICU are not only safe and effective, but that physicians and nurses alike embrace them “if implemented properly. The Emory Healthcare System in Atlanta is a case in point. “A sizeable number of insulin infusions are given to patients before, during or after a procedure.” ~ Noble Maleque, MD Emory University Hospital Midtown A study conducted at the system’s flagship Emory University Hospital looked at the safety and efficacy of a continuous insulin infusion protocol. Researchers analyzed more than 200 patients in a 12-month period who received insulin infusion on the floors. The study, published in the April 2010 Journal of Hospital Medicine, found that the rate of hypoglycemic events among those patients was similar to research findings on subcutaneous insulin regimens. A similar protocol has been in place for the better part of 10 years at Emory University Hospital Midtown, a 511-bed teaching hospital in midtown Atlanta. As hospitalists Continue reading >>

Intravenous Insulin Therapy

Intravenous Insulin Therapy

Overview Patients with hyperglycemia in the ICU have increased morbidity and mortality. Hyperglycemia is associated with immune dysfunction, increased systemic inflammation, and vascular insufficiency. Elevated blood glucose levels have been shown to worsen outcomes in medical patients who are in the ICU for more than 3 days. Hyperglycemia may result from stress, infection, steroid therapy, decreased physical activity, discontinuation of outpatient regimens, and nutrition. [1] Improved control of hyperglycemia improves patient outcomes, but clinical confirmation of this thesis has proven elusive. Significant interest was generated by initial single-center results that have not been replicated in multisite studies. In 2001, a randomized controlled study in a surgical ICU demonstrated a decrease in mortality from 8% to 4.6% in patients with intensive continuous intravenous insulin therapy. [2] The author repeated the protocol in a study of 1200 patients in a medical ICU. [3] The conventional treatment group was treated to maintain a blood glucose level between 180-200 mg/dL, whereas the intensive treatment group was treated to maintain a blood glucose level between 80-110 mg/dL. Mortality was not significantly reduced by intensive insulin therapy and was actually higher in patients in the intensive treatment group who were in the ICU for less than 3 days. In patients who were in the ICU for longer than 3 days, the intensive treatment group did demonstrate reduced morbidityfrom decreased kidney injury, earlier weaning from mechanical ventilation, and earlier discharge from the medical ICU and hospital. Hypoglycemia occurred more often in the intensive treatment group than the conventional treatment group. In addition, an experienced physician was actively involved in admin Continue reading >>

Glycemic Control In Adults With Continuous Insulin Infusion After Cabgs

Glycemic Control In Adults With Continuous Insulin Infusion After Cabgs

Abstract PURPOSE: The purpose of this study was to examine nurses’ adherence to a continuous insulin infusion (CII) protocol in adults having CAGBS. Literature suggests protocols for tight glycemic control may lead to increased incidence of complications. There is however very little evidence to demonstrate practice patterns associated with the implementation and management of CII protocols. METHODS: Retrospective review of medical records from a convenience sample of 100 consecutive CABG cases from July to December 2009, at a single University affiliated hospital was conducted. One observer gathered data on patient demographics, operative characteristics and protocol adherence using a standardized proforma. Outcomes were tracked from admission to ICU until the cessation of CII. According to institutional protocol CII was to commence at 2.5 units/hour if blood glucose (BG) level was > 9.1 mmol/L but < 15 mmol/L. Rate adjustment was dependent on BG level measured hourly for three hours if adjustment was necessary. The primary endpoint was protocol adherence during CII. Initiation, monitoring and dose adjustment violations were tracked. RESULTS: CII was commenced for 79 patients, 47 (59.5%) who had no diabetic history. At commencement BG level was on average 8.8 mmol/l (SD = 2.4). Infusions continued for a median of 27 hours (Q1 16, Q1 36) after surgery and it took approximately 6.3 hours to achieve target BG levels. Only 52.6% of BG results were within protocol target range of 6 to 9 mol/L. Two patients experienced an episode of hypoglycaemia requiring intervention. Initiation violations occurred in more than 50% of patients requiring CII. BG levels were monitored less frequently than was recommended (n = 455, 62.7% violations) and there were 270 (37.3%) episodes of in Continue reading >>

A Nurse Managed Computerized Program For Continuous Iv Insulin Infusion:jiip(jefferson Insulin Infusion Protocol) And Non Jiip.

A Nurse Managed Computerized Program For Continuous Iv Insulin Infusion:jiip(jefferson Insulin Infusion Protocol) And Non Jiip.

Requirements: RN will review the PowerPoint presentation. RN will practice titration guidelines on practice pathway on computer. RN will complete program quiz with a grade of 100%. Unit CNS will review quiz results with staff member. Introduction Uncontrolled hyperglycemia in hospitalized patients results in poor clinical outcomes. IV insulin is the drug of choice for optimal glycemic management in many patients. Safe administration of IV insulin is a complex task. The Jefferson Hospital Insulin Infusion Protocol(JIIP) applies to all adult patients requiring IV insulin but ONLY if the JIIP is ordered. General Guidelines Physicians who do not order the JIIP but want continuous IV insulin infusion (NON-JIIP) for their patients, are responsible for the hourly titration of the infusion and specific fluid orders. The RN may titrate a non –JIIP infusion based on previous infusion guidelines online but only if the glucose and piggyback protocol is followed. JIIP Candidates ICU patients with BG>180mg/dl x 2 consecutive measurements. NOTE: Check Blood glucose (BG) on admission to ICU and q4 hours thereafter. If BG <140mg/dl for first 24 hours, measure BG daily or as clinically indicated. JIIP Candidates Type 1 DM requiring surgery/general anesthesia. Type 2 DM with uncontrolled hyperglycemia or insulin requiring type 2 DM needing surgery/general anesthesia. Note: It is best to start an IV insulin infusion the night before surgery. (Suggest Endo Consult for insulin orders.) Never discontinue insulin on patients with type 1 diabetes. If BG 70 or less,follow hypoglycemia protocol and restart insulin when BG normal. Physician enters order for JIIP and orders the bolus dose and the initial infusion rate as follows: Non DKA/HHS ex: (Pre-surgery, uncontrolled hyperglycemia,NPO p Continue reading >>

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