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/clinical/nursing-hub/npg/quick-help/resources/Quick-Help-for-Nurses-Insulin-Drip-2017-FINAL.pdf

201710290

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100

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Learning and Development,Nursing,

Clinical Hub,Nursing Hub,Nursing Practice Guidelines,Quick Help for Nurses,Resources

Insulin Drips (Adults) - Nursing Quick Help

Insulin Drips (Adults) - Nursing Quick Help - Clinical Hub, Nursing Hub, Nursing Practice Guidelines, Quick Help for Nurses, Resources


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Hello Nurses. I’m Gwen Klinkner, a Diabetes
Clinical Nurse Specialist here at UW Health. To
your left you will find some quick topics to help
you take care of patients with insulin drips.
Just click on the pictures to the left to
learn more.
Quick Help for Nurses:
Insulin Drips
Nursing Practice Innovation, 2017

Quick Help for Nurses:
Insulin Drips
Transitions and Other
Frequently Asked Questions
Moving Columns: Meals,
Meds, & More
Orders &
Documentation
Key Points







HOME
Restarting after Hypoglycemia
Don’t restart infusion after a hypoglycemia event until insulin has been off for
30 minutes AND glucose is in Target Range or higher (i.e., ≥ 110 mg/dL)
Rate & Column Changes
Use decision tree to determine column changes and additional “Rules for
Making Rate and Column Changes.”
Max Rates for General Care/IMC
Maximum rate for General Care/ IMC is 30 units/hour; additional columns (7-9)
are for patients in ICU only
Prime & Setting Up Tubing
When using new IV tubing, waste additional 20 mL of insulin to saturate all
tubing binding sites.
Monitoring
Monitor glucoses hourly. If BG is within target for 3 consecutive hours, may change to
every 2 hours. Must resume hourly checks if BG ever deviates from Target Range.
Target Range
110 – 150 mg/dL
Key Points

Nursing Practice Innovation, 2017
Click on images for
direct links
Case Studies:
Access case studies on
the Inpatient Diabetes
Management page under
Practice Resources.

Orders & Documentation

HOME
Nursing Practice Innovation, 2017
Prioritize charting in
Health Link
Most units also use
paper worksheet to
more easily track trends
Worksheet is NOT part
of the permanent
record – Chart
comments in Health
Link
Paper worksheet
can be found on
U-Connect
Consider using Diabetes
Management summary
report to see overview
Links to Orders/Protocol:
Insulin Infusion Protocol (columns 1-6)
Insulin Infusion Protocol (columns 7-9) (ICU only)

Moving Columns:
Meals, Meds, & More
HOME
Reduction or
discontinuation of
vasopressors
Reduction or
discontinuation
of steroids
(as above)
Reduction or
discontinuation of
tube feeding or TPN
2-4 hours after
giving 1st dose of
subcutaneous basal
insulin (i.e.,
glargine)
Initiation or increase of
vasopressors
(including epinephrine,
norepinephrine, vasopressin)
Initiation or increase of
steroids
(including prednisone,
dexamethasone,
methylprednisolone, and/or
hydrocortisone)
Initiation or increase of
tube feeding or TPN
Nursing Practice Innovation, 2017
Consider moving Left after...
Consider moving Right after…
…if BG values increase
with subsequent
monitoring.
…if BG values decrease with
subsequent monitoring.
When Patients Eat:
SQ rapid-acting insulin
should be given with
meals. Stay in the same
column for the next 2
hours; continue to
adjust rate based on
hourly BG checks.
Or Or
Or Or Or

Transitions & Other FAQs

HOME
Columns: Where do I start?
Question: Which column should I start in?
• Answer: You will start in Columns 1-3, depending on patient circumstances such as
insulin sensitivity, glucose level, medications being used, etc. See protocol for
“Initiating the Infusion” for details. Do NOT start in Columns 4-6.
Column 7: ICU transfer?
Question: My general care/IMC patient is in column 6 and meets criteria to move to
column 7. Do they always need to transfer to the ICU?
• Answer: If criteria are met to move to column 7 for a general care/IMC patient currently in
Column 6, notify provider/ DMS to determine if SC insulin could be added or if ICU transfer is
warranted. Column 7 cannot be used on general care/IMC units.
Eating: Why SQ insulin?
Question: My patient is on an insulin drip and is now eating meals. Why do I have
orders for SQ insulin?
• Answer: SQ insulin has a longer action time than IV insulin so it will cover glucose
excursions after meals more effectively than IV boluses.
Stopping the Drip: SQ insulin?
Question: I have orders to stop the insulin drip and start SQ insulin. Does it
matter when I give the SQ insulin dose?
• Answer: Yes. IV insulin has a 30-60” half-life. SQ insulin needs to be given BEFORE the
drip is turned off so that it begins to work before the IV insulin stops working.
Surgical Site Infection (SSI) Prevention: Drips?
Question: Why are we starting insulin drips post-operatively for surgical
patients?
• Answer: The evidence supports keeping blood glucoses <200 mg/dL regardless
of diabetes history to prevent surgical site infections. Insulin drips provide the
best control for short-term glycemic management. See protocol details.