Continuous Insfusion of Insulin Neonate

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Connecticut Childrens Medical Center - Policy and Procedure Manual

Neonatal Intensive Care Unit (NICU) Date Effective: August 23, 2011

Continuous Infusion of Insulin for the Neonate Date of Origin: April 01, 1996

Approved By: CCMC-UCHC NICU Collaborative Group Date Approved: June 30, 2011

I.Purpose It is the purpose of this policy to describe preparation and administration of continuous insulin infusions to neonates in the Neonatal Intensive Care Unit (NICU) and to provide guidelines for the nursing management of the neonate receiving insulin by continuous infusion.

II.Policy It is the policy of Connecticut Childrens Medical Center (Connecticut Childrens) that all infants with glucose intolerance, resulting in hyperglycemia and/or glucosuria, be evaluated for and treated with a continuous insulin infusion. A continuous insulin infusion can improve the infants tolerance of the glucose load required to maintain adequate growth.

III.Criteria A.Considerations

1.If hyperglycemia (defined as plasma > 150 whole blood >125 mg/dL,) develops during the first few days of life, adjust the glucose concentration to maintain a desired GIR before implementing use of a continuous insulin infusion. Hypotonic IV solutions will not be administered in an effort to reduce glucose infusion rates.

2.Insulin infusions must be administered on an infusion pump. 3.Only regular insulin is used to prepare an insulin infusion. 4.Do not use an in-line filter. 5.Insulin should run with dextrose solution at all times. When dextrose is shut off

then insulin is shut off. When it is piggybacked into the maintenance IV fluids, use the port closest to the patient to insure stability of the solution. Check the compatibility of the solutions before using a piggyback method to infuse.

6.Insulin binds to foreign substances (e.g., plastic), therefore the tubing used to deliver the insulin infusion must be primed with the infusion prior to starting the continuous drip.

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IV.Procedure A.Dose Calculation:

1.To calculate the infants initial insulin requirement: a)Calculate the amount of dextrose the patient is receiving (in grams) per 24

hours (D10 = 10 grams/100ml). The patients initial insulin requirement is estimated to be 0.1 units of regular insulin per day for each gram of dextrose per day that the patient is receiving.

b)Divide this number by 24 to determine units of insulin per hour. c)Calculate the rate of infusion needed to deliver the desired dose. A standard

insulin infusion concentration of either 0.5 units per ml or 1 unit per ml is recommended. Infusion rates less than 0.4 ml/hour are preferred.

2.Subsequent dose adjustments: a)Infusion rates are generally adjusted up or down in increments of 0.05

units/hour, every 2 hours to maintain blood glucose between 50-150 mg/dL. B.Administration:

1.Explain the purpose and the goals of the therapy to the infants parents. Allow adequate time for questions and/or discussion.

2.Obtain and record: heart rate, respiratory rate, blood pressure (BP), temperature, and blood glucose level.

3.Assess the IV site for patency. Avoid flushing IV to prevent administration of Insulin bolus.

4.Verify the physicians order for an insulin infusion per Connecticut Childrens policy, including: a)Type of insulin. b)Dose and amount of insulin in Units. c)Type and volume of IV solution.

5.Except in an emergency, the infusion should be prepared by the Pharmacy. 6.Connect the micro-bore tubing to the 60 ml syringe. Micro-bore tubing is used to

decrease the number of potential binding sites for the insulin, which has an affinity to plastic.

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7.Prime the tubing (including t-connector), then run approximately 20-30 ml of solution through the tubing over a 2-3 minute period to saturate available binding sites. This allows the infusion reaching the infant to arrive at the appropriate concentration of medication.

8.Place the 60 ml syringe in the infusion pump, and begin infusion. Use a smaller syringe as needed per pump specifications.

C.Monitoring: 1.Check a blood glucose level no more than one hour after infusion starts. 2.Check blood glucose levels 1 to 2 hours after any dose change. Allow at least 60

minutes between dose changes. 3.Once blood glucose has stabilized, check level every 4-8 hours, continuing to

monitor the infants other vital signs. 4.Calculate and report if urine output has changed from baseline. 5.Notify the attending practitioner/covering practitioner if:

a)Blood glucose < 40 mg/dL, or > 250 mg/dL. b)If blood glucose

Continuous Insfusion of Insulin Neonate

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