Suitability of Capillary Blood Glucose Analysis in Patients Receiving Vasopressors

Overview

Journal Am J Crit Care

Specialties Critical Care
Nursing

Date 2013 Sep 3

PMID 23996422

Citations 7

Authors

Myra F Ellis

Kesi Benjamin

Morgan Cornell

Kelsey Decker

Debra Farrell

Lynn McGugan

Gloria P Porter

Helen Shearin

Yanfang Zhao

Bradi B Granger

Affiliations

Soon will be listed here.

Abstract

Background: Glycemic control in critically ill patients decreases infection and mortality. Patients receiving vasopressors have altered peripheral perfusion, which may affect accuracy of capillary blood glucose values measured with point-of-care devices.

Objectives: To compare capillary and arterial glucose values measured via point-of-care testing (POCT) with arterial glucose values measured via clinical chemistry laboratory testing (CCLT) in patients after cardiothoracic surgery. To determine if vasopressors or diminished peripheral perfusion influence the accuracy of POCT values.

Methods: In a prospective, convenience sample of 50 adult postoperative cardiothoracic patients receiving insulin and vasopressors, 162 samples were obtained simultaneously from capillary and arterial sites during insulin infusion and tested via both POCT and CCLT. Clarke error grid analysis and ISO 15197 were used to analyze level of agreement. Two-way analysis of variance was used to analyze differences in glucose values with respect to vasopressor use and peripheral perfusion.

Results: An unacceptable level of agreement was found between the capillary POCT results and arterial CCLT results (only 88.3% of values fell in zone A, or within the ISO 15197 tolerance bands). Arterial POCT results showed acceptable (94.4%) agreement with CCLT results. Vasopressor use had a significant effect on the accuracy of arterial blood glucose values (F=15.01; P<.001).

Conclusions: Even when the more accurate POCT with arterial blood is used, blood glucose values are significantly less accurate in patients receiving more than 2 vasopressors than in patients receiving fewer vasopressors. CCLT may be safer for titrating insulin doses in these patients.

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References

Clarke W, Cox D, Gonder-Frederick L, Carter W, POHL S . Evaluating clinical accuracy of systems for self-monitoring of blood glucose. Diabetes Care. 1987; 10(5):622-8. DOI: 10.2337/diacare.10.5.622. View

Brunkhorst F, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N . Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008; 358(2):125-39. DOI: 10.1056/NEJMoa070716. View

Akinbami F, Segal S, Schnipper J, Stopfkuchen-Evans M, Mills J, Rogers Jr S . Tale of two sites: capillary versus arterial blood glucose testing in the operating room. Am J Surg. 2012; 203(4):423-7. DOI: 10.1016/j.amjsurg.2011.10.013. View

Lazar H, McDonnell M, Chipkin S, Furnary A, Engelman R, Sadhu A . The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. Ann Thorac Surg. 2009; 87(2):663-9. DOI: 10.1016/j.athoracsur.2008.11.011. View

Thomas S, Gough J, Benson N, Austin P, Stone C . Accuracy of fingerstick glucose determination in patients receiving CPR. South Med J. 1994; 87(11):1072-5. DOI: 10.1097/00007611-199411000-00003. View

Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M . Intensive insulin therapy in critically ill patients. N Engl J Med. 2002; 345(19):1359-67. DOI: 10.1056/NEJMoa011300. View

Preiser J, Devos P, Ruiz-Santana S, Melot C, Annane D, Groeneveld J . A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study. Intensive Care Med. 2009; 35(10):1738-48. DOI: 10.1007/s00134-009-1585-2. View

Lonjaret L, Claverie V, Berard E, Riu-Poulenc B, Geeraerts T, Genestal M . Relative accuracy of arterial and capillary glucose meter measurements in critically ill patients. Diabetes Metab. 2012; 38(3):230-5. DOI: 10.1016/j.diabet.2011.12.003. View

Maser R, Butler M, DeCherney G . Use of arterial blood with bedside glucose reflectance meters in an intensive care unit: are they accurate?. Crit Care Med. 1994; 22(4):595-9. DOI: 10.1097/00003246-199404000-00014. View

10.

Finfer S, Chittock D, Su S, Blair D, Foster D, Dhingra V . Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009; 360(13):1283-97. DOI: 10.1056/NEJMoa0810625. View

11.

Sylvain H, Pokorny M, English S, Benson N, Whitley T, Ferenczy C . Accuracy of fingerstick glucose values in shock patients. Am J Crit Care. 1995; 4(1):44-8. View

12.

Kanji S, Buffie J, Hutton B, Bunting P, Singh A, McDonald K . Reliability of point-of-care testing for glucose measurement in critically ill adults. Crit Care Med. 2005; 33(12):2778-85. DOI: 10.1097/01.ccm.0000189939.10881.60. View

13.

Dubose J, Inaba K, Branco B, Barmparas G, Lam L, Teixeira P . Discrepancies between capillary glucose measurements and traditional laboratory assessments in both shock and non-shock states after trauma. J Surg Res. 2012; 178(2):820-6. DOI: 10.1016/j.jss.2012.04.003. View

14.

Hillis L, Smith P, Anderson J, Bittl J, Bridges C, Byrne J . 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for.... J Am Coll Cardiol. 2011; 58(24):e123-210. DOI: 10.1016/j.jacc.2011.08.009. View

15.

Furnary A, Wu Y, Bookin S . Effect of hyperglycemia and continuous intravenous insulin infusions on outcomes of cardiac surgical procedures: the Portland Diabetic Project. Endocr Pract. 2004; 10 Suppl 2:21-33. DOI: 10.4158/EP.10.S2.21. View