Arterial Catheter Setup for Glucose Control in Critically Ill Patients: A Randomized Controlled Trial

Abstract

Background Use of an arterial catheter to obtain hourly blood samples for intensive insulin therapy monitoring avoids causing patients the discomfort of repeated fingersticks. Returning the clearing volume may decrease procedure-related blood loss by 50% and minimize the risk of anemia. Objectives To compare the feasibility of 2 arterial catheter clearing-volume return setups for hourly blood extractions and to evaluate the related complications and the accuracy of arterial samples in determining glycemia.Methods In an open clinical trial, 90 critical patients undergoing intensive insulin therapy who had a radial arterial catheter were randomized to an intervention group-nonwaste needleless setup or nonwaste syringe setup and compared with the standard setup (control group). Mechanical and infectious complications related to the arterial catheter were evaluated. Blood glucose measurements at point-of-care glucometer (arterial catheter or fingerstick sample) were compared with laboratory results (venous blood). Results No patient had catheter-related infection in the intervention group (an estimated 12 776 manipulations); the control group had 2 infection episodes in 5230 catheter-days (an estimated 13 075 manipulations). The incidence of bacterial colonization was not significantly higher in the needleless group than in the syringe group (22.2% vs 12.2%; relative risk, 0.55; 95% CI, 0.16-1.71), with 1778 (SD, 114) and 1918 (SD, 82) catheter manipulations, respectively. Arterial catheter complications were negligible in all patients. Glycemia was detected from arterial catheter samples as effectively as with laboratory results (venous samples) except when hematocrit was less than 25%. Conclusions Use of blood obtained via an arterial catheter is safe and effective for glucose monitoring in patients undergoing intensive insulin therapy, with no increase in complications of catheterization.

Expert consensus on the glycemic management of critically ill patients

“…Post hoc analysis after matching the burn area and wound score indicated that the ADRR was the only blood glucose index significantly associated with the mortality of patients <43 years of age ( P < 0.01). [118] Dahagam et al [115] also confirmed that in critically ill patients with severe burns, glycemic variability was higher among those who died than those who survived (26% [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] vs. 21%, [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , P < 0.05), and multiple regression analysis showed that high glycemic variability was associated with prolonged hospital stay ( P < 0.05). Thus, excessive blood glucose variability and frequency of blood glucose falling outside the normal range should be avoided.…”

“…Rationale : In critically ill patients, the sampling priority for glucose monitoring is arterial > venous > capillary. [27] A prospective observational study [28] found that the accuracy of arterial blood glucose values (69.9% and 76.5% with a glucose meter and a blood gas analyzer, respectively) was higher than capillary blood glucose values (56.8% and 56.8%, respectively). The accuracy of capillary blood glucose values was only 26.3%, and the accuracy of arterial blood glucose values measured with a glucose meter or a blood gas analyzer was 55.6% and 64.9%, respectively.…”

Recent Advances in Multidisciplinary Critical Care

“…Returning the clearing volume may substantially decrease procedure-related blood loss. 57 RaurellTorredàand colleagues 57 questioned whether arterial catheter setup influenced the rate of mechanical problems and catheter infection, and whether the glycemic values matched those obtained from venous samples. patients were randomized to either the intervention group (equipped with a nonwaste needleless setup) or the control group (equipped with the nonwaste syringe setup).…”