Insulin Pump Therapy in Patients with Diabetes Undergoing Surgery

Nassar, Adrienne A.; Boyle, Mary E.; Seifert, Karen M.; Beer, K; Apsey, Heidi A.; Schlinkert, Richard T.; Stearns, Joshua D.; Cook, Curtiss B.

doi:10.4158/ep11157.or

Cited by 27 publications

(30 citation statements)

References 12 publications

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“…12,13,63 When a continuous insulin infusion is warranted (eg, DM 1 patients), a VRIII or glucose-insulin-potassium infusion should be used. 64 The fear of hypokalemia when administering insulin infusion without potassium during short procedures does not seem to be justified. 10 Insulin pumps can be continued intraoperatively, especially if the surgical procedure is expected to be of short duration.…”

Section: Intraoperative Considerationsmentioning

confidence: 99%

Ambulatory anesthesia: optimal perioperative management of the diabetic patient

Polderman¹,

Wilpe²,

Eshuis³

et al. 2016

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Given the growing number of patients with diabetes mellitus (DM) and the growing number of surgical procedures performed in an ambulatory setting, DM is one of the most encountered comorbidities in patients undergoing ambulatory surgery. Perioperative management of ambulatory patients with DM requires a different approach than patients undergoing major surgery, as procedures are shorter and the stress response caused by surgery is minimal. However, DM is a risk factor for postoperative complications in ambulatory surgery, so should be managed carefully. Given the limited time ambulatory patients spend in the hospital, improvement in management has to be gained from the preanesthetic assessment. The purpose of this review is to summarize current literature regarding the anesthesiologic management of patients with DM in the ambulatory setting. We will discuss the risks of perioperative hyperglycemia together with the pre-, intra-, and postoperative considerations for these patients when encountered in an ambulatory setting. Furthermore, we provide recommendations for the optimal perioperative management of the diabetic patient undergoing ambulatory surgery.

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Section: Intraoperative Considerationsmentioning

confidence: 99%

Ambulatory anesthesia: optimal perioperative management of the diabetic patient

Polderman¹,

Wilpe²,

Eshuis³

et al. 2016

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“…The perioperative period was defined as the time from patient admission to the preoperative suite to the time of discharge from the PACU. 12,13 Each of these perioperative segments include transition points in the care of the patient on CSII therapy, during which the status of the insulin pump and glycemic control should be assessed and documented.…”

Section: Overview Of Cpmmentioning

confidence: 99%

“…[7][8][9][10][11] Previous work from the authors' institution with regard to use of perioperative CSII devices uncovered suboptimal documentation of whether the insulin pump was present and insufficient frequency of intraoperative glucose monitoring. 12 Lack of documentation suggests lack of staff awareness, and infrequent glucose monitoring risks that extremes in glucose levels will be missed-both potential safety issues. Other safety concerns include inadvertent dislodgement or disconnecting of the device, failure to move the insertion site of out of the surgical field, and trauma to the insulin pump during transition of the position throughout the perioperative phase of care.…”

mentioning

confidence: 99%

“…Because of the lack of consensus guidelines, a requirement to provide a structured approach to management to ensure patient safety, and the need to close gaps in our own institutional surgical care of the technology, 12 we developed a CPM that allowed CSII treatment to be transitioned through the different segments of perioperative care. 5 Initial reports immediately after implementation of the CPM were positive in that necessary elements of management were being accomplished and that CSII therapy appeared to be safe during the perioperative period.…”

mentioning

confidence: 99%

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Update on a Quality Initiative to Standardize Perioperative Care for Continuous Subcutaneous Insulin Infusion Therapy

Mackey

Thompson

Boyle

et al. 2015

J Diabetes Sci Technol

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Objective: The objective of the analysis was to review the effectiveness of a care process model (CPM) developed to guide management of patients on insulin pump therapy undergoing elective surgical procedures. Methods: Electronic medical records were reviewed to assess the impact of the CPM on documentation of insulin pump status, glucose monitoring, and safety during the perioperative phase of care. Post-CPM care was compared with management provided before CPM implementation. Results: We reviewed 45 cases on insulin pump therapy in the pre-CPM cohort and 106 in the post-CPM cohort. Demographic characteristics, categories of surgery, and perioperative times were not significantly different between the 2 groups. Recommended hemoglobin A1c monitoring occurred in 73% of cases in the pre-CPM cohort but improved to 94% in the post-CPM group ( P < .01). There was a higher frequency of documentation of the insulin pump during the preoperative, intraoperative, and postanesthesia care unit segments of care in the post- vs pre-CPM periods (all P < .01). The number of cases with intraoperative glucose monitoring increased (57% pre-CPM vs 81% post-CPM; P < .01). Glycemic control was comparable between the 2 CPM periods. Hypoglycemia was rare, with only 3 episodes in the pre-CPM group and 4 in the post-CPM. No adverse events associated with perioperative insulin pump use were observed. Conclusions: This analysis adds to previous data on use of insulin pump therapy during the perioperative period. Some processes require additional attention, but data continue to indicate that a standardized approach to care can lead to a successful and safe transition of insulin pump therapy throughout the perioperative period.

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“…5,[7][8][9] While CSII and CGMS are intended for outpatient use, these devices are also being encountered by inpatient clinical care teams. 10,11 Technology-enhanced simulation can improve learning outcomes. 12 Simulations of clinical cases can be delivered through various modalities, including computers or mobile devices (screen-based patient simulation) or in person (immersive patient simulation).…”

Section: Introductionmentioning

confidence: 99%