Accuracy of roche accu-chek inform whole blood capillary, arterial, and venous glucose values in patients receiving intensive intravenous insulin therapy after cardiac surgery.

Intravenous insulin protocols are increasingly common in the intensive care unit to maintain normoglycemia. Little is known about the accuracy of point-of-care glucometers for measuring glucose in this patient population or the impact of sample source (capillary, arterial, or venous whole blood) on the accuracy of glucometer results. We compared capillary, arterial, and venous whole blood glucose values with laboratory plasma glucose values in 20 patients after cardiac surgery. All 4 samples (capillary, arterial, and venous whole blood and laboratory plasma glucose) were analyzed hourly for the first 5 hours during intravenous insulin therapy in the intensive care unit. There were no significant differences between median capillary whole blood (149 mg/dL [8.3 mmol/L]) and laboratory plasma (151 mg/dL [8.4 mmol/L]) glucose levels. The median arterial (161 mg/dL [8.9 mmol/L]) and venous (162 mg/dL [9.0 mmol/L]) whole blood glucose levels were significantly higher than the median laboratory plasma glucose level. Capillary whole blood glucose levels correlate most closely with laboratory plasma glucose levels in patients receiving intensive intravenous insulin therapy after cardiac surgery.

[1]  G J Kost,et al.  Effects of different hematocrit levels on glucose measurements with handheld meters for point-of-care testing. , 2009, Archives of pathology & laboratory medicine.

[2]  K Kuwa,et al.  Relationships of glucose concentrations in capillary whole blood, venous whole blood and venous plasma. , 2001, Clinica chimica acta; international journal of clinical chemistry.

[3]  S. Kane-Gill,et al.  Intensive Insulin Therapy for Critically III Patients , 2004 .

[4]  I Guilhem,et al.  Clinical and statistical evaluation of self-monitoring blood glucose meters. , 1998, Diabetes care.

[5]  M. Mlynarek,et al.  An Insulin Infusion Protocol in Critically Ill Cardiothoracic Surgery Patients , 2004, The Annals of pharmacotherapy.

[6]  S. Colagiuri,et al.  Comparability of venous and capillary glucose measurements in blood , 2003, Diabetic medicine : a journal of the British Diabetic Association.

[7]  Suzanne H. Atkin,et al.  Fingerstick glucose determination in shock. , 1991, Annals of internal medicine.

[8]  M. Haeusler,et al.  Toward universal criteria for gestational diabetes: relationships between seventy-five and one hundred gram glucose loads and between capillary and venous glucose concentrations. , 1998, American journal of obstetrics and gynecology.

[9]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[10]  O. Pelletier,et al.  Precision of glucose measurements in control sera by isotope dilution/mass spectrometry: proposed definitive method compared with a reference method. , 1987, Clinical chemistry.

[11]  P. Dodek,et al.  Intravenous insulin nomogram improves blood glucose control in the critically ill , 2001, Critical care medicine.

[12]  James D Dziura,et al.  Implementation of a safe and effective insulin infusion protocol in a medical intensive care unit. , 2004, Diabetes care.

[13]  J. Fleiss,et al.  Intraclass correlations: uses in assessing rater reliability. , 1979, Psychological bulletin.

[14]  M Schetz,et al.  Intensive insulin therapy in critically ill patients. , 2001, The New England journal of medicine.

[15]  Brian Hutton,et al.  Reliability of point-of-care testing for glucose measurement in critically ill adults* , 2005, Critical care medicine.

[16]  T. Whitley,et al.  Accuracy of fingerstick glucose values in shock patients. , 1995, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[17]  P. Stuart,et al.  Capillary versus venous bedside blood glucose estimations , 2005, Emergency Medicine Journal.

[18]  Salmaan Kanji,et al.  Standardization of intravenous insulin therapy improves the efficiency and safety of blood glucose control in critically ill adults , 2004, Intensive Care Medicine.