June 1, 2023

Hi today we’re gonna go through insulin continuous iv infusions so let’s get started so i’m taking care of a jason morris today and i’ve received an order for insulin he mule in our continuous iv he’s been having blood sugar issues he’s been having very labile blood sugars so the doctor would like him to be started on something that can help him get his sugar’s

Down so what we’re gonna do first is we’re gonna compare our physicians order to our mar and make sure that they’re transcribed correctly so first of all we’re gonna compare write patient so we’re not doing our writes right now but we want to make sure it’s correct so morris morris jason jason and m rn 0 9 9 0 1 2 7 m rn 0 9 9 0 1 2 7 he’s 25 years old 25 years

Old normally you’d have a birth date on here and you could use that as an identifier as well we are going to look at the drug so insulin female and our insulin humulin are its continuous iv continuous iv it’s at 3 units per hour 3 units per hour and we’re our goal blood sugar or blood glucose is 6 to 10 6 to 10 so those match up i’ve checked jason’s blood sugar

Level and it’s 18 which is high and that makes sense that we would start an infusion for that so we want to make sure that we have checked his blood sugar level i’m also going to be looking at the parenteral drug monograph to learn a little bit more about what i do with this and how i prepare that so over here i have insulin regular it’s important that we know it’s

Regular it’s not a long-acting alternate named novel in toronto it’s an anti diabetic med so it’s a high alert medication which means i need to have a second nurse around to help me with that i can give it iv continuous i’m a nurse so i can give it and there are special policies with that so every hospital will have their own policy it says i should have d50 w

Readily available on the unit that’s an emergency drug i would give if the patient became hypo wemmick there is different some specifications for the physicians order so i’m going to review that i’m then going to look at the second page it tells me that i be continuous i need a hundred units of insulin and it’s very specific about what kind of syringe i’m going to

Use what kind of needle and how much to drop and i’m putting it in a 100 ml mini bag of normal saline i need to use for iv continuous a colleague pump and i have to use tubing with no ports okay this is the recipe right here it’s very important that i i create the 0.99 units per ml and that i use a hundred ml of normal saline or d5w so i’m gonna really want to make

Sure i review this compatibility wise i’m going to be mixing it up i think i’ll use normal saline that should work and there are potential hazards of hypoglycemia so i want to make sure that i’m monitoring my patient very frequently for that i need to be checking sugars regularly and that looks about right it tells me that i need to be careful if the patient’s not

Receiving any oral intake or tube feeds and they’re saying that dextrose if he’s not eating is recommended but he is eating so i’m going to stick with normal saline so i’m starting with my first check i need to have my mar my pdm and my vial which i’ve grabbed from the fridge i’ve also grabbed a 100 ml normal saline bag as well which i’m going to be using after so

We’re gonna start with right patient so i’m looking morris jason and his m rn and i checked that with the orders already the right drug is insulin humulin r and very specifically we have to check the type of insulin so it’s humulin r and i’m reviewing that on the pd on its insulin regular and i’m also checking my vial hulan r okay so it’s insulin and we’re making

Sure it’s the right type doctor has ordered three units per hour and we need to look at our pdm first to kind of understand how that’s mixed up there so the dose in the bag what how many units were drawing up is a hundred units of the insulin are so here in in this it’s a hundred units per ml so when we mix up our bag we’re going to have a final concentration of

0.99 units per ml in this bag okay so when we think about it we need to know how much is going to run so it’s three units per hour into the patient but when we have our bag mixed up we want to know that it’s 0.99 units per ml so it’s very important to understand the concentration in the bag and the dose per hour that’s being run we are now looking at right route

So continuous iv i am looking at iv continuous so this is correct what i’m looking at and the right time it’s been ordered now so i just want to make sure that i am starting it now all right now that i’ve drawn up my medication i have labeled my insulin hundred units which is one ml and i’m ready to do my second check so we’re gonna start over at the mar and we’re

Gonna be using our med label so we’re gonna look at right patient which is morris jason morris jason right drug is insulin humulin arm and then we have insulin right here we have hume yulin are right here we’re looking at the pd m insulin humulin are here and i also have that on my label for the dose i know that i need three units per hour which i also have on my

Label and i’m also looking at the recipe for that so i need to know the concentration in the bag so i’m going to take a hundred units which is one ml of the 100 units for ml insulin i have done that here i have taken one ml of the 100 units per ml insulin which you can see here the insulin are i’ve drawn that up so i have a hundred units in this one ml and i need

To add that to a hundred ml of normal saline which i have in this bag and that will give me a final volume of 101 with a final concentration in the bag of 0.99 units per amount so then i’m going to look at the right route which is going to be iv continuous this is an infusion so it’s iv and i’ve been looking at iv continuous and the right time is now now that i’ve

Completed my second check i’m ready for my second nurse to come my colleague is gonna come and she’s gonna verify that everything is done correctly before i inject it into the bag all right i’m ready to inject the medication so i’m going to swab for 30 seconds and dry for 15 i’m gonna make sure i’m doing this in a nice aseptic way and to not poke myself i’m going to

Inject that when i cap i’m being very careful to do it so i don’t hurt myself and i’m going to go like this and apply my label which now has a second signature all right so prior to going into the room i’m just gonna prime well i already did i primed portlets tubing like the pdm said just to make sure that it’s safe for the patient so i’m gonna go ahead and do my

Third check in the room okay i’ve washed my hands i’ve gone into my patients room i have my bar and my labeled insulin infusion bag there so i’m just gonna say hi to my paycheck hi mr. morris how are you can you just i know you know me but can you just tell me your name please and your native birth thank you so so much i’m just gonna verify that here i’m looking

At my mar because i want to make sure you’re the right person and that we’re giving the right drug to the right person so i’m just looking at my label morris jason morris jason there and morris jason so they all match up sorry verify that so jason you’ve had some high blood sugars it was actually 18 which is really high for you and the doctors decided to start an

Insulin infusion so kind of like those needles that you’re getting but you’re gonna be getting it through an iv now it’s insulin and it’s going to bring your sugar’s down so i’m going to be monitoring you and you’re gonna be seeing me a lot more often i’ll be checking more sugars and making sure that you’re within the range the doctor wants are you okay with this

All right i will be monitoring you for any kind of complains of sweating you hunger if you feel dizzy if you feel weird in any way it could be a sign of your sugar being too low it’s very important that you tell me right away all right thanks so much now that i’ve done my education and my assessment talk with jason i’ve also verified who he is i’m gonna continue

On so right drug is insulin humulin are insulin is right here and my dose is three units per hour three units per hour and that was the hundred units in the bag the right route it’s continuous iv and insulin infusion so it’s iv and we’re gonna run it now because the doctor ordered it to be started now so that’s my third check before i program my pump i really want

To make sure i’ve done a good safety check of what he already has infusing so currently he has portlets tubing there’s normal saline which is compatible with insulin and it’s running at a low tea kvo rate into a peripheral iv so if i follow that along i see this y/y tubing and this allows for the insulin to be running with something called a carrier infusion it’s

Really important that i have this carrier infusion because if i make the calculations for my insulin it would actually be only three cc’s per hour running for three units per hour that’s not enough to keep his vein open and to make sure that that medication gets to him so we want to run something that is going to push that in and we call those like that a carrier

So the carrier is the normal saline it’s running into this iv and i’m going to be hooking up my insulin into this so just want to make sure it looks good which it does all right something i just want to also point out is that i am not going to hook this up until i put it into the pump first what happens if you do that is you run the risk of bola singh so if i just

Were to hook this up to the patient without having it regulated by the pump i do run the risk of bola singh my patient with a bunch of insulin that’s very very dangerous so i never want to hook this up to the patient until it’s been put in the pump i also first another safety feature here is i put insulin on a label here and the date and time the reason i do that

Is because i want anybody coming to the bedside to know that i’m running insulin because it’s a high alert medication so very very important so now that i’ve already done my third check i can just use the label to program my comic so i have my pump on standby it’s a kali guardian and as a requirement in our policy that we run an infusion through there so i’m gonna

Click primary and i can’t use a regular screen i actually have to use the kali guardian feature so i’m gonna click on that and i need to find insulin so i’m just gonna page down and i’m gonna go over to insulin so you see insulin i’m going to select that and it’s really nice because it actually pulls up what your recipe is right there and what i’m just gonna do is

I’m gonna take my bag and i’m gonna compare what’s on this screen to what’s on the label so we know that we’ve got a hundred units which it says on my label the diluent amount is a hundred and one so we’ve got a hundred and one in the bag in total mls the concentration is 0.99 units per ml which it does say on my label so the dose the dose is per hour is what we’re

Looking for here units per hour very important that we know that it’s the correct units per hour that we’re talking about and it is three based on the doctor’s order it says that on my label which i checked with my mar during the third check it then equals three mls per hour which i talked about that that’s not fast enough that’s why we have a carrier and we have a

Total volume of 101 i want to make sure i’m happy with this but this needs to be confirmed with a second nurse so i’m gonna actually have a nurse come and do that check to verify so now i’m going to just confirm my primary now that my second nurse has confirmed that it’s correct i’m going to confirm and i am going to now hook it up to my patient so before i press

Start i just want to make sure so i i’ve hooked up the iv line to the patient and i’m going to be doing a really good visual check of all my claps in a real life situation you always want your clamps off when you’re running infusions sometimes you’ll find in the lab if it’s something’s running gravity will clamp it because we don’t want to overflow the mannequin

It’s very important that these clamps are off if they’re supposed to be running so when i look at my line here i’m doing a visual inspection it is clamped i need to uncommon it’s safe to do that because it’s in my pump already so i’m gonna unclamp that and that’s gonna make sure that it runs to the patient i’m happy with that i feel good about it i’m going to

Press start so that is something that i’m gonna be looking at is it dripping it would take a long time on something running only at three mls per hour to really see three drips so that’s why it’s so important to check your clamps and you’re gonna be checking them all the way from the patient all the way up the tubing so we’re looking for our clamps so for example

This one is clamped that’s my one that’s running my carrier so i would unclamp that and just make sure that it’s running at the tk vo rate i would just want to make sure that after that i’ve made sure he has the call light that i’m monitoring him and that i’m documenting after the last safety feature that you really want to do before you leave the room is you want

To lock out the pump this is a requirement according to the policy as well it is a black button you’re gonna push it i’m going to show you now what the screen looks like so you see a little lock that means the pump is locked if somebody tries to press the screen the front panel is now locked and nobody can can play around with the settings because it is a high alert man

Transcribed from video
Insulin Continuous IV Infusion By University of Manitoba Nursing Skills