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Donna Fritz
IV insulin

We are giving IV push insulin on our med-surg units.  A procedure was writting for this.  I would like your comments on this aspect:

How do I administer IVP Insulin?

·         Draw up the Insulin in an Insulin syringe, transfer to 3 or 5 cc syringe, dilute with 3-5 cc NS and administer within one minute, utilize needless port closest to the IV access; flush with 10cc  NS afterwards, even if there is a running IV.

·         Reason for flushing: Insulin sticks to the IV tubing and it is not clear how much medication passes from the infusion port to the patient.

 

 

I am  concerned about transferring from the insulin syringe to a 3-5 cc syringe because of contamination during the process of transfer.  Also, what about dilution?  Doesn't a slower rate of administration via a NS mainline accomplish the same thing?

lynncrni
You have good reason to be

You have good reason to be concerned about a procedure requiring syringe-to-syringe drug transfer. The 2011 INS standards state this should be avoided, see page S60, Practice Criteria I. The reference for this is from ISMP. I would need to know the rationale used by the procedure authors about why they think this is necessary. It could be they only have insulin syringes with a fixed needle that can not be attached to your needleless connectors, but there are insulin syringes with removable needles available. It could also be the old concept of not using any syringe smaller than a 10 mL on any CVC. But you did not say this was only for CVC use. If the catheter is open and patent with flow fluids, assessed with a 10 mL saline filled syringe for absence of resistance and good blood return, then it is appropriate to use a syringe size that is best for the drug volume being given. Transfer to another syringe increases risk of contamination and loss of part of the measured dose.

Insulin does adhere to the plastic of fluid containers and sets, but there is no evidence that flushing will make any difference. You are correct that the infusion of primary fluid will dilute any drug being given as a push through the line.

Transferring all drugs between syringes is a dangerous and unnecessary practice, in my opinion. Lynn

 

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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