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Connecticut Childrens Medical Center - Policy and Procedure Manual


Neonatal Intensive Care Unit (NICU) Date Effective: August 23, 2011
Continuous Infusion of Insulin for the Neonate Date of Origin: April 01, 1996
Approved By: CCMC-UCHC NICU Collaborative
Group
Date Approved: June 30, 2011
I.Purpose
It is the purpose of this policy to describe preparation and administration of continuous
insulin infusions to neonates in the Neonatal Intensive Care Unit (NICU) and to provide
guidelines for the nursing management of the neonate receiving insulin by continuous
infusion.

II.Policy
It is the policy of Connecticut Childrens Medical Center (Connecticut Childrens) that all
infants with glucose intolerance, resulting in hyperglycemia and/or glucosuria, be
evaluated for and treated with a continuous insulin infusion. A continuous insulin
infusion can improve the infants tolerance of the glucose load required to maintain
adequate growth.

III.Criteria
A.Considerations
1.If hyperglycemia (defined as plasma > 150 whole blood >125 mg/dL,) develops
during the first few days of life, adjust the glucose concentration to maintain a
desired GIR before implementing use of a continuous insulin infusion. Hypotonic
IV solutions will not be administered in an effort to reduce glucose infusion rates.
2.Insulin infusions must be administered on an infusion pump.
3.Only regular insulin is used to prepare an insulin infusion.
4.Do not use an in-line filter.
5.Insulin should run with dextrose solution at all times. When dextrose is shut off
then insulin is shut off. When it is piggybacked into the maintenance IV fluids, use
the port closest to the patient to insure stability of the solution. Check the
compatibility of the solutions before using a piggyback method to infuse.
6.Insulin binds to foreign substances (e.g., plastic), therefore the tubing used to
deliver the insulin infusion must be primed with the infusion prior to starting the
continuous drip.









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Connecticut Childrens Medical Center - Policy and Procedure Manual
Neonatal Intensive Care Unit (NICU) Date Effective: August 23, 2011
Continuous Infusion of Insulin for the Neonate Date of Origin: April 01, 1996
Approved By: CCMC-UCHC NICU Collaborative
Group
Date Approved: June 30, 2011
IV.Procedure
A.Dose Calculation:
1.To calculate the infants initial insulin requirement:
a)Calculate the amount of dextrose the patient is receiving (in grams) per 24
hours (D10 = 10 grams/100ml). The patients initial insulin requirement is
estimated to be 0.1 units of regular insulin per day for each gram of dextrose
per day that the patient is receiving.
b)Divide this number by 24 to determine units of insulin per hour.
c)Calculate the rate of infusion needed to deliver the desired dose. A standard
insulin infusion concentration of either 0.5 units per ml or 1 unit per ml is
recommended. Infusion rates less than 0.4 ml/hour are preferred.
2.Subsequent dose adjustments:
a)Infusion rates are generally adjusted up or down in increments of 0.05
units/hour, every 2 hours to maintain blood glucose between 50-150 mg/dL.
B.Administration:
1.Explain the purpose and the goals of the therapy to the infants parents. Allow
adequate time for questions and/or discussion.
2.Obtain and record: heart rate, respiratory rate, blood pressure (BP), temperature,
and blood glucose level.
3.Assess the IV site for patency. Avoid flushing IV to prevent administration of
Insulin bolus.
4.Verify the physicians order for an insulin infusion per Connecticut Childrens
policy, including:
a)Type of insulin.
b)Dose and amount of insulin in Units.
c)Type and volume of IV solution.
5.Except in an emergency, the infusion should be prepared by the Pharmacy.
6.Connect the micro-bore tubing to the 60 ml syringe. Micro-bore tubing is used to
decrease the number of potential binding sites for the insulin, which has an affinity
to plastic.








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Connecticut Childrens Medical Center - Policy and Procedure Manual
Neonatal Intensive Care Unit (NICU) Date Effective: August 23, 2011
Continuous Infusion of Insulin for the Neonate Date of Origin: April 01, 1996
Approved By: CCMC-UCHC NICU Collaborative
Group
Date Approved: June 30, 2011
7.Prime the tubing (including t-connector), then run approximately 20-30 ml of
solution through the tubing over a 2-3 minute period to saturate available binding
sites. This allows the infusion reaching the infant to arrive at the appropriate
concentration of medication.
8.Place the 60 ml syringe in the infusion pump, and begin infusion. Use a smaller
syringe as needed per pump specifications.
C.Monitoring:
1.Check a blood glucose level no more than one hour after infusion starts.
2.Check blood glucose levels 1 to 2 hours after any dose change. Allow at least 60
minutes between dose changes.
3.Once blood glucose has stabilized, check level every 4-8 hours, continuing to
monitor the infants other vital signs.
4.Calculate and report if urine output has changed from baseline.
5.Notify the attending practitioner/covering practitioner if:
a)Blood glucose < 40 mg/dL, or > 250 mg/dL.
b)If blood glucose <80 stop infusion and notify credential practitioner.
c)Change in blood glucose level +/ 60 mg/dL in one hour.
d)Abnormal electrolyte values with daily labs (especially potassium).
D.Documentation:
1.Document insulin infusion on the infusion record/medication administration record.
2.Record infusion rate hourly on NICU flowsheet.
3.Record all blood glucose levels on NICU flowsheet.
4.Describe infants response to treatment on the flowsheet or Progress Notes.
5.Describe any parent education regarding administration of an insulin infusion.

V.References

VI.Related Documents
Medication Administration
Care of the ELBW Infant
Medication Administration Record
Intravenous Fluid Administration

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