Comparison of Glucose Point-of-Care Values With Laboratory Values in Critically Ill Patients

2009 ◽  
Vol 18 (3) ◽  
pp. 224-230 ◽  
Author(s):  
Anna Shearer ◽  
Marilyn Boehmer ◽  
Melanie Closs ◽  
Rosalina Dela Rosa ◽  
Jean Hamilton ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Laboratory ◽  
Point Of Care ◽  
Method Comparison ◽  
Laboratory Analysis ◽  
Convenience Sample ◽  
Blood Samples ◽  
Glucose Testing ◽  
Laboratory Values

Background Blood from central venous or arterial catheters as well as from fingersticks is often used for point-of-care glucose testing.Objectives To compare glucose values obtained with a point-of-care device for catheter and fingerstick blood samples with values obtained by clinical laboratory analysis of a catheter blood sample.Methods A method-comparison design was used. Point-of-care values for fingerstick and catheter blood samples were compared with laboratory values for blood from catheters in a convenience sample of 63 critically ill patients. Device bias and precision were calculated and graphed according to the Bland-Altman method, and a t test was used to determine differences in glucose values for the 2 methods.Results Laboratory glucose values for blood from a catheter sample differed significantly from point-of-care values for blood from a fingerstick (t1,61 = 5.01; P < .001) and from a catheter (t1,61 = 3.91; P < .001). Bias and precision for the point-of-care device was large (fingerstick, 8.7 and 13.7; catheter, 7.0 and 14.0); 20% of the values differed from the laboratory glucose values by more than 20 mg/dL. Point-of-care glucose values for fingerstick and catheter samples did not differ (P = .41).Conclusions Glucose values obtained with a point-of-care device differ significantly from those obtained by laboratory analysis. The magnitude of these differences calls into question the widespread practice of using point-of-care glucose testing to guide insulin titration for tight glucose control. Errors in dosing could easily be made because of the large bias and precision associated with a point-of-care device.

Differences in Glucose Values Obtained From Point-of-Care Glucose Meters and Laboratory Analysis in Critically Ill Patients

2009 ◽  
Vol 18 (1) ◽  
pp. 65-72 ◽  
Author(s):  
Anjannette Cook ◽  
Delyla Laughlin ◽  
Margery Moore ◽  
Doreen North ◽  
Kathleen Wilkins ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Method Comparison ◽  
Venous Catheter ◽  
Laboratory Analysis ◽  
Hematocrit Level ◽  
Convenience Sample ◽  
Indwelling Catheters ◽  
The Difference

Background Blood for glucose analysis is often obtained interchangeably from indwelling catheters and fingersticks. Objectives To determine the level of agreement between glucose values obtained by laboratory analysis and with a point-of-care device for blood from 2 different sources: fingerstick and a central venous catheter. Methods A method-comparison design was used. Point-of-care values for blood from fingersticks and catheters were compared with laboratory values for blood from catheters in a convenience sample of 67 critically ill patients. The effects of hematocrit level and finger edema on differences in glucose values between the 2 methods were also evaluated. A t test was used to determine differences in glucose values obtained via the 2 methods. Differences and limits of agreement were also calculated. Results Laboratory glucose values for blood from a catheter differed significantly from point-of-care values for blood from the catheter (t1,66 = −9.18; P < .001) and from a fingerstick (t1,66 = 6.53; P < .001). Glucose values for the 2 methods differed by 20 mg/dL or more for 1 of 6 patients (15%) for catheter samples and for 1 of 5 (21%) for fingerstick samples. Point-of-care glucose values for fingerstick and catheter samples did not differ (P = .98). Hematocrit level significantly explained the difference in glucose values between the 2 methods for both catheter (R2 = 0.288; P < .001) and fingerstick (R2 = 0.280; P = .02) samples. Conclusions Use of a commonly used point-of-care device when precise glucose values are needed may lead to faulty treatment decisions.

437: POINT-OF-CARE GLUCOSE TESTING IN CRITICALLY ILL PATIENTS

2018 ◽  
Vol 46 (1) ◽  
pp. 202-202
Author(s):  
Kylie Scimio ◽  
Chris Carter ◽  
Seraj El-Oshar
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Glucose Testing

Point-of-care glucose testing in critically ill patients: Visual logistics and a glycemic variability hypothesis *

2009 ◽  
Vol 37 (10) ◽  
pp. 2841-2843
Author(s):  
Gerald J. Kost ◽  
Nam K. Tran ◽  
Jorge R. Sifontes ◽  
Dan M. Mecozzi ◽  
Richard F. Louie ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Glycemic Variability ◽  
Glucose Testing

Remote Continuous Glucose Monitoring With a Computerized Insulin Infusion Protocol for Critically Ill Patients in a COVID-19 Medical ICU: Proof of Concept

2021 ◽  
Author(s):  
Georgia M. Davis ◽  
Eileen Faulds ◽  
Tara Walker ◽  
Debbie Vigliotti ◽  
Marina Rabinovich ◽  
...  
Keyword(s):  
Real Time ◽  
Critically Ill ◽  
Continuous Glucose Monitoring ◽  
Critically Ill Patients ◽  
Insulin Infusion ◽  
Point Of Care ◽  
Glucose Monitoring ◽  
Proof Of Concept ◽  
Computerized Decision Support ◽  
Glucose Testing

<b>Objective: </b>The use of remote real-time continuous glucose monitoring (CGM) in the hospital has rapidly emerged to preserve personal protective equipment (PPE) and reduce potential exposures during COVID-19. <p><b>Design and Methods:</b> We linked a hybrid CGM and point-of-care (POC) glucose testing protocol to a computerized decision support system for continuous insulin infusion (CII) and integrated a validation system for sensor glucose values into the electronic health record. We report our proof-of-concept experience in a COVID-19 ICU.<b></b></p> <p><b>Results: </b>All nine patients required mechanical ventilation and corticosteroids. Seventy six percent of sensor values were within 20% of the reference POC glucose with an associated average reduction in POC of 63%. Mean time in range (70-180 mg/dL) was 71.4 ± 13.9%. Sensor accuracy was impacted by mechanical interferences in four patients.</p> <p><b>Conclusions: </b>A hybrid protocol integrating real-time CGM and POC is helpful for managing critically ill patients with COVID-19 requiring insulin infusion. </p>

Point-of-Care Glucose Testing

2000 ◽  
Vol 124 (2) ◽  
pp. 257-266 ◽  
Author(s):  
Richard F. Louie ◽  
Zuping Tang ◽  
Demetria V. Sutton ◽  
Judith H. Lee ◽  
Gerald J. Kost
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Point Of Care ◽  
Reference Method ◽  
Glucose Levels ◽  
Glucose Testing ◽  
Primary Reference ◽  
Glucose Meter

Abstract Objective.—To assess the clinical performance of glucose meter systems when used with critically ill patients. Design.—Two glucose meter systems (SureStepPro and Precision G) and a modular adaptation (Immediate Response Mobile Analysis-SureStepPro) were assessed clinically using arterial samples from critically ill patients. A biosensor-based analyzer (YSI 2700) and a hospital chemistry analyzer (Synchron CX-7) were the primary and secondary reference instruments, respectively. Patients and Setting.—Two hundred forty-seven critical care patients at the University of California, Davis, Medical Center participated in this study. Outcome Measures.—Error tolerances of ±15 mg/dL for glucose levels ≤100 mg/dL and ±15% for glucose levels &gt;100 mg/dL were used to evaluate glucose meter performance; 95% of glucose meter measurements should fall within these tolerances. Results.—Compared to the primary reference method, 98% to 100% of SureStepPro and 91% to 95% of Precision G measurements fell within the error tolerances. Paired differences of glucose measurements versus critical care variables (Po2, pH, Pco2, and hematocrit) were analyzed to determine the effects of these variables on meter measurements. Po2 and Pco2 decreased Precision G and SureStepPro measurements, respectively, but not enough to be clinically significant based on the error tolerance criteria. Hematocrit levels affected glucose measurements on both meter systems. Modular adaptation did not affect test strip performance. Conclusions.—Glucose meter measurements correlated best with primary reference instrument measurements. Overall, both glucose meter systems showed acceptable performance for point-of-care testing. However, the effects of some critical care variables, especially low and high hematocrit values, could cause overestimated or underestimated glucose measurements.

A New Study of Intraosseous Blood for Laboratory Analysis

2010 ◽  
Vol 134 (9) ◽  
pp. 1253-1260 ◽  
Author(s):  
Larry J. Miller ◽  
Thomas E. Philbeck ◽  
Diana Montez ◽  
Cathy J. Spadaccini
Keyword(s):  
Blood Cell ◽  
Critically Ill ◽  
White Blood Cell ◽  
Critically Ill Patients ◽  
Blood Chemistry ◽  
Laboratory Analysis ◽  
Blood Samples ◽  
Cell Counts ◽  
Blood Cell Counts ◽  
White Blood Cell Counts

Abstract Context.—Intraosseous (IO) blood is frequently used to establish a blood chemistry profile in critically ill patients. Questions remain regarding the reliability of IO blood for laboratory analysis and established criteria regarding the amount of marrow/blood to waste before taking an IO sample are not available. Objectives.—To evaluate IO-derived blood for routine laboratory blood tests needed in the care of critically ill patients and to determine the amount of marrow/blood to waste before drawing blood from the IO space for laboratory analysis. Design.—Blood samples were drawn from peripheral veins of 10 volunteers. Within 5 minutes, 2 IO blood samples were obtained; one following 2 mL of waste and another following 6 mL of waste. Samples were analyzed for complete blood count and chemistry profile. Values were analyzed using Pearson correlation coefficients. Levels of significance were determined using the t distribution. Mean values for the draws were calculated and compared, with the intravenous blood sample serving as a control for the IO samples. Results.—There was a significant correlation between intravenous and IO samples for red blood cell counts and hemoglobin and hematocrit levels but not for white blood cell counts and platelet counts. There was a significant correlation between intravenous and IO samples for glucose, blood urea nitrogen, creatinine, chloride, total protein, and albumin concentrations but not for sodium, potassium, CO2, and calcium levels. Conclusions.—When venous blood cannot be accessed, IO blood aspirate may serve as a reliable alternate, especially for hemoglobin and hematocrit levels and most analytes in a basic blood chemistry profile. Exceptions are CO2 levels and platelet counts, which may be lower, and white blood cell counts, which may appear elevated.

scholarly journals Remote Continuous Glucose Monitoring With a Computerized Insulin Infusion Protocol for Critically Ill Patients in a COVID-19 Medical ICU: Proof of Concept

2021 ◽  
Author(s):  
Georgia M. Davis ◽  
Eileen Faulds ◽  
Tara Walker ◽  
Debbie Vigliotti ◽  
Marina Rabinovich ◽  
...  
Keyword(s):  
Real Time ◽  
Critically Ill ◽  
Continuous Glucose Monitoring ◽  
Critically Ill Patients ◽  
Insulin Infusion ◽  
Point Of Care ◽  
Glucose Monitoring ◽  
Proof Of Concept ◽  
Computerized Decision Support ◽  
Glucose Testing

<b>Objective: </b>The use of remote real-time continuous glucose monitoring (CGM) in the hospital has rapidly emerged to preserve personal protective equipment (PPE) and reduce potential exposures during COVID-19. <p><b>Design and Methods:</b> We linked a hybrid CGM and point-of-care (POC) glucose testing protocol to a computerized decision support system for continuous insulin infusion (CII) and integrated a validation system for sensor glucose values into the electronic health record. We report our proof-of-concept experience in a COVID-19 ICU.<b></b></p> <p><b>Results: </b>All nine patients required mechanical ventilation and corticosteroids. Seventy six percent of sensor values were within 20% of the reference POC glucose with an associated average reduction in POC of 63%. Mean time in range (70-180 mg/dL) was 71.4 ± 13.9%. Sensor accuracy was impacted by mechanical interferences in four patients.</p> <p><b>Conclusions: </b>A hybrid protocol integrating real-time CGM and POC is helpful for managing critically ill patients with COVID-19 requiring insulin infusion. </p>

scholarly journals Remote Continuous Glucose Monitoring With a Computerized Insulin Infusion Protocol for Critically Ill Patients in a COVID-19 Medical ICU: Proof of Concept

2021 ◽  
Author(s):  
Georgia M. Davis ◽  
Eileen Faulds ◽  
Tara Walker ◽  
Debbie Vigliotti ◽  
Marina Rabinovich ◽  
...  
Keyword(s):  
Real Time ◽  
Critically Ill ◽  
Continuous Glucose Monitoring ◽  
Critically Ill Patients ◽  
Insulin Infusion ◽  
Point Of Care ◽  
Glucose Monitoring ◽  
Proof Of Concept ◽  
Computerized Decision Support ◽  
Glucose Testing

<b>Objective: </b>The use of remote real-time continuous glucose monitoring (CGM) in the hospital has rapidly emerged to preserve personal protective equipment (PPE) and reduce potential exposures during COVID-19. <p><b>Design and Methods:</b> We linked a hybrid CGM and point-of-care (POC) glucose testing protocol to a computerized decision support system for continuous insulin infusion (CII) and integrated a validation system for sensor glucose values into the electronic health record. We report our proof-of-concept experience in a COVID-19 ICU.<b></b></p> <p><b>Results: </b>All nine patients required mechanical ventilation and corticosteroids. Seventy six percent of sensor values were within 20% of the reference POC glucose with an associated average reduction in POC of 63%. Mean time in range (70-180 mg/dL) was 71.4 ± 13.9%. Sensor accuracy was impacted by mechanical interferences in four patients.</p> <p><b>Conclusions: </b>A hybrid protocol integrating real-time CGM and POC is helpful for managing critically ill patients with COVID-19 requiring insulin infusion. </p>

Point-of-care glucose testing in critically ill patients: Visual logistics and a glycemic variability hypothesis*

2009 ◽  
Vol 37 (10) ◽  
pp. 2841-2843 ◽  
Author(s):  
Gerald J. Kost ◽  
Nam K. Tran ◽  
Jorge R. Sifontes ◽  
Dan M. Mecozzi ◽  
Richard F. Louie ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Glycemic Variability ◽  
Glucose Testing

scholarly journals Clinical Reliability of Point-of-Care Glucose Testing in Critically Ill Patients

2019 ◽  
Vol 14 (1) ◽  
pp. 65-69
Author(s):  
Kylie Pilackas ◽  
Seraj El-Oshar ◽  
Chris Carter
Keyword(s):  
Blood Glucose ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Mean Difference ◽  
High Blood Glucose ◽  
Glucose Testing ◽  
Capillary Glucose ◽  
The Mean ◽  
Clinically Significant

Background: Point-of-care (POC) glucometers are commonly used in intensive care units (ICUs). The Centers for Medicare & Medicaid Services have called into question the accuracy of POC glucometers in critically ill patients. This study sought to identify specific characteristics within our facility’s ICU patients that were associated with inaccuracies in POC glucose measurements. Methods: We conducted a prospective cohort study that compared POC capillary blood glucose samples with venous samples collected in our ICU. All nonpregnant patients >18 years old admitted to the ICU with orders for daily laboratory testing that included blood glucose were eligible for inclusion. Results: A total of 46 patients were enrolled and 85 samples were collected. The mean difference between venous and POC samples was 5.23 mg/dL (95% CI, 3.16-7.3 mg/dL). Measurement inaccuracies would have altered treatment in 7/85 instances (8.2%). The only clinically significant inaccuracy found was the omission of 2 units of insulin in 1 hyperglycemic patient. Measurement inconsistencies generally underestimated low blood glucose values (2/2 instances) and overestimated high blood glucose values (4/5 instances). Conclusions: In our study, the mean difference between venous and POC glucose samples was small. Similarly, measurement inaccuracies that would have altered treatment were rare and only one instance was deemed clinically significant. We conclude that POC capillary glucose testing within our cohort and in similar critically ill patients is likely safe and effective.

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