Unique Plan Description: Therapeutic Hypothermia Insulin Drip
Plan Selection Display: Therapeutic Hypothermia Insulin Drip
PlanType: Medical                                 
Version: 3          
Begin Effective Date: 2021-05-24 08:47:10
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-01-23 15:32:10
Available at all facilities: No

Therapeutic Hypothermia Insulin Drip
IV Solutions
	insulin regular 100 units/NS 100 mL Premix
		100 mL, IV, Routine, Total Volume = 100
			Comment: Concentration:1 unit/mL, Initial Rate: 2 mL/hr = 2 units/hr, continuous if glucose greater than 180.   Titrate infusion to target glucose of 140-180.  If glucose is:   1) Less than 100 discontinue infusion, continue blood glucose monitoring and follow Insulin IV infusion hypoglycemia treatment parameters if necessary; restart drip at 1/2 previous rate when glucose >140.  2) 100-139, decrease infusion by 1 unit/hr. 3) 140-180, no change.  4.) 180-219, and glucose is greater than or equal to the previous glucose, increase infusion by 1 unit/hour.  5.) 180-219, and glucose is less than the previous glucose, maintain the same rate.  6.) Greater than 220, increase infusion by 2 units/hour.   Initiate insulin drip during cooling phase if BS >180 or as otherwise directed.  Obtain glucose POC-RN q1hr starting with initiation of drip. Discontinue Regular Insulin Infusion 24 hours after rewarming completed.  Contact MD if rate >10 unit/hr.  If the glucose decreases >75mg/dl from the last glucose check, decrease insulin rate by 50% and check blood glucose in 30 minutes.  If enteral and/or parenteral nutrition support is stopped or held, decrease infusion to 0.5 unit/hour and notify physician.
		100 units, EVERY BAG, 2 units/hr
	insulin regular 100 units/NS 100 mL IV
		100 mL, IV, Routine, Total Volume = 100
			Comment: Concentration:1 unit/mL, Initial Rate: 2 mL/hr = 2 units/hr, continuous if glucose greater than 180.   Titrate infusion to target glucose of 140-180.  If glucose is:   1) Less than 100 discontinue infusion, continue blood glucose monitoring and follow Insulin IV infusion hypoglycemia treatment parameters if necessary; restart drip at 1/2 previous rate when glucose >140.  2) 100-139, decrease infusion by 1 unit/hr. 3) 140-180, no change.  4.) 180-219, and glucose is greater than or equal to the previous glucose, increase infusion by 1 unit/hour.  5.) 180-219, and glucose is less than the previous glucose, maintain the same rate.  6.) Greater than 220, increase infusion by 2 units/hour.   Initiate insulin drip during cooling phase if BS >180 or as otherwise directed.  Obtain glucose POC-RN q1hr starting with initiation of drip. Discontinue Regular Insulin Infusion 24 hours after rewarming completed.  Contact MD if rate >10 unit/hr.  If the glucose decreases >75mg/dl from the last glucose check, decrease insulin rate by 50% and check blood glucose in 30 minutes.  If enteral and/or parenteral nutrition support is stopped or held, decrease infusion to 0.5 unit/hour and notify physician.
		100 units, EVERY BAG, 2 units/hr
Medications
	Dextrose 50%
		25 mL, Injection, IV Push, Q15MIN, PRN, see comment
			Comment: If glucose <60mg/dL. Notify provider if given with corresponding POC glucose recheck value.
Patient Care
	Glucose Level
		Q1H, spec type = Blood
			Comment: Goal range: < 180, must be drawn out of line, not fingerstick, during cooling phase. Start during cooling phase if blood sugar >180. After 24 hours, when glucose is in target range (140-180) for 4 hours, cancel q1h glucose order and enter order for q2h.
	Notify MD
		T;N, if glucose POC >200mg/dL for 2 consecutive checks
	Discontinue
		T;N, insulin drip protocol 24 hrs after patient has been rewarmed and begin Insulin Sliding Scale Novolog Level 1
	Notify MD
		T;N, for instructions if dietary change: abrupt change in oral intake, change to NPO status, tube feedings are held or discontinued, TPN held or discontinued.  (caloric intake necessary to prevent hypoglycemia)
		T;N, If insulin requirements > 10units/hr for further instruction
	Hypoglycemia Treatment Parameters
		T;N
			Comment: Hypoglycemia protocol initiated for patients with glucose <70mg/dl. Blood glucose <40mg/dl (critical value), treat with Dextrose 50%, 25 mL, then immediately notify physician.  Repeat glucose in 15 minutes. Blood glucose 40-55 mg/dL give Dextrose 50% 25 mL. Repeat glucose 15 min after treatment. Notify physician after follow-up value is obtained. Blood glucose 56-70 mg/dL administer 4 oz apple juice.  If patient NPO or unable to tolerate oral intake, give Dextrose 50%, 25ml.  Repeat glucose in 15 minutes after treatment.  If repeat glucose 55-70, repeat apple juice or Dextrose. Obtain another glucose, Give 1 complex carb (15g) and 1 protein snack (7g) or patient meal if patient able to take orals any time hypoglycemia is treated.
		T;N, Hypoglycemia protocol initiated for patients with glucose <70mg/dl.  Patient should have an IV while in Hypoglycemia Protocol.
		T;N, glucose <60 mg/dL treat with Dextrose 50% 25 mL as per medication orders. Notify provider as per critical result protocol.
			Comment: Repeat treatment as outlined in hypoglycemia parameters. Notify provider of all treatments given and POC glucose recheck values. When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy
		T;N, glucose 60-70 mg/dL, administer 4 oz apple juice, 4 oz non-diet soda, or glucose gel.  If patient NPO or unable to tolerate oral intake, give Dextrose 50% 25 mL as per medication orders.
			Comment: Repeat treatment as outlined in hypoglycemia parameters. Notify provider of all treatments given and POC glucose recheck values. When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy.
		T;N, After initial treatment of any glucose value </= 70 mg/dL, repeat POC glucose in 15 min; if result </= 70mg/dL continue treating as per protocol and rechecking glucose 15 min after treatment until glucose >70mg/dL.
			Comment: Notify provider of all treatments given and corresponding POC glucose recheck values. When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy.
		T;N, Once glucose is within normal limits, give 1 complex carb and 1 protein source (such as ½ sandwich OR 1 individual container of peanut butter and 3 packs of crackers) or patient meal if patient able to take orals to prevent recurrent hypoglycemia.
			Comment: When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy.

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase