Drug Safety Update

Volume 5, Issue 12 July 2012

Latest advice for medicines users

Glucose solutions: false blood glucose readings when used to flush arterial lines, leading to incorrect insulin administration and potentially fatal hypoglycaemia

Article date: July 2012
Summary
There have been reports of glucose-containing solutions being inadvertently used to flush arterial lines of patients in intensive care units. As a result blood samples drawn from the lines gave falsely high plasma glucose readings resulting in inappropriate insulin administration. These actions lead to several cases of hypoglycaemia, some of which were fatal.

Clinicians are reminded that solutions containing glucose should not be used to flush arterial lines, unless there is no suitable alternative. Saline infusions are recommended as the flush solution for arterial lines, to minimise the risk of contamination and adverse effects.

If samples are drawn from arterial lines for estimation of biochemistry, a minimum volume of three times the dead space of the cannula system should be discarded first to avoid contamination.

Arterial lines are routinely fitted for severely ill patients in critical care and are flushed with a solution to maintain patency, and ensure that blood does not clot in the line. Saline is recommended as the flush solution for arterial lines.

Case reports of fatal hypoglycaemia

There are several examples of glucose solutions being inadvertently and incorrectly used to flush arterial linesSinha S, Jayaram R, Hargreaves CG. Anaesthesia 2007; 62(6): 615 620 Panchagnula U, Thomas AN. Anaesthesia 2007; 62(10):1077 1078 National Patient Safety Agency, 2008. New guidance issued following problems with infusions and sampling from arterial lines. This has lead to inaccuracies in blood glucose measurements, which resulted in unnecessary administration of insulin and subsequent cases of hypoglycaemia, some of which have been fatal.

It is important to note that even a fraction of a millilitre of glucose-containing solution is likely to raise the measured plasma glucose to extremely high levels (5% glucose infusate has approximately 280 mmol/L of glucose).

Care should be taken when selecting the flush solution for arterial lines – saline infusions are recommended.

Advice for healthcare professionals

  •  Do not use glucose-containing solutions as infusates for maintaining arterial line patency, unless there are no suitable alternatives
  • Saline infusions are recommended as the flush solution for arterial lines, to minimise the risk of incorrect blood glucose estimation and inappropriate insulin administration
  • If samples are drawn from arterial lines for estimation of biochemistry, a minimum volume of three times the dead space of the cannula system should be discarded first to avoid contaminationBurnett RW, Covington AK, Fogh-Andersen N, et al. Eur J Clin Chem Clin Biochem 1995; 33(4): 247 253
  • Remain vigilant when selecting a solution for arterial line infusate. Similarities between glucose and saline solution bags means that confusion may occur
  • Ensure that the arterial infusion line length is kept to the minimum necessary

Article citation: Drug Safety Update July 2012, vol 5 issue 12: A2

References

Search tips and FAQs

  • Looking for previous DSU publications?

    Search by publication date above or view earlier publications in PDF

Page last modified: 28 January 2013