RNs,Are You Ready?. A Nurse Managed Computerized Program For Continuous IV Insulin Infusion:JIIP(Jefferson Insulin Infusion Protocol) and Non JIIP. Joan Moshang RN BSN MEd. CDE. CIII Program Content. Indications for JIIP and NON-JIIP Physician,Nurse and Pharmacy responsibilities.
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A Nurse Managed Computerized Program For Continuous IV Insulin Infusion:JIIP(Jefferson Insulin Infusion Protocol) and Non JIIP.
Joan Moshang RN BSN MEd. CDE
140-180mg/dl while on infusion
70-140mg/dl while off infusion
must be OK’d by Attending physician.
Endocrine service may be consulted in these circumstances.
or a D10 solution at 50cc/hr.
CAUTION: post cardiac surgery DM patients on epinephrine should NOT receive D10 at greater than 25cc’s/hr.
Infuse D5 @50cc/hr.or [email protected] 25cc/hr.)
Patients with BG <250mg/dl NOT receiving a source of dextrose/glucose cannot be on the JIIP.
Attending physician must be notified for further instruction.
are either JIIP or NON-JIIP.
(Ex: Current BG 200 divided by 100=2 units bolus and 2 units/hr.)
(Ex: Weight in Kg.= 50 Kg x 0.1=5 Units bolus and 5units/hr.)
Note difference between bolus and initial start rate of DKA/HHS AND NON DKA/HHS.
…but still spilling ketones
…will require a higher hourly rate of glucose to allow for continued insulin administration. Call physician for order change.
The Blood glucose is usually corrected before the ketones are cleared. Premature discontinuation of the insulin infusion will cause a rebound effect.
type 1 or type 2 DM.
-If not DKA/HHS,
Initial BG divided by 100 and
rounded to nearest 0.1unit.
-If DKA/HHS, 0.1unit/kg.
The RN must be vigilant in: --assessing patient for nutritional changes,
-meds which can increase or decrease BG values, fever ,etc.
-Reason for infusion- DKA,Surgery,uncontrolled hyperglycemia?
(the bolus and start rate depend on the reason why the infusion was initiated).
# titrates according to the rate calculated by titration table.Stop Infusion for 15 minutes. Restart @50% of previous rate. Make sure D/5 or D/10 is added.
If altered consciousness,give ½ amp D50 (12.5gm)
- Starting or stopping steroid therapy.
-Starting or stopping dialysis.
-Starting, stopping or rate change of tube feedings or hyperalimentation.
-Infusion rate change.
-If receiving 120 gms of carbohydrate in 24 hours,may maintain D5W @40cc’s/hr.
-To continue JIIP, must have glucose source @100ml/hr.
Review section on Monitoring.
When Transitioning To Subcutaneous Insulin titrates according to the rate calculated by titration table.:
Start subcutaneous Insulin PRIOR to the discontinuation of insulin drip based on type of insulin given. The best times for transition are PRIOR to breakfast or dinner.
RECOMMENDED OVERLAP TIMES
Lispro or 75/25 15 minutes
Regular or 70/30 30 minutes – 45 minutes
NPH 2 hours
Lantus or Levemir 2-3 hours
Note: Actual calculator will be updated to reflect use on all care units-not only Intensive care units.
for DKA/HHS vs. Non-DKA/HHS.
1.Physicians may order the JIIP without piggybacking the infusion into a main line. True False
2.The titration table is the same for both DKA/HHS and non DKA/HHS patients. True False
3.Two RN’s must verify all rate changes. True False
4.In the event of a clogged or dislodged feeding tube,it is important to maintain a steady rate of insulin.
5.The blood glucose is often corrected before the blood ketones. Therefore, maintain the insulin infusion in type 1 diabetics until ketones are normalized even if the BG is normal.
6.The critical value protocol is the same whether on or off the insulin infusion. True False
7.Blood glucose test results must be entered into the computer within 10-15minutes. True False
8.Insulin rate changes are based on the current blood glucose result. True False
9.Stop the infusion if BG <than 70mg/dl;restart @ 50% of rate when BG is 100mg/dl. True False
10.Maintaining a normal BG and preventing hypoglycemia are the main goals of continuous IV insulin therapy.
-Completion of Nurse Managed JIIP
power point and quiz with grade of
- Proficiency in use of training pathway.