Endocrine Abstracts

Background: The nursing management of DKA in children is labor intensive. The traditional management of DKA involves numerous physician ordered changes of parenteral fluids. This is time consuming for the nurse; challenging for the pharmacy and can lead to delays in proper fluid administration.

Aims: The purpose of this pilot study was to investigate whether a streamlined process using a three-bag-system for treating children with DKA would improve efficiency for nurses, length of hospitalization, cost, and blood glucose levels.

Methods: Standardized orders for fluid solutions and rates of infusion were developed using a three-bag-system.

(1): ¾NSS with 20 mEq/L KCL and 20 mEq/L K-Phosphate

(2): D10% ¾ NSS with 20 mEq KCL/L and 20 mEq/L K-Phosphate.

(3): 250 units regular insulin/250 ml NSS.

Nurses manage IV fluids based on standardized orders with physician communication only as needed for uncovered contingencies. A comparative non-experimental design was used to evaluate the outcomes of children hospitalized with DKA before and after initiation of the three-bag-system. Thirty medical records were reviewed with 16 patients not using three-bag-system (control group) and 14 patients using three-bag-system (study group).

Results: Independent samples t-test and χ² were used to determine significance. No difference found in glucose between groups. Length of stay, number of IV bags, and cost were reduced in the study group. This change was insignificant. Verbal orders decreased in study group (14%; P<0.008) vs control group (68%).

Conclusions: Using the three-bag-system, there was a reduction in IV bags, cost, and length of stay; however, the sample size was too small to demonstrate significance. The reduction in verbal orders was statistically significant.

Clinical implications: Using a three-bag-system within standardized DKA orders creates a streamlined process reducing frequency of verbal orders, creating efficient care. Further studies using larger sample sizes are warranted verifying additional benefits using a three-bag-system.

References: American Diabetes Association. Hyperglycemic crisis in diabetes. Diabetes Care 2004 27 (Supplement 1) S94–S102.

Poirier MP, Greer D & Satin-Smith M. A prospective study of the ‘two-bag system’ in diabeteic ketoacidosis management. Clinical Pediatrics 2004. 43 809–813.

Felner EI & White PC (2001). Improving Management of Diabetic Ketoacidosis in Children. Pediatrics 2001 108 (3) 735–740.

Comments/keywords: Keywords: Diabetic Keto-acidosis (DKA).