Analysis of the Accuracy and Its Related Factors of Long-term Blood Glucose Measurement by Means of Bedside-type Artificial Pancreas in Septic Patients with Severe glucose Intolerance

• Published in: Jinko Zoki Vol. 29; no. 2; pp. 433 - 439
• Main Authors: Hoshino, M, Ohsawa, H, Sakai, M, Hayashi, K, Haraguchi, Y, Saegusa, H
• Format: Journal Article
• Language: Japanese
• Published: JAPANESE SOCIETY FOR ARTIFICIAL ORGANS 2000; 一般社団法人 日本人工臓器学会
• Subjects: artificial pancreas; blood glucose measurement; diabetes mellitus; intensive and critical care medicine; sepsis
• ISSN: 0300-0818; 1883-6097
• DOI: 10.11392/jsao1972.29.433

The accuracy of blood glucose (BG) measurement by bedside-type artificial pancreas (BGAP) performed for 253 days, as well as related factors and countermeasures, were analyzed in 14 septic patients with glucose intolerance. [Method] Indicator of accuracy (X): The product of the daily proportion of BGAP in relation to true BG. The surface of the blood sampling tube and the electrode for BG measurement was studied with an electron-microscope. [Results] 1) Mean of maximum, minimum, and final X were 113. 6 ± 15.4, 54.1 ± 24.8, and 65. 7 ± 31.7%, respectively. 2) Daily increase of X by more than 15% and prompt increase of BGAP after the blood sampling route was flushed occurred on 10.3% and 7.1% of the cumulative days, respectively. 3) Acute decrease of X (Xd) (daily decrease of more than 15%/day) occurred on 13.8% of the cumulative days (17 times). Xd disturbed the operation of AP and necessitated countermeasures, including a change of the sampling route on 41% (7 times). Leukocytes and fibrin-like substances were detected by electronmicroscope. Changing the sampling route did not improve Xd in 2 patients. [Conclusion] Increase of X seems to occur via removal of blood- derived substances deposited to the route (S) and is contributed to by other factors, including decreased function of the multichannel pump. Countermea-sures included adjustment of BGAP and route flushing. Decrease of X seems to occur via factors that disturb blood sampling, including (S) and the proximity of the catheter tip to the venous wall. In the case of Xd, countermeasures include changing the route and/or changing the location of the catheter tip.