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Kontinuerlig mätning av blodsocker på intensivvårdspatienter, ett sätt att öka patientsäkerheten?
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
2020 (Swedish)Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
Abstract [sv]

Bakgrund Som intensivvårdssjuksköterska är man skyldig att uppfylla uppdraget att leverera professionell och högteknologisk vård samtidigt som man tar hänsyn till det specifika lidande som intensivvårdspatienter utsätts för. Ett vanligt tillstånd bland intensivvårdspatienter är hyperglykemi och insulinresistens. Förbättrade metoder för blodsockermätning i kombination med insulinbehandling är associerat med bättre återhämtning och positiva utfallsmått hos alla grupper av intensivvårdspatienter. Med hänvisning till Orems teori om egenvårdsbrist, patientlagen och patientsäkerhetslagen har vi strävat efter att öka patientsäkerheten genom kunskapsinhämtning om noggranna och effektiva metoder för blodsockermätning inom intensivvård. Om beslutsfattandet för sjuksköterskor förbättras genom säkrare omvårdnadsmetoder kan intensivvårdspatienternas egenvårdskapacitet rehabiliteras.

Syfte Att undersöka och klargöra om en kontinuerlig mätmetod för blodsocker är patientsäkert för intensivvårdspatienter. 

Metod En litteraturstudie med kvantitativ ansats om kontinuerlig mätning av glukos hos kritiskt sjuka patienter har genomförts. Tretton artiklar har bearbetats och analyserats systematiskt med hjälp av granskningsmall för kvantitativ forskning. Sökningen genomfördes i PubMeds databas med publicering ej äldre än 10 år.

Resultat Av 13 granskade artiklar visade 11 att kontinuerlig mätning av blodsocker gav korrekta och tillförlitliga glukosvärden hos kritiskt sjuka patienter. Alla tre studier som beskrev mikrodialys som en kontinuerlig glukosmätningsmetod ansåg metoden som tillförlitlig. Subkutan kontinuerlig glukosmätning var lika pålitlig som standardmätning i tre studier. I två studier ifrågasattes tillförlitligheten.

Slutsats Studien visar på att kontinuerlig mätning av blodsocker är en lovande metod men med bristande evidens. Ytterligare forskning bör genomföras för att undersöka vilken metod som passar den specifika subgrupp av intensivvårdspatienter, eller helst passar alla intensivvårdspatienter.

Abstract [en]

Background                                                                                                                                    As a critical care nurse, one is obliged to fulfill the mission of delivering professional and high-tech care, whilst calculating the specific suffering that intensive care patients are exposed to. A common condition in critical care populations is hyperglycemia and insulin resistance. Enhanced methods of glucose measuring combined with insulin treatment, are associated with better recovery and outcome, in all intensive care populations. With reference to Orem's theory of self-care, the Patient Act and the Patient Safety Act, we have endeavored to increase patient safety through knowledge acquisition on accurate and effective methods for glucose measurement in intensive care. If decision-making for nurses can be improved by safer nursing methods, the intensive care patients' self-care capacity can be rehabilitated.

Aim To investigate whether continuous glucose monitoring is a reliable method for glucose control in the intensive care unit.

Method An overview of scientific literature, concerning continuous monitoring of glucose in critically ill patients has been conducted. Thirteen peer-reviewed articles have been processed and analyzed systematically using a review template for quantitative research. The search was performed in Pub-Meds database and the articles were published within the last 10 years.

Result Out of 13 peer reviewed articles 11 showed that continuous monitoring of glucose gave accurate and reliable glucose levels in critically ill patients. All three studies describing micro-dialysis, as a continuous method of measuring glucose, were in favor of its reliability. Subcutaneous continuous glucose monitoring was as reliable as standard measurements in three studies. In two studies the reliability was questioned. 

Conclusion Continuously monitored blood glucose is a promising method but lacks evidence. Further research should be carried out, to explore which method suits which specific critical care patient population, or preferably, suits all intensive care patients. 

 

Place, publisher, year, edition, pages
2020. , p. 44
Keywords [en]
Critical Care, Blood glucose Monitoring, Patient Safety, Insulin treatment
Keywords [sv]
Intensivvård, blodsockermätning, patientsäkerhet, insulinbehandling
National Category
Nursing
Identifiers
URN: urn:nbn:se:uu:diva-403711OAI: oai:DiVA.org:uu-403711DiVA, id: diva2:1390814
Subject / course
Caring Sciences
Educational program
Freestanding course
Supervisors
Examiners
Available from: 2020-02-03 Created: 2020-02-03 Last updated: 2020-02-03Bibliographically approved

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