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Publication Type: Drug Safety Update
Single or Multiple Incident: Multiple
Date: 7/1/2012 12:00:00 AM
Country: United Kingdom
This safety update discusses the potential for false blood glucose readings when dextrose is used to flush arterial lines instead of saline. This can result in incorrect insulin administration and potentially fatal hypoglycemia. Even a fraction of a millilitre of glucose-containing solution is likely to raise the measured plasma glucose to extremely high levels. The alert contains recommendations to prevent such adverse events.

Additional Details

Medication/Gas/Fluid:
insulin, dextrose IV, glucose IV, normal saline (0.9% sodium chloride)
Medication/IV List:
insulin, subcutaneous and IV

Rules / Policies / Procedures
  1. do not use glucose-containing solutions as infusates for maintaining arterial line patency, unless there are no suitable alternatives.
  2. Saline infusions are recommended as the flush solution for arterial lines, to minimise the risk of incorrect blood glucose estimation and inappropriate insulin administration.
  3. 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,
  4. Remain vigilant when selecting a solution for arterial line infusate. Similarities between glucose and saline solution bags means that confusion may occur.
  5. Ensure that the arterial infusion line length is kept to the minimum necessary.

Glucose solutions: false blood glucose readings when used to flush arterial lines