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Insulin CRI Setup

Views: 7032 - Comments: 8

Megan Brashear, CVT, VTS (ECC), demonstrates the proper technique for preparing an Insulin CRI for patient use.

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Megan Brashear's picture
Megan Brashear

CVT VTS(ECC)

Enrolled: 07/2011

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Megan Brashear's picture

Nicole, we do not cover our insulin CRIs, but our ICU has no natural sunlight (which is the most dangerous for insulin breakdown) and we change out the CRI every 24 hours (which is usually the threshold for light sensitive drugs).

Kathleen Terry's picture

Hi, can you please tell me why you change the insulin CRI bag every 24 hours.

Chris Green's picture

Kathleen, great question regarding changing of insulin CRI Bags after 24 hours. According to Plumbs Veterinary Drug Handbook, Eighth Edition, for immediate use, insulin products (except glargine) can be diluted with normal saline for injection, but the potency cannot be predicted after 24 hours. There is also concern because the antibacterial preservatives present in the insulin formulations may be lost if stored at room temperature (Trissel 2013). With this in mind, we have set the protocol that insulin CRIs expire 24 hours after the insulin has been added. As an interesting side note, our doctors actually formulate insulin CRIs with the goal of them lasting approximately 24 hours in most cases. The insulin “dose” we are calculating to put the CRI together is a unit/kg/day dose for the patient in question. I hope this answers your question, feel free to contact us if you have any other questions.

Sinuhe Flores's picture

Would making a CRI with the same formula in a 60ml syringe be a good alternative to the 250ml bag os sodium chloride. We do no have access to this size anymore.

Joanie Abrams's picture

Hi Sinuhe. You can make a CRI in any size container (we are currently using 100ml Saline bags) but you do want to ensure that you make enough so that you are still able to run some through the line and allow the insulin to bind to the plastic. 60ml may not be large enough since you are using 50ml to bind the plastic. Great question.

Brittany Racecic's picture

Great video! My question pertains to the drip sets, do you change these out every 24 hours as well? My thinking would be yes, since after 24hrs the efficacy of insulin is decreased? Thoughts? Thank you!!

Jessica Waters-Miller's picture

Hi Brittany,
Thank you for the feedback! That could be up to your hospital. Megan says in the video you could use it again as long as you remember to run 50mls of the new insulin CRI through the line. Best practice would be to change out the insulin CRI and drip set (and extension set) at the same time that way everything is clean and starting fresh. I hope that makes sense!