Preventing sternal wound infections in the post operative cardiac surgery patient is an important aspect of post operative care. Sternal infections can increase length of stay, be a substantial financial impact, and increase mortality’ Occurrence of sternal infections is rare and it has been reported as 0.4–4%.

Managing hyperglycemia post-operatively has been one intervention implemented to make a significant impact on reducing sternal infections. It is for this reason we manage such glucose control for these patient and why glucose control <200 mg/dL by POD 1 and POD2 is part of the Surgical Care Improvement Project. Our most recent data has shown that we have met the 100% mark for maintaining glucose control for this patient population. This is excellent work and is a tribute to the excellent post operative nursing care.

Question have come up with the recent changes to the Epinephrine/Insulin glycemic management. Epinephrine is a natural catecholamine produced in our body by the adrenal glands (endocrine gland on top of the kidney). Production of epinephrine and conservation of glucose is a parasympathetic action to prepare our body for “fight” or “flight” stress situations. Epinephrine stimulates the liver to produce glucose by glycogenolysis and gluconeogenesis. Additionally, Glucagon (hyperglycemic hormone) and Cortisol (steroid hormone) are also contributors to hyperglycemia in stress induced states impacted by epinephrine.

Epinephrine interacts with cellular receptors and sends messages from cell to cell to inhibit insulin, elevate glucagon, and manages glucose utilization or conservation.

For these reasons when Epinephrine is infusing, glucose checks are essential. Most likely if the drip continues an insulin drip will follow. The Epinephrine infusion order in Epic indicates checking glucose every 30 minutes to address Hyperglycemia and Hypoglycemia when titrating epinephrine. This frequency of glucose checks is to help us reach goal of <200mgdL.

However, if a patient is on epinephrine and glucose has stabilized within a normal range for a significant amount of time (i.e. 48 hrs with or without insulin infusing) consider revising the frequency of glucose checks. Start at 2 hours. Be sure to get an order so this change in practice is communicated to everyone. From there on, the glucose checks can be modified further.

If situations do progress into an infection state there is potential