Recommended Protocol for Fiasp (Insulin Aspart) Infusion
For intravenous Fiasp infusion, prepare a standard concentration of 1 unit/mL in normal saline solution and prime the infusion line with 20 mL of the insulin solution before connecting to the patient to ensure accurate dosing. 1
Preparation and Administration
Solution Preparation
- Dilute Fiasp to a concentration of 1 unit/mL in normal saline solution 1
- Gently invert the bag several times to ensure proper mixing 1
- Unopened insulin should be refrigerated at 36-46°F (2-8°C) 1
- In-use insulin may be kept at room temperature (59-86°F) for up to 30 days 1
Infusion Line Setup
- Prime the infusion line with 20 mL of insulin solution before connecting to the patient 2, 1
- This waste volume ensures accurate dosing by removing air bubbles and saturating binding sites in the tubing 2
- Use dedicated infusion lines for insulin to prevent medication errors 2
Dosing and Monitoring Protocol
Initial Dosing
- For critically ill patients: Start with continuous intravenous insulin infusion 2
- For diabetic ketoacidosis: Initial bolus of 0.15 U/kg followed by continuous infusion at 0.1 U/kg/hour 1
- For standard hyperglycemia management: Follow institutional protocol with dose adjustments based on blood glucose readings 2
Monitoring Requirements
- Check blood glucose every 1-2 hours until stable, then every 4 hours 2
- Target glucose range: 140-180 mg/dL for most critically ill patients 1
- For cardiac surgery patients: Target 110-140 mg/dL 1
- Monitor potassium levels closely as hypokalemia is a contraindication to insulin therapy 1
Dose Adjustments
- Adjust infusion rate according to validated protocols 1
- Aim to reduce glucose by 50-75 mg/dL per hour 1
- Reduce infusion rate to 0.05-0.1 units/kg/hour when glucose levels approach target 1
Transitioning from IV to Subcutaneous Insulin
Timing of Transition
- Transition when blood glucose levels are stable for at least 24 hours 2
- Transition should coincide with resumption of oral feeding 2
- Stop IV insulin when hourly output is ≤0.5 IU/h 2
- Consider continuing IV insulin if output is ≥5 IU/h, which indicates major insulin resistance 2
Dosing for Transition
- Calculate subcutaneous insulin dose based on IV requirements:
- Administer basal insulin immediately after stopping IV infusion 2
- Administer rapid-acting insulin at the first meal, adjusted to carbohydrate intake 2
- For patients not previously on insulin with IV infusion <24 hours: Start with 0.5-1 IU/kg (half basal, half rapid-acting) 2
Special Considerations
Hypoglycemia Management
- For blood glucose <3.3 mmol/L (60 mg/dL): Administer glucose immediately even without symptoms 2
- For blood glucose 3.8-5.5 mmol/L (70-100 mg/dL) with symptoms: Administer glucose 2
- Prefer oral glucose for conscious patients; use IV glucose for unconscious patients 2
Advantages of Fiasp in Infusion Pumps
- Fiasp has shown better post-prandial glycemic control compared to standard insulin aspart in pump settings 3
- Studies show reduced time in hypoglycemia with Fiasp compared to standard insulin aspart 4
- Fiasp has demonstrated no increased risk of infusion set clogging compared to standard insulin aspart 5
Potential Complications and Mitigation
Common Issues
- Unexplained hyperglycemia may be more common with Fiasp than with standard insulin aspart 5
- Premature infusion set changes might be needed more frequently with Fiasp 5
- Monitor for hypokalemia, which is a contraindication to insulin therapy 1
Safety Measures
- Insulin is a high-risk medication; implement a systems-based approach to reduce errors 2
- Use standardized protocols for insulin dosing and monitoring 2
- Consider computerized decision-support systems for better glucose control than paper-based systems 2
- Perform routine and frequent assessment of glucose metrics 2
By following this protocol for Fiasp insulin infusion, healthcare providers can optimize glycemic control while minimizing the risk of complications in hospitalized patients.