Bad pump sites

okay, so our son has been pumping since early october so we are still kind of new at this, but...

we have had 3 sites that went in wrong and were not working, a couple of sites that went bad because we had trouble reconnecting after a bath (quicksets) and 3 sites that got ripped out and changed before they would have needed changing otherwise.

but my question is can a site just go bad for no apparant reason? he was low actually at bedtime and had some snacks, which we bolused for. I went to check him before i went to bed and he was 13.4 (canadian, so a little higher than he is usually at that time). I thought this was a little odd given he was low earlier and so i waited another hour and checked again. This time 19! I did correct, but I was wondering what the possibility is that the site is bad given that there is nothing (to my knowlege) that could have made it go bad? (It was changed yesterday afternoon).

Also, In less than 2 months of pumping we have gone through almost an entire extra box of infusion sets, which is costly, so i was wondering how often you have 'bad' sites that need changing long before 3 days is up. Thanks.

oh yeah, and we also had the tubing kink one time and sound a no delivery alarm.

but the tubing on this site looks fine.

Absolutely yes. Or, more accurrately, I’m sure they go bad for a reason, just not a reason we can figure out. We’ve had sites tear out, cannuals get bent, sites pull out just the tiniest bit so that you think it’s still in there just right but it’s not. I’m sitting up at almost 1:00 am right now wondering why my daughter is still high, and I’m thinking about doing a site change. If you change every 3 days, a box of 10 should last month. I bet a box only lasts us 3 weeks because of site issues. It’s frustrating.

Also, a lot of people think that the site doesn’t work as well on the 3rd day as it does on the 1st, although I have not especially noticed this to be true.

we were actually told to change every 2 days because of this. then once i forgot and hi numbers were fine. then with all the site issues, i am hesitant to change a site that is working well and twice i have noticed numbers climbing on the 3rd day. last time we were on the 3rd day we actually battled lows all day. this site was only changed yesterday, however, so this is definately not the case. I am waiting up also at 1:00 to check again shortly to see if i need to change the site! I have also noticed that this meter is horribly innacurrate when he is high and if I get say an 18 and 24 within a minute of each other i don’t know what to correct. they are sending us another which won’t help us tonight. so if the site is good i also may have over corrected as i didn’t double check this reading.

I guess we’er in the same sad boat tonight. I did just change her site, and now I’m going to bed. But I’ll be back up at 2:30. : (

hope i don’t have to join you there, but I will know shortly!

now an hour after correction i get 18.7. not really down, but not up either. of course, with this meter i don’t really know what he was before and i don’t really know what he is now. so actually i don’t even know if he is coming down. i will have to check again. grrr.

i too had to change his site. an hour after the 18.7 he was 19.9 immediately followed by 18.3. got my husband’s accuchek meter which read 23, so he seemed to be going up. 45 minutes after site change/correction bolus he is 22.0 (accuchek) and so i gave .2 more and am waiting up to make sure he is indeed on his way down. grrr. how long have you been pumping? and do you really have lots of site issues? which infusion sets do you use?

We’ve been pumping since January, using a Ping with Micro Orbit infusion sets. We’ve had a lot of trouble with insertions on the thigh, and plenty of growing/hormone adjustment issues. It’s really feeling like a grind recently. I slept so little last night that I was useless today. I hoped to be in bed an hour ago, but no, she was high again. It’s really frustrating. I’m off to check her again, and I hope it’s the last time tonight.

we tried the orbit micros, but apparantly his body did not like the steel sets. the first one started stinging (next morning) then fell out (in the centre, not the sticky part). I thought he had caught in on something, but he claimed he didn’t. next one started stinging next morning then after lunch we got a no delivery alarm and he had gone from 3.4 to 20 in just over 1 hour! We also tried the cleos, but it fell off after 3 hours. they told us that young children usually need to have their infusion sets changed after 2 days because the numbers will climb on the 3rd day. luckily we tested this theory and his numbers don’t seem any different on the 3rd day because if i have a good site that is working I don’t want to change it any sooner than is necessary! good luck to you:)

There is always a reason for a bad site, we just may not be able to always figure it out. Our endos told us to change the site every 2 days. this prevents infection, but also, i have noticed when I let it go for 3 days, his numbers tend to be higher. Be sure that you are rotating where you put the sites also. If you are only able to use one location (ie only butt) because of not having enough fatty tissue on other areas of his body (it was like this for us until about 2 months ago) be sure you alternate sides (ie. if you can only use the butt, put the site on the right side, then when you change sites again, put it on the left side, then next change put it on the right, but not in the same area as the first). I typically try to go about an inch away from the previous site location, to help be sure no scar tissue will form.

As for the low, then high… the high could have just been a rebound high from correcting the low.

I wait for 3 high sugar levels in a row before changing the site thinking it is bad… OR if ketones are moderate or high I will change then, no matter how many high sugar levels in a row my son has had.

I have seen it where my son has kinked the cannula just by laying ontop of it while sleeping at night.

If you are having to pay for the pump supplies out of pocket 100%, you could do your own price checking online to see if you can find some cheaper of the same kind you use. Maybe try ebay or something of that nature, sometimes they have diabetic supplies.

since deciding to use the emla cream for site changes we get more site rotation then we ever did with shots. we had another bad site last night, but he had trouble reconnecting to the pump before bed and when i pulled the cannula out it was indeed kinked. it is the ones that appear to have no reason that frustrate me the most. We pay 80%, but we do have to pay first and wait for reimbursement. We are also going to try the minimed soft set and pray that the mios come to canada soon-lol. 3 or 4 of the bad sites we had were due to not being able to reconnect properly, so at least if we can eliminate those…

I recommend going to the bent needle and using Tegaderm tape With IV prep. You need to allow the IV prep to partially dry before you apply the Tapes. Do this by fanning the spot with your hand and then right before it dries, apply the tape evenly. Push down on the site with your whole hand over it and make sure that the tape bonds to all of the nooks and crannies around the tube and the needle. I can do just about anything with this setup, including surfing. The softserter and all of those plasticky sets have never worked for me.

I just wanted to add a response about your “sets going wrong for no reason” question. Anything thats inserted into the skin is viewed as an irritant by the body. Sometimes due to a number of factors including perspiration, water getting in, and excessive twisting or physical contact with the site area, the site will become inflamed.

Its often not noticeable, but its the body’s way of trying to work foreign objects out of the skin. Much as with a bad splinter, the area swells and starts to scab and callace internally to keep contaminants away from the blood and the tissue. If the site feels overly sensitive or if it looks red this is probably the case. Only your son will really be able to know.

Even the steel bent needle will get “no delivery” a few times a year. Sometimes a kink isn’t a kink, but a blockage of dense tissue. I’ve had the restriction be so significant that the insulin leaks out onto the surface of the skin. Sometimes things go bad, but it should not be very often. I’ve seen just about every possibility after 10 years and 3 pumps. I think the bent needle should solve most of your problems. It works on me, and I am 6’ 148lbs with almost no fat tissue. Just keep an eye on your sun and make sure he isn’t writing and squirming around all the time. That will often kink or cause the site to become irritated.

The canula is probably kinked. I have experienced this a numerous amount of times without a notification from the pump. I would give him a shot of insulin to bring down his levels and then change the site asap. The pump probably isn’t alarming because there is probably a little amount that is going through the line, but obviously not enough. Hope this helps!! Poor little guy probably feels like crap having his BG level so high :frowning:

what do you mean by the bent needle? are you talking about the angled infusion sets?

I also find that sometimes a site just doesn’t absorb well. When I see higher numbers and I take the site out, I try to watch how much insulin flows out (I know – not very scientific), but I tend to notice that when I have these highs more insulin is coming out compared to routine site changes.

Have you considered the Sure-T infusion set? I use this now and it has a metal cannula, but it is even thinner than the plastic ones. It is supposed to be good for kids, but you would need to check if it is comfortable for your son. One part that I like is I find insertion to be much less painful (about the same as an insulin injection) AND if I think that the site is not good, then I can relocate the site without changing the infusion set. I just pull it out clean off my skin (with IV Prep to increase stickiness), reinsert it and tape it down. The Sure-T needs to be changed every 2 days because of the teflon cannula, but I get 4-6 days out of each infusion set (and I think that they are even cheaper than other infusion sets). If I even have doubts that the site might be bad, I just move it.

The bent needle is an infusion set that has been around for at least 10 years, and I see that Medtronic don’t even list it as a product on their website anymore, but you can order it through the Medtronic online store.

They do still make this product though! In fact I just received my 3 month supply order of these. The bent needle is kind of a slang term for it. The official name is “Paradigm Polyfin QR With Wings” As the name suggests, its inserted at a 45 degree angle, and it has a very easy to use quick disconnect. I would ask Medtronic to send you a trial of the Polyfin and the SureT. My experience is that if one of the plastic infusion sets don’t work for you, the rest probably won’t either.