Infusion Set and D-Tech "Fun"

Diabetes Technology Insulin Pumps
1

I’ve just come off a Bad D-Tech Weekend… The fun started on Friday morning with an early site change. The previous site was just getting a bit irritated, so changed it out Friday morning instead of Friday afternoon, as planned. No big deal, right?

At least until Friday afternoon, when I prepared to take a shower and… OOPS! Probably shouldn’t have scratched that “itchy spot” – but, I got to take a shower without an infusion set attached… (bonus?). Unfortunately, that’s where the fun began. After the shower, I took out a new set, inserted it (intending to just attached the already-primed and ready tubing that was dangling from my pump) – but the new set just plopped right off - did not stick AT ALL. So, I got to do a third insertion in the same day… (this one stuck and is still fine).

The fun continued in the form of a nagging irritation in the area of my Dexcom sensor and transmitter… Ignoring the irritation did not stop it from getting worse until on Sunday afternoon, I had to rip the thing off to get relief (which I did get, immediately). Prep a new site; insert a new sensor and… WHAT-THE… The tape FAILED TO STICK! I tried to add some tape to hold it in place, but at around the 3-hour point, the numbers in the receiver with plummeting, even though my BG was not… New sensor time… AGAIN.
This time, though the sensor I grabbed was past its expiration date, I got it to stick and (so far) work just fine…

I waited until today for the inevitable phone calls. Called Dexcom and was cherrfully offered replacements for both of the “failed” sensors – even with expedited shipment to account for the upcoming holiday. Sweet. I got quite a different response when I called Animas. They forwarded me to a nurse who tried (and succeeded) to discover something I’m doing wrong procedurally (apparently I prime it differently than directed) – in order to place the blame for the failure on me, rather than a defective component. They then “thanked me” for my call and disconnected. Rather than file a defect report with the FDA, I opted to call them back and request a replacement - since, after all my error has nothing to do with non-sticking tape! In the end, they are sending me a “one-time courtesy” replacement.

I use Inset sets … When trained, I was advised that it’s often easier to perform the insertion before priming the tubing, etc. SO… I prep the site, open the set, unwind the tubing, remove the adhesive protector and needle cover, then set the insertion device, then insert the canula. After 10-seconds, remove the inserter. THEN, disconnect the tubing and go thru the process of filling the cartridge and priming the tubing. Finally, connect the tubing and prime the canula. In this instance, with a fully primed pump/tubing and simply an accidentally removed set, the process made even more sense - insert and connect. They told me that no, it HAS to be first connected to the cartridge, and primed while the tubing is still connected to the set and before insertion – otherwise, they will not support it – even though that process is MORE likely to ruin the tape than what I was shown to do.

Thoughts, anyone?

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I’ve reviewed both the Animas Ping User Guide and the Unomedical Inset package insert. It turns out I have doing set changes in the wrong order for seven years. Obviously, their order does not make a big difference.

Here’s how I do it:

  1. Fill cartridge
  2. Open infusion set package and unwind infusion set line off of spool.
  3. Remove adhesive tape backing and introducer needle sheath.
  4. Insert infusion set cannula.
  5. Remove introducer needle.
  6. Disconnect infusion set from site hub.
  7. Connect infusion set to luer lock on cartridge making sure to thread cartridge compartment cap.
  8. Prime set holding the length of the infusion set vertical and watch/wait for insulin to drip from connector needle.
  9. Click infusion connector to set hub on body.
  10. Prime cannula with 0.5 units of insulin.

Unomedical and Animas want you to prime the entire assembly so that insulin is coming out the end of the introducer needle, then insert set cannula, remove introducer needle and prime. This is a distinction without a difference in my book. At least with my method I don’t risk wetting the adhesive with insulin during the prime shot.

By the way, when trying to describe cocking the inserter to insert the infusion set cannula, I wrote,
“C-o-c-k inserter,” and realized I’d been busted by the word nanny again! Why do I feel there’s a bunch of fifteen-year old boys smirking behind the scenes??! :wink:

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I’ve always been taught to prime the tubing and infusion set first because then you can see insulin dripping out the end. Otherwise, it could be a clogged set or something and you would have no idea. Also, there’s a chance you could prime too much and end up low. But I don’t see how that relates to the tape sticking or not sticking… I think they should replace the set.

Incidentally, I had my site “go bad” today and, after spending all night low, spiked to 18.7 (336) after breakfast and stayed high despite a correction until I changed the set a couple of hours later. I still fail to see how a metal set can just fail like that (I’d only put it in yesterday), but I’ve thought about calling Animas and asking about it.

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I have been following a procedure essentially the same to what you’ve been doing @Terry4.

[quote=“Terry4, post:2, topic:50024, full:true”]
Unomedical and Animas want you to prime the entire assembly so that insulin is coming out the end of the introducer needle, then insert set cannula, remove introducer needle and prime. This is a distinction without a difference in my book. At least with my method I don’t risk wetting the adhesive with insulin during the prime shot.[/quote]

Agreed! And that is exactly what I told the Aniams rep – to which they replied “We recommend that you point the set down while priming to avoid wetting the adhesive backing, then look for five drops to come out of the end of the tubing.” Uhm… so… point it down and have insulin pour into my eye while I watch for droplets? Seems like fun…

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Sure, you can’t see if the set is blocked - but once the tubing is connected to the site, any prime would come out of the introducer needle, which will be removed, anyway - no way to see if the remaining canula is clogged or damaged by insertion until the BG results go off. (I always watch for insulin to come out of the tubing before attaching it, and prime it while it’s not connected to me, of course…)

6

I haven’t used Insets much, but when I have used them I prime the set before “cocking” it, so that the needle isn’t up in the contraption with the tape where things could get wet. I hold it over the sink and prime so the insulin goes into the sink (I don’t wait for five drops, though; more like two).

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@Jen is right. Priming through the entire course of the cartridge/infusion set confirms there is no blockage for the entire path. My method has worked for me 100% of the time for seven years. Next time I’ll try the text-book method. Not sure about old dogs and new tricks, however.

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I will try it their way - at least the next set change (tonight), as well – but as we both said earlier, this difference would still in no way make it more likely (or less) that the tape wouldn’t stick properly. Regardless – what would you do when those “tubing nasties” occur – such as doorknobs and, as in my case, the “itch” that turned out to have been an infusion site? Full rewind/prime sequence – or just replace the site itself (discarding or otherwise storing the tubing that came with it) ?? My preference is the latter - though my thinking is “clearly” flawed from my (excellent) experience with the “late” Asante Snap pump, whose sets helpfully came with and without tubing just for those “in between” site change needs…

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OK … I tried it “their way”… My assessment is not so positive. I found it awkward to insert and prime the cartridge while trying to make sure that the insertion needle was pointing down so as not to wet the tape backing… I found is even more awkward to insert the set while trying to hold my pump in one hand and insert with the other. My choice of sites (arm) may have had something to do with this, but the process is much more difficult with little clear benefit (from my perspective)…

sigh

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I see little risk in the priming method that we’ve been using. Now you know what you have to say to Animas when you talk to them, though.

What amount do you use when you “fill cannula?”

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Yeah, that’s essentially why I do it that way. It’s not so much that I expect things would go wrong the other way. Rather I long ago developed the habit of, as much as is possible, testing the entire path, not just parts of it. In this case I want to see insulin coming out of the cannula so that I know insulin will come out of the cannula. It makes me happy. :sun_with_face:

I think I picked up this habit a long time ago. Probably while I was still writing code while in school. Assuming that “Hey, if this part works then there is simply no need to check that other part because I just know it’s gonna work.” is a good way to find yourself spending an entire night and into the next morning trying to chase down a single bug. Things like that can alter your perspective. :scream: :blush:

I had a bad infusion set this weekend too. In my case I tried to prime the set and … well, and nothing. I could not push insulin into the tubing. After fiddling a bit to ensure the connection bits were good, I gave up and opened another set.

Usually I don’t call set problems into Medtronic mostly because they happen while I am wearing the set and I’m less sure what is at fault in that context. But in this case it was so clear cut that the set was defective in some way I figured I’d have it replaced just on principle.

The Medtronic HelpLine rep was (surprisingly ? :wink:) easy to work with and the replacement Quick-Set should arrive tomorrow afternoon. Whoo and Hoo.

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For filling the canula, I use the recommended amount - 0.3u for the 6mm and 0.5u for the 9mm canulas…

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I’ve always found the angled sets to perform very well for me. I can’t recall having a bad site, maybe like ever? I pulled out a Quikset “straight” set at TKD in like 2008, tried the Silhouette angled sites and have not looked back. I insert them manually and it’s very reliable, I seem to be able to get good site as you can sort of feel around to avoid scar tissue, organs, ribs, etc. The Medtronic setup doesn’t bother with the priming out the infuser needle, that’s inserted separately.

I’ve had a few that got “crunchy” from antics but, most of the time, they work really well. The goo on the Medtronic Silhouettes is strong enough that if I have the unclipped pump on my lap and stand up, the site will “catch” the pump when it plummets to the ground, before it hits the ground w/ 23" or 32" tubes I use.

On occasions, I’ll perceive a site not quite working well and will clear what I figure are “rusty pipes” by redlining my basal to 200% usually for an hour and, when whatever insulin seems to start cooking, I cut the temp basal and keep an eye on it.

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@Thas, @Terry4, here is my “heretical” method:

The ONLY time I attach new tubing is when I change the cartridge. When I put a new infusion set in and the cartridge has plenty of insulin remaining, I prime the canula with 0.7U (I use an angled set similar to the Silhouette), and continue with my day.

15

I have always figured that if the introducer needle is coming out of the end, then insulin will flow through the canula once the needle is removed. I have had only one set in 15+ years where the needle didn’t come out of the end of the canula - it took me a moment to realize why I couldn’t get the needle to pierce my skin, since it was fully encased in the canula - so I discarded it.

The fly in the ointment has always been the potential for kinking the canula when removing the introducer, but as @Thas pointed out, you can’t know that until your numbers start going high without explanation. Like @acidrock23, I have had really minor problems with my angled sets. Accu-Chek calls them Tender II. My biggest complaint is every box of 20 sets has 10 sets with tubing and I probably throw 5 sets of the tubing out. What a waste!