Morning!! I’ve been T1D for 24 years, dx at 14, pumping for 11 years. I’ve always used Minimed Paradigm with Quick Sets. I’m 5’6", 112 soaking wet, and running out of good spots, so the Product Team suggested I try Silhouettes. I’ve received the complimentary Serter and the sample pack is on back-order. In prep for trying them out, I just had a couple questions. My last visit to my CDE was for a week-long CGM study, and my next quarterly with my Endo isn’t until the end of July, so I thought I’d look for some perspectives here in hopes of avoiding an extra CDE appointment.
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How do you find the best angle? On the back end of the Serter arms, it looks like there’s a flat area that would make it a pretty shallow angle. Is it okay to rock it back that far?
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I’ve always used the IV Prep that leaves your skin sticky, but with Quick Sets you take the paper off before you place the Serter on your skin. With the Silhouette, I fear the paper would stick to the sticky skin. Would it work to insert the needle into dry skin, then hold up the front flap of the tape to swipe it with the IV Prep and put the tape back down?
If I’m repeating a thread, I’m happy to be referred to an already-existing one. Thanks in advance for any advice!!
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If you are skinny (or even not so skinny), I would strongly recommend you try the short cannula version (13mm long ) rather than the standard 17 mm set.
AVOID the 'serter! Its a monumental PITA to use and tend to result in bent cannulas. Manual insertion is easy to do - here’s a Youtube video showing you how to do it.
My slight variation on this (as taught by my first DSN) is to first pinch the two side paper tabs between thumb and middle finger and squeeze them together so you are now also gripping the sides of the plastic set. Peel off the front tab and use your free index finger to hold the front of the sticky patch backwards away from the skin. Remove needle cover and insert needle (about 30 degrees but it is not critical). Move your index finger to release the front part of the patch and stick it down. Squeeze the sides to release the needle and withdraw it. Then you can peel off the remaining protective paper and stick the rest of the set down.
I don’t need to use adhesive, but if you do need it I would just paint the area with skin tac either before or after inserting the needle. With the manual insertion as described above, there is no chance of accidentally sticking the paper to your skin as you use the thumb, index and middle fingers to hold the patch away from the skin until you stick it down.
Good luck
After 9 years, I can do the whole operation in less than 10 seconds.
I don’t find the angle particularly critical especially with the 13 mm sets. Stick the needle in at anywhere from around 30 to 45 degrees. Peel off the protective paper from the sticky patch under where you have inserted and stick it down. Hold it in place with one had and pinch and withdraw the needle with the other. Peel off the other protective tab and stick the set down.
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Like @jjm335 I have always inserted Silhouettes (Comfort Shorts with other pumps than Medtronic) manually. My original pump trainer 12+ years ago counseled me not to use the inserter and I have never owned or used one.
I have tried almost every 90-degree set on the market and always come back to my angled set. I rarely have painful sites and even more rarely have sites that fail or absorb poorly. I have used the shorter version of the set ever since it was released, but started with the longer version. One thing to know is that you don’t even have to insert it all of the way in and manually you can easily use different angles. So find what works for you.
Although I am a fan of manual insertion, I will admit that it can be painful when you poke that ugly needle into yourself. After all these years I still have to take a breath and just do it. But the payoff of trouble-free, mostly pain-free sites is worth it.
For manual insertion I was taught to peel off the small front piece of paper and hold the stickly part back as I insert. I then press it down and remove the bigger piece of paper and press that down. I usually use something like IV Prep, but often use nothing if I am applying after a shower. I have never had any problems with these sets sticking.
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I’m a relatively new user of the MiniMed Silhouette infusion sets. I’ve been using them since November 2016. Unlike others, I have used the inserter with consistent success. Using the inserter allows me to access sites with compromised direct vision. As others have said, I don’t think trying to maintain a precise angle is that important.
When I start a new site, I load the needle/cannula/adhesive assembly into the inserter. At this point, the only thing I remove is the needle guard. I leave both the small and large adhesive paper on. Once the needle is inserted, I disconnect the inserter itself first. I then place one finger on the center of the infusion hub and fold back the flap on the small adhesive portion. Then I peal off the paper backing and smooth that adhesive fabric down. I withdraw the needle and then remove the paper from the large side and smooth it down, too.
I find the performance of these sets to be rock-solid. I’ve not had one site failure in six months. I don’t use any adhesive help as the set only stays in place for three days. I do use Skin-Tac on my Dexcom CGM sensor bandage as it usually stays in place for 14 days. In that case, I apply some Skin-Tac over the top of the bandage once it’s in place. I use the Skin-Tac bottle with the fabric ball applicator attached to the underside of the container lid.
Thanks all for the tips. My Quick Sets are 6mm so we are planning the 13mm Silhouette. With that said, manual insertion is not for me. One of my biggest hurdles when I was coming out of my long late-teens-and-early-twenties rebellion (but that’s for another thread) was that I had developed an emotional block to sticking the needle in–I was on vial and syringe at that time, and my CDE of that time actually found me a 'serter for a syringe.
Thanks again for your thoughts. I will try not to over think the angle and see how well it works without IV Prep.
So, update:
LOVE. IT.
I went ahead and ordered a whole box because the sample never showed–they did send me a free serter though.
Before the Silhouette, I had three places I could use–right belly, left belly, and right small of back/top of bum. With my third Silhouette, I went left small of back. Within 24 hours it was bloody, I had to change it and the blood didn’t want to stop for a few minutes–must have hit a vessel, and I haven’t been back there in several changes as I’ve been letting the mini-hemotoma heal. But I do think I’ll try near there again.
Yesterday morning I went to my thigh. First needle to touch my leg since I was on MDI, but forbone Quick Set that failed instantly because it hurt. This one WORKS and I am SOOOOOO excited to be finding new functional real estate!!! I feel like the world is opening up!
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