Reviewing Set Insertion Technique (or old dogs and new tricks)

I had a hard time getting used to inserting infusion sets when I started using my Ping in 1/11. I sat down and slowly followed the directions line by line for weeks. I don't have the best hand-eye coordination in the world! Gradually I got more comfortable and now just do it, no instructions needed.

So 16 months in I was frustrated yet again this morning by another bent canula. I have often felt I lose too many sets. I know it's possible to develop a bad habit and just keep doing it. So I decided to take the instructions and go over them again to see if I could perfect my technique. I use the Inset 30s. So I read the instructions and when I got to the actual insertion part it said "place your index finger on the top release button and your thumb on the bottom release button." "bottom release button?" What bottom release button!. I had just been putting my thumb and third finger on the side indentations and using my index finger on the top release button. Which when I looked at it is a pretty awkward position! So now we'll see if the correct way makes a significant difference. So I wanted to suggest this periodic review of technique to others.

On this topic, though, I'm curious as to what percentage of sets people have fail on them over time. I asked this question once in my Type 1 Women's Group and one woman said "5%". I was astonished at how low that seemed. So what about you, (whichever type you use). What is the approximate percentage of sets you have fail from any cause?

Well, I use the Inset 30 as well been pumping a little over a year with maybe 5-6 failures, so 5% seems right. Usual location of bad sites are on my upper buttocks, moving around in my sleep tends to stretch the skin around the cannula causing bleeding around and sometimes in the cannula, so I will change it early then. One time I hit a blood vessel and had blood fill the cannula as soon as I withdrew the inserter and changed immediately then as well.

Five or 6 failures in over a year??? Yikes! I'm definitely doing something wrong. I look forward to seeing if my procedure correction helps!

I had two no delivery's in 2008 and experience some set fade (poor absorption) three or four times a year and change a set big deal

I use 6mm QuickSets on my arms and 13mm Sill's on the rest of my body.

I have been using a Medtronic pump and Silhouette canula set since September 2008. I have not had any set failures, although I have pulled 3 or 4 out on my kitchen drawer knobs in the 3-1/2+ years.

Change to a set that is inserted at a angle by hand and your troubles will disappear...;-)

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What exactly do you mean by set failures?

There's insertion failure where the insertion process doesn't work or the set just looks wrong. I've probably had a couple of those over the last year, with Insets on my hip. Once the inserter collapased the other time the canula just didn't go in.

Then there are the cases where I change early because BGs just aren't reacting properly or the set hurts or one sees blood, I call that a bad site rather than a bad set. I've probably changed out early 4 or 5 times in the last year. I usually leave a set in for 4 days.

I agree with JohnG manual insertion of an angled set has fewer failures, but I can still get it in at too deep an angle.

I use Insets, Inset30s or Comfort Shorts.

In 5+ years I've never had what I would describe as a bent canula, I'm not quite sure what people mean by this.

Wow! I have at least 3 or 4 a month! When that girl said 5% I should have listened! Kim, is that canula also an inserted by hand one? If you both recommend that I would get Animas' version. Though I am definitely going to see if my corrected technique works before I try to learn a whole new thing (that a lot of people reported being too hard for them!)

Wow, again! When I say set failures I include all the possible snafus: insertion doesn't work, I can see through the window on the inset-30 it isn't in right or there is blood, the set hurts or BG's are not reacting properly which would include absorption problems. When I have a bent canula I can see only the teeniest little bit of it through the window and when I pull it out it's bent down at a sharp angle.

Again with the "4 or 5 times in the last year". Yikes! LOL. I like to leave it in 4 days too and haven't experienced any of the degradation of insulin people report after 3, but I rarely keep a set long enough to do that (sometimes through set problems and sometimes because I just didn't put enough insulin in)

I am soooo glad I posted this. If anyone has any other suggestions as to how to prevent problems, bring them on! I can't be the only person with sucky hand eye coordination. The other day I was thinking I really can't afford to be on a pump (after I paid the $500 deductable for supplies). But I still - despite these problems - love it too much to go back

The Comfort™ is the same as the MM Silhouette, Unomedical makes both sets.

Comfort™ Short Infusion Set

Thanks, John. I'll see if I can get a sample. But like I said - miserable hand-eye coordination so if some people have trouble using them I definitely might!

I also use a Medtronic pump and don't have site failures. My sets are SofSets and I rarely have a kinked or bent canula (if I had to count I'd say 3 or 4 total). I insert my sets manually because when I started pumping there was no such thing as an inserter device. I would try without the device and see if that works better.

Thanks, Karen. I am definitely seeing I have been accepting as normal a ridiculously high rate of set failures! I'm going to see if my improved technique helps and also ask for a sample of Comforts from Animas to see if I can do that. Wow, to have my site last 4 days nearly all the time sounds like bliss!

As I said I've never had a bent canula, but my friend in England has a lot, it's better now she's changed from Insets to Inset30s, but they still happen. She says she has more success when she keeps the new sets in the fridge & inserts the canula cold. I've never done this, but she swears by it.

Hmmm..interesting! I'm hopeful that the way I was doing it (see my OP) was awkward enough that correcting that should make a big difference. Isn't amazing how hopeful we can remain with this condition?

I inserted them by hand for about the first year, but then it got really uncomfortable and I started using the "Sil-serter" that came with my pump. The inserter for me is more comfortable, and a little easier.

If 5% includes only outright failures (i.e., where you change your site and three hours later are 350 with ketones and clearly getting no insulin), then it sounds about right to me.

I have sets with a slightly bent cannula "tip" fairly regularly which don't seem to be bad because my blood sugars seem okay, but if you counted those it would be much higher. It tends to happen with sets on my arms, probably because they are hitting muscle.

My biggest issue with sets is that I'm allergic to the cannula and adhesive, so often sets will fail just due to bad absorption from irritation/allergies.

No, I was including much milder examples than that, Jen.I've rarely had that experience. I either see it didn't go in right or it hurts and I know it's bad, or else more commonly it's fine for a day or something then I notice high numbers, or I notice the canula looks bent or there is blood. And I'm definitely less active than many, so I think the canula is either a little bent as you say and it gets worse in time, or something like that.

I don't think I have any of the allergy problems as I never have itching or rashes, but sometimes I think poor absorption is definitely my problem. It looks a bit pink under the plastic window, but I was assuming the allergies are more severe?

I've only had a couple since 2008. I had one Quick-set that sweated off at TKD, a couple that fell out running and maybe one or two I pulled because they didn't seem to be working. Most of the time, if it seems not to be working, I'll turn my basal rate up to 200% for a couple of hours to "clean out the pipes" and it seems to work. I use Silhouettes and stick them in manually and pay pretty close attention to getting them stuck. After a couple of pull-outs on long runs, I also started taping down the tubes for those and that also seemed to help.

A couple since 2008!!!??? Yikes! I've had a couple since last week! Another vote for the manuals, ok, I'm definitely ordering samples!!