Usually infusions sets are no problem. They go in, they stay for a few days, they come out. But sometimes the cannula either enters a blood vessel or nicks one on the way in. You find this out in one of several ways.
The first way is that you see some blood around the cannula, under the bandage. This shows up pretty quickly and is a clear indicator I’ve nicked a blood vessel. Sometimes, the insulin doesn’t absorb right, so my blood sugar runs high. This might indicate the cannula is dumping your insulin into a blood vessel, though that’s not necessarily the case. Or the site might hurt and be sensitive to the touch. That’s usually a strong indicator that I’ve hit a blood vessel, but not always. Sometimes you can tell because there’ll be a bruise forming under the infusion set, but usually you don’t notice this until after you’ve changed it out.
Then there’s the last way. The way I dread each time I change my insulin pump, and one I actively plan for with each site change. The stealth option. You switch to a new site after the insulin runs low on day three. The pump is back up and running on a new infusion set and new reservoir. So you go to remove the old one. It’s a bandage, so you rip it off, taking the cannula out with it. And then there’s blood.
If you’re lucky, it’s just a little bit of blood that shows up, but doesn’t ooze. I’ve even seen where scabs have already formed under the infusion set by the time I take it off. Yay. Or sometimes it bleeds just a little, but stops easily with just a bit of pressure for a few seconds, like when you check your blood sugar. Those are good days.
But sometimes it’s worse than that.
Changing infusion sets has taught me, over the years, a number of wonderful life skills. Like how to open bandages with one hand while applying direct pressure with the other. (The secret? Use your teeth to grip one part of the wrapper while pulling with your hand. I know, but it works and the paper tears pretty easily, if you get the right brands.) And how to get blood out of clothing. (Hydrogen peroxide if you can’t wash the clothes immediately. That will dissolve a blood stain before your eyes.) It has taught me that I can force myself to remain calm, even as I watch blood ooze, flow, or, yes, sometimes even spray out of my side. I’ve learned that blood is an extremely dark color when there’s more than just a little bit of it. (I used to say that movies had fake blood that was too dark. I realize now that their fake blood color isn’t so wrong after all.) I’ve learned that sometimes one bandage isn’t enough; that the Red Cross First Aid training rule about adding a second bandage over the first is really the best tactic there, when blood flows through the little air holes on a band-aid. And that it can soak through kleenex, toilet paper, paper towels, and clothes faster than you can imagine.
I’ve learned not to remove my infusion sets when standing on carpet. And to always be ready, just in case. I’ve learned to travel with bandages any time I will have to change my insulin pump away from home. Or if I’m at work, I will switch to the new infusion set and leave the old cannula capped and in place until I’m home. I’ve learned that it’s okay to panic, just a little bit, but not until after the bleeding stops. And then you can breathe for a minute before you start cleaning up the drops on the floor and the bathroom vanity and clothes (remember, your underwear probably has blood on the waistband now too). That gives your hands time to stop shaking and your heart rate / breathing to settle back to a normal rate before you go back out to face people.
These are the things no one tells you when they’re training you on how to use an insulin pump.