Ultraflex "kinking" (Jeremiahtren's question)

I’ve made a ‘Discussion’ for you, because there might be a lot of ‘back-and-forth’ about your question. And this is way too lengthy for the comment board.

I don’t know if you mean the Tubing (at the pump); or the Canula (in your body). I have comments regarding both. :wink:

1) Tubing: The Spirit pump sends the tubing straight up and out from the end. This is much more prone to getting bent, causing leaks or delivery failure than some other pumps. (The old DTron and DTron+ models, which I used, had an adapter which sent the tubing out sideways, along the “width” of the pump’s body. The first couple of inches of tubing was largely protected by having the pump body right next to it.)

Animas is also like the old DTron+ model; the infusion set comes out sideways. And in their advertising, they list this as an advantage. I think that they’re right about this. :frowning: But the Animas cartridge holds only 200 Units; you and I would be changing cartridges about 50% more often.

Anyway, the same tubing (connected to Spirit, instead of Dtron+) is vastly more prone to bent too sharp, or tangled up in things, by daily life. I protect mine by wearing it inside various pockets (shirt pockets, pants pockets) with slits inside the pockets, so that the tubing goes completely underneath my clothing almost immediately. But I’m aware that fashion requirements make this method nearly impossible for women to use: Most pants are tighter and more ‘shapely’; it would be extremely distracting for everyone you meet to see equipment causing one titty to bulge immensely (compared to the other), and so on. At a young age, baggy painter pants are a great solution (and they come with extra pockets, too – so you can avoid distorting your “look” at the hips, where shape matters most.) And for older women who have to wear “traditional 9-5 clothing”, hanging it all in the middle (via a “bra thingy”) avoids the out-of-balance look.

2) Kinked Canula: I see that you already commented on Jake’s Thread about the new UltraFlex-compatible inserter; it’s already in PMA. But if they choose not to put it on the market, (that would be for financial reasons; I’ll SWAG that final FDA approval is actually very likely), and until it becomes available, here are my techniques and “theories” about the problem:

The nearly universal cause of kinked canula is bad technique when pulling the inserter needle out. Going In, the inserter needle keeps it straight – unless you’re pushing it in so slowly that the Teflon actually drags on the needle. (That’s just plain wrong; push it in firmly, quite quickly- and be absolutely sure that you don’t change the amount of skin-pinch, or the angle of your insertion, while doing it.) Don’t use too much skin pinch; you’re only making a bulge to assure that the adhesive fabric lands properly at the end. If you’re pinching drastically, to create a bit of pain for distraction, it becomes extremely likely to “kink” when you pull the needle out – because the teflon tubing ends up misaligned with your skin tissue when you let go of the pinch.

And because of that, you need to let go of your pinch BEFORE !!! pulling the needle out. Just let the skin fall back to it’s natural position, with the inserter needle still in place. Then put two fingers on the fabric, snug against the plastic (to keep the whole assembly motionless while you pull the needle out), but WITHOUT pressing on your skin.

We’re almost at the end…

With your other hand, grab the blue end (thumb and index finger). Then do a tiny twist of the needle in both directions, really fast, without pulling at all. This special trick “disconnects” the Teflon fabric from the needle. You need to keep the motion really tiny, just 1/16 of an inch, or you might end up with the whole problem starting early-- the Teflon tube sticking with the needle, rather than your body tissue. You don’t have to pull out immediately after; just create the disconnection first. Then, with your two fingers still holding it all in place, but NOT pressing down on your skin, pull the needle. FAST. And most important of all, ABSOLUTELY, 100% STRAIGHT backwards from the direction you pushed in.

Does it work? Usually. When in doubt, pull it out!

For your daughter, and possibly for you too- if pain is “an issue” :

As one of the most pain-fearing adults around here, I have a suggestion. The following product is a single-ingredient (lidocaine-only) gel which works GREAT for reducing/eliminating insertion pain. . IMO, the 4% is more than adequate; don’t buy the 5%.

As a person working in the medical field, you probably remember the FDA Warnings on Topical Anesthetics from a few years ago. I understood the main findings and recommendations to be as follows:
(1) They explicitly recommended AGAINST using products which contain multiple active ingredients (for example, a creme containing both lidocaine and prilocaine). In their studies, they found that the margin of safety between “effective dose” and “overdose” was actually reduced by creating a mixture – even though a “common sense” SWAG by a non-chemist would be the opposite.
(2) They shut down a lot of un-regulated, uninspected, and unreliable “compounding pharmacy” operations behaving as de-facto pharmaceutical manufacturing firms.
(3) They highlighted the murderous results of untrained salon employees slathering deadly quantities of these products on (typically) one or even both legs of a “patient” undergoing hair removal, or removal of extremely large tattoos. Such “salon treatments” were actually unlicensed, unqualified, and deadly medical procedures.
(4) They further clamped down on several firms marketing these OTC products as “Medical Drugs”. BTW, the firm I’m recommending had been hit with such a warning back in 2005, and modified their marketing statements and website to be in compliance. (Unlike the “compounding pharmacies” problem, though, the product itself was never at issue.)

My understanding may not be very good- and you will want to review all of this with your (or her) qualified, treating MD. I am not licensed or qualified to give any kind of medical advice! This is a suggestion which worked for me, and I reviewed it with MY OWN Endo and a couple of other MDs-- but that doesn’t make right for you, or her. Don’t do it review and approval from your own treating physicians!

LMX4 is also a single-active-ingredient product (roughly the same as Topicaine, but for me, the cream was less effective than Topiciaine’s gel formulation ). EMLA is not the same as these two “good” ones. EMLA is exactly the kind of lidocaine+prilocaine formula which the FDA scientists found to be more dangerous, so I would suggest that you avoid using it.


They recommend using a thick application (1/8"), uncovered. But I always preferred to use much less, and use a temporary covering of Glad Press’n-Seal plastic wrap to spread it out and keep it from drying out. (The website explicitly recommends against covering, i.e. “occlusion” … but all of the major studies which they list in support of it’s superior effectiveness did it my way.) I found that coverage about the size of a nickel did a good job. Quantity equal to 4-5 raindrops, the use a square “patch” of Press’n-Seal to spread it. (The Press’n-Seal needs to be considerably larger, because it doesn’t stick to the gel. Maybe about 2 inches square, and you might need gauze tape to hold all in place while you wait.)

The key to using this stuff is time: Less than 45 minutes, you’ll still have considerable pain. More than 75 minutes, the effectiveness is wearing off. Just a bit less than an hour seemed perfect, for me. (YMMV, of course.) Removal of remaining gel occurs via your usual site preparation- soap and water first, then (maybe) some added disinfectant or tape-assist compound. Just be sure to make careful note of the exact location for the middle of the nickel-sized circle, because it won’t be prominent very after you remove the tape and wash it.

I’ll SWAG that Overdose is utterly impossible when using such a small quantity, covering such a small area of skin, far away from the face and head, and not in continuous use. So I’d guess that the health risks which are present would all be allergy-related. But again, those are only guesses by the lay person… I’m UTTERLY unqualified to make medical decisions and recommendations about such things.

And YMMV! But if you want your DD to have a good pump-startup experience, I’d ask her Endo about this. (And bring a copy of my entire post.) I feel that pain is under-treated in the USA, and there are some high-quality, peer-reviewed studies which support this opinion. If your “kinking” issues relate to pain on insertion, definitely consider whether this might help.

Iam using the link assist device to put it in and the canula still bends.Idk maybe i got a faulty box.They sending me the rapid d tommorow and they said hopefully it would work.

Hi jeremiahtren,

I’m Rob Muller with Roche Diagnostics in Indianapolis. It sounds as if you’ve already called our customer care, but I wanted to make sure. I also wanted you to know that I forwarded your comments to the appropriate product folks here.

Please keep me posted as to how things are going. Feel free to email me directly too: rob.muller@roche.com

Have a good day.

Rob

hi rob thanks,yeah i contacted them and they have been great!! just started the rapid d this morning so far so good

now using the rapid d.i find it more comfortable and effortless insertion.Still havind adhesive issues inspite of taxederm.

Really would like a newer adhesive option, such as the ICU medical “wipe/heat activated” stuff they use on the Orbit sets… I have to do the sandwitch thing to get sets to stick well. but as of late, as long as i use a product on the skin i attach the tegaderm to, it usually stays well enough… (Currently using Hibistat/Skin Prep (NOT IVPREP), then inserting through the tegaderm… Could also try some Skin Tac H ON TOP of the tegaderm as well as underneath… I like to leave a donut though Skin Tac H is a bit runny and a hairdryer can set it with a little less dripping. I wonder if they could come out with a right angle adapter to replace the standard cap so any infusion set can go up the side instead of out straight…