When in doubt..Alarms

Hi

I am new to the pump group. Despite being a nurse I feel overwhelmed by all the information. I have gone to a few insulin pump classes as figured that this would be my best option if working in the ICU setting, unless the alarms will be set off by electromagnetic waves from all the high level equipment ?? Not sure if this will be an issue.

But dont understand why my CDE keeps saying " when in doubt , take it out ". Are pump failures common ? What about occlusion of the infusion set ? Am thin as a rail and somewhat needle-phobic ( not when giving shots to other people..)

Is the rate of infusion set occlusion HIGH ? And what contributes to it ?

Does everyone here follow the same mantra of "If in doubt , take it out ?"

Ai YI YI

overwhelmed...

becca

I am fairly new to the pump too. My CDE also subscribed to that mantra. I have found that either an infusion set works well from the start, or it obviously does not (as evidenced by a bolus squirting onto me, rather than into me). My biggest challenge has been insertion, and getting the correct angle (I use the angled ones, not the straight in ones, due to my lack of flab.) I wasted a bunch, due to that.

Over time, you will get more confident and comfortable.

Yes, if I doubt that my pump or my insulin is working, I change it (I am on the Omnipod,) but no, it doesn't happen often.

Don't be overwhelmed....you'll get it.

Becca,

I've been on a pump since 1998 and, while occlusions have happened with me, I wouldn't say that they are frequent. I remember one time where I was running high all day long. I eventually delivered insulin via injection, changed my infusion set and still didn't come down. I changed my site again and still didn't come down. The only thing I could come up with is that I was putting my insertion site into an area of scar tissue and that was affecting absorption. I think most CDE's use "if in doubt, take it out" is because it's a relatively easy and simple to change the infusion set/site if you're running high and don't know why (missed bolus, stress). Just remember that this all takes time to figure out.

No, I don't think occlusion rates are high. There are a few things I'll check before ripping out a set, especially if it's new. If the site is wet, chances are the insulin is going on you rather than in you. This has only happened to me once. I'll usually do an injection - if it works, something is wrong with the site or insulin, so change time. I have had the occasional bent canula, more user error than anything else.

That overwhelmed feeling will pass, there's a lot to learn and to tweak, you'll get it!

I don't follow this rule (I've been pumping for six years), but nearly every time I don't take it out, I've regretted it. The big part of that phrase, the one to be concerned with, is "in doubt". If you can rationalize, or even hypothesize, why your BG levels are where they are, then there may not be a problem. But if you keep delivering bolus after bolus and nothing happens, it's time for a change.

Just as an added note, there are issues that could happen other than honest-to-goodness occlusions. Sometimes, you hit scar tissue and the insulin pools up under the skin but doesn't get absorbed (careful! When you remove it, the insulin could get agitated and absorbed all at once, leading to a low). Sometimes the cannula falls out completely, and the insulin just drips out all over the place. Once, my tubing got damaged and insulin leaked out before reaching the infusion site.

In all these cases, there won't be an occlusion. An occlusion is when the motor tries to push insulin through the tubing and encounters resistance. Here, there is no abnormal resistance, the insulin just isn't being delivered where you want it.

Good to 'see' you Scott!