@Richard157’s thread on site infection is causing me to post about our first pump site infection as an FYI that may be useful to others.
About 8 weeks ago we had a pump site day 3 where insulin use was huge and BG was not coming down from the 300s. We took out the pod early, and found an angry red site, raised about 3mm for a diameter of about 3/4" (mixing units to satisfy everyone…).
I was not sure if we should see someone, so just in case I called the endo clinic. The nurse immediately recommended seeing our PCP quickly due to infection danger.
When we went the same day, the PCP diagnosed an infection, gave us a course of antibiotics and started a culture to test for MRSA (it was not).
The infection went away in a few days. We kept track of it everyday by surrounding the affected area with a pen. But the site is still red and unusable, for how long I am not sure.
Our NP recommended not using this arm for about 8 weeks.
Lessons for me:
Suspect a pump site earlier when correct tio have no effect (@Jen suggests 2 corrections before yanking)
Immediately go to PCP or Urgent Care when it looks like an infection
It is a pain to lose a pump site area for a long while. I felt a sense of loss
We always use alcohol before setting up a site. I don’t know what else we could have done to avoid it—I think nothing.
@Michel, thanks for reporting this incident. I’m sorry that your son had that infection. Is there a needle initially involved at the site? I use Sure-T infusion sets, and I am very careful to not touch that needle with my fingers before insertion.
this makes me feel wary with regard to my infusion sets. i use steel needles and insert them manually, not with the device that comes with them. my endo knows this about me, and i have spoken with tech support and have been told that the way that i do it is fine. just make certain that my hands and fingers are 100% sterile. i’ve been doing this for 18 years and luckily have never run into a problem. (although i did have a problem once with inserting a dex sensor; i must have hit a nerve or something, b/c the entire area swelled up like a golf ball and i had to pull out the sensor and hold a warm towel against the spot all evening)
It is an Omnipod pump, so the needle is self-enclosed with the reservoir, and comes down electronically when you start the Pod. Now that you mention it, I’ll have to analyze my son’s procedure to figure out if there is a risk he could contaminate the area somehow.
Wow, there’s an inserter for steel needles? What’s it called? I’ve been using steel needles for the past seven years and have always inserted manually. But there are some locations that I can’t reach and it would be useful to have an inserter as an option, if one still exists.
i use the MM tethered Paradym pump. i dont know what they make for other pumps; but, Medtronic sent me the inserter. i have never used it b/c i like to control the angle that the needle goes in (i like it to be very low under the subq area). but call the company tech line and ask. i deff understand about wanting to insert it in a hard to reach location.
Ah, it sounds like we’re using different sets. I use contact detch, which are 90-degree sets. Yours sound like angled sets. Thanks for the information!
mine are NOT angles sets. my introducer needle is straight. its 13mm, and i just slide it in at about a 25-45 degree angle so it doesnt go so low and hit a capillary or nerve.
But DM, that’s what “angled set” means. It means one that you put in at an angle. The other kind is the 90 degree sets that you put straight down, not at a (shallow) angle.
ok. now i understand. when i was originally put on the pump i had a very very long introducer needle, and it hurt like a MF. i didnt know, at the time, that i had a choice until i met a pregnant woman who was using the “quick set.” as soon as i saw hers, i made the change immediately.
(i used to dread doing pump changes. absolute horror and fear.) also, btw, my first pump didnt have all the fancy and convienient setting features as are available now. i had one basal setting and i dont even know if i had any ICR options. it was big and clunky, but i was still thrilled with it enough to keep at it.)
So you are using quick-sets, and manually inserting at an angle?
Typically the MM silhouettes are most common set for angled insertion. Quick-sets are designed to be 90 degree, but I suppose could be manually inserted at an angle. I use Quick-sets with the inserter, so it is 90 degree.
maybe i am not clear about what an angled silhouette is. is it a bent needle? b/c mine is deffinitly a silhouette and it is NOT bent; also, i called it a “quick set” b/c it detaches with just a pinch from the site where the infusion goes. squeeze and pull out, and then the “tethered” tubing is removed and all that remains is the adhesive “patch” holding the site in place.
@Michel, do you harvest unused insulin from used pods? Is there any chance that that played a role? I do that sometimes and I sanitize the pod port before I withdraw insulin from the used pod, but I’ve wondered if it’s got too much potential for introduction of contaminants.
@T1Allison, we rarely do so, only when we have a pod fail early, in the first 24 hours. In this case (this story), we did not salvage. I agree with you that there is some potential for contamination there.
i have heard that there are shorter introducer needles/cannulas than the 13mm ones that i use. do you (or anyone) know anything about them? i was concerned that the cannulla would pop out from under the skin. but i use these specifically b/c i am so lean. its hard for me sometimes b/c i can so easily hit a capillary or a nerve when inserting. it can be extremely frustrating, especially now that i am changing them out every 2nd day.
“The MiniMed Silhouette infusion set is available in 4 tubing lengths and 2 cannula lengths. The 13mm cannula is available in 18”, 23", 32", and 43" lengths; the 17mm cannula is available in 23", 32", and 43" lengths."
The quick set cannula is shorter, because it goes in straight at 90 degree. So Quick set cannula is deeper into my skin.
Whereas the Silhouette goes in at angle based on how shallow or deep you use during manual insertion.
thank you for this. it is exactly what i do with one exception: i dont have 1 inch on belly skin to pull up. i have about a 1/4 inch to work with. i think that this is why i tend to hit capilaries and nerves on occasion. this morning when i changed out my set, the needle went in smoothly w/out any pain whatsoever. this is not always the way it works ; sometimes it hurts quite a bit and the skin is firmer and harder to slide in the needle.
