Hello everyone,my daughter was fitted with her accu-chek combo pump yesterday and although things seem to be going ok at the moment,I am really worried about changing the cannula and infusion set.The cannula is due to be changed tomorrow and the infusion set on monday.When changing the cannula do i need to switch the pump off?.I was told all this yesterday at the training session.I know im just worrying and the more I do it the easier it will be.But to be honest I feel really out of my depth,there is just so much to remember.So I would be greatful for any advice.
pump just fitted,advice needed
- Thread starter martina
- Start Date
we dont have the same pump so i cant help u with the ins and outs but set changes get loads easier when u have done them a few times, i worried myself to death about it and now we can change it all in 5 mins without thinking about it too much theres alot to think about with a pump but it all becomes second nature honestly, perservere and it will all be worth it. im here if u ever need a chat
anna marie
anna marie
donnellysdogs
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Hi Martina
1st off....what type of cannulas are being used.
There is a bit of difference in the way that plastic ones are primed compared to the metal rapid d ones.
Yes, you will need to put the pump to stop mode to then go through the menu's to prime the sets. Would be handy to know which sets your daughter is using....
Get your big training manual in front of you whilst doing it. It can help.....although it tells you how to set things up rather than taking things out on your first time.....
You will need to disconnect the old set. I would recommend leaving the old set in the skn, until after you have put the new one in.
Change the set before doing a bolus for a meal. Ideally at least 3 hours before bed.
Be assured the first set change and first cartdige change can be longer than when you get used to doing it. When used to doing it, it can be done in literally minutes.....
1st off....what type of cannulas are being used.
There is a bit of difference in the way that plastic ones are primed compared to the metal rapid d ones.
Yes, you will need to put the pump to stop mode to then go through the menu's to prime the sets. Would be handy to know which sets your daughter is using....
Get your big training manual in front of you whilst doing it. It can help.....although it tells you how to set things up rather than taking things out on your first time.....
You will need to disconnect the old set. I would recommend leaving the old set in the skn, until after you have put the new one in.
Change the set before doing a bolus for a meal. Ideally at least 3 hours before bed.
Be assured the first set change and first cartdige change can be longer than when you get used to doing it. When used to doing it, it can be done in literally minutes.....
thank you,we are using rapid d ling cannula's.I have just come back from the school was called because her bloodsugar was 17.6 i thought the idea behind the pump was to stop these highs. I know that this is probably down to a change in insulin that is needed.If it was a problem with the pump im i right in thinking that it would have alarmed.Its all very confusing as yesterday at this time she was 2.7.the carbs in her breakfast was exactly the same.help!!!!!!!!
Hi Martina, first of all did you remember to bolus for her breakfast? Sounds silly but it can happen.
Her basal rate may be out untill you finish doing all the testing but we were started off on a very small basal and then increased it slowly untill we got it right.
You need to put the pump in stop and prime them through before putting them in otherwise you will have air in the tube. Once we have primed the cannula we set the pump to start and disconnect again then insert the cannula and reconnect.
It will get a lot easier as you go along so good luck with it and I'm sure you will have much better control and freedom with the pump.
Harry
Her basal rate may be out untill you finish doing all the testing but we were started off on a very small basal and then increased it slowly untill we got it right.
You need to put the pump in stop and prime them through before putting them in otherwise you will have air in the tube. Once we have primed the cannula we set the pump to start and disconnect again then insert the cannula and reconnect.
It will get a lot easier as you go along so good luck with it and I'm sure you will have much better control and freedom with the pump.
Harry
Did your DSN or pump rep show you how to do pump checks when blood sugars go too high? And did they explain how to treat highs with a pump? I'm not sure about your pump but our Animas won't always alarm if there's a delivery problem because of air in the cartridge or tubing.
Sometimes we get an air bubble in the tubing or cartridge and this can cause a high BG reading, only once when we've had this problem did our pump alarm for an occlusion. We find that the bubble problem occurs a few hours after a cartridge change, even if the cartridge appeard to be bubble free at the change. So now we do the cartridge change but the next morning (we do the change in the evening) we take the cartridge out of the pump and knock new bubbles that have appeared overnight out through the tubing and them reload the cartridge and prime to get them all out, then reconnect the pump and we're good to go and bubble free until the next cartridge change.
For a high BG like your daughter had we'd do a pump check, make sure there are no bubbles or anything else that might have caused the high. I look back in the history to make sure nothing has been missed. Then deliver insulin for a correction. Test again in 2-3 hours. If the reading is still high you can't leave it, inject insulin with a pen to bring the reading down and try to resolve the pump problem. Don't leave the reading high like that for hours, we were told one chance to try and bring it down and then inject insulin. Also keep an eye on ketones until her BG comes back to normal.
Sometimes we get an air bubble in the tubing or cartridge and this can cause a high BG reading, only once when we've had this problem did our pump alarm for an occlusion. We find that the bubble problem occurs a few hours after a cartridge change, even if the cartridge appeard to be bubble free at the change. So now we do the cartridge change but the next morning (we do the change in the evening) we take the cartridge out of the pump and knock new bubbles that have appeared overnight out through the tubing and them reload the cartridge and prime to get them all out, then reconnect the pump and we're good to go and bubble free until the next cartridge change.
For a high BG like your daughter had we'd do a pump check, make sure there are no bubbles or anything else that might have caused the high. I look back in the history to make sure nothing has been missed. Then deliver insulin for a correction. Test again in 2-3 hours. If the reading is still high you can't leave it, inject insulin with a pen to bring the reading down and try to resolve the pump problem. Don't leave the reading high like that for hours, we were told one chance to try and bring it down and then inject insulin. Also keep an eye on ketones until her BG comes back to normal.
for us a reading that high usually indicates a prob and more often than not its a pesky air bubble like today went in checked dylan he was 18.5 :shock: but my first instict is check for bubbles and there it was a huge one stuck in the tubing so i primed it out did a correction and meal bolus and by the time he gets home tonight he will be right back where he should be. it can be frustrating when this happens but it is usually delt with quickly and efficiently.
anna marie
anna marie
martina said:
Hi,
I hope the cannula change went well if you've already done it.
I remember doing my first cannua change, i felt like i forgotten all of what i'd been shown, after i got the manual out for back up it all came flooding back and it went smoothly as i'd hoped.
It's natural to worry as it's like having your first insulin injection all over again, it's all new and you're right there is alot to remember, just take things one step at a time, if you feel really stuck call the accu-chek careline, they are always helpful to me and would be willing to talk things through with you if you need.
It's good that you are changing things one at a time, if you changed her cannula today she will be due another change on sunday if you are keeping it in for the two full days, so by time monday comes to change the tubing you will be more confident, and by time it comes to change the cartridge you'll be even better. As time goes on you will wonder why you ever were worried as it'll come so naturally to you.
Don't worry too much, we're here to help on the forum if you need advice, sounds like your doing a fantastic job already.
Theres great advice here already about the high's so i won't go into that one.
Good luck
donnellysdogs
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Martina...did I read correctly that you are using rapid d links, the steel ones.....if so, are you changing them on the 2nd day of using....i.e. You were set up on the Monday morning, so did you do the set change sometime on Wednesday? How did it go? If the set up of pump was on Monday, then Sunday will be the cartridge changeover...do check for airbubbles-as I was sent home from hospital with a huge airbubble in mine, that DID go down the tubing....
Also the rapid d links are good, because you prime everything before you put them in.
What time did your daughter go high?
First thing I do, is to check that I did the bolus for my meal if it was within 2 hours of having a meal.
Next I check the set, and make sure it hasn't any leakage visible, then I check my tubing. If in any doubt I will change the set, and would also inject if I am above 15-which is very, very, very rare nowadays.
Tee basals and bolus will have been set up initially to try and avoid hypo's on a flat level. You need to be able to some fasting tests, perhaps over the weekend, also bear in mind that if levels are going high or low 2-3 hours after food-then it is more than likely that the bolus needs to be changed.
If levels are going high/low at 11am, for instance the basals for 8, 9 and 10am need to be changed-NOT the actual hour when going high/low...if levels are high, then the basals need to be raised to give more insulin, and if hypo's are occuring then the basals need to be lowered to give less insulin.
Please let us know how you and your daughter are managing...
Also the rapid d links are good, because you prime everything before you put them in.
What time did your daughter go high?
First thing I do, is to check that I did the bolus for my meal if it was within 2 hours of having a meal.
Next I check the set, and make sure it hasn't any leakage visible, then I check my tubing. If in any doubt I will change the set, and would also inject if I am above 15-which is very, very, very rare nowadays.
Tee basals and bolus will have been set up initially to try and avoid hypo's on a flat level. You need to be able to some fasting tests, perhaps over the weekend, also bear in mind that if levels are going high or low 2-3 hours after food-then it is more than likely that the bolus needs to be changed.
If levels are going high/low at 11am, for instance the basals for 8, 9 and 10am need to be changed-NOT the actual hour when going high/low...if levels are high, then the basals need to be raised to give more insulin, and if hypo's are occuring then the basals need to be lowered to give less insulin.
Please let us know how you and your daughter are managing...
Hi everyone,Thank you all for advice given,My daughter went high at 10am.However today at the same time she was 8.8, so I am thinking perhaps it was just the excitment of school as she was pretty keen to show of the pump.Before we got the pump she did seem to go very high around this time in school.This was something her nurse said the pump would fix.I had to ring the careline on wednesday evening as we noticed that there was a tiny amount of blood in the tubing.The lady i spoke to was so nice and talked me through changing the tubing.I was so nervous but did it all without any problems.As you have all probably noticed I worry too much.Im due to change the cannula today again but im not to worried.I change the cartridge on sunday.Im i right in thinking that Ijust go through the menus until I get the thing I want to do then press the tick.For example do I press stop then change cartridge then pime line then start the pump.I get very stressed out but have noticed that her levels are more stable throughout the day and night already.The main thing is that my daughter has taken to the pump really well.It doesnt seem to hinder her in any way.Arent children great,the way they just except things?Thanx again for all the advice,I really appreciate it.
donnellysdogs
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Hi Martina
I get everything ready first-the new cartridge and the tubing.
I generally fill the new cartridge first from room temp insulin, and there is a cap in the packaging of each new cartridge so then I just put the cap on it and stand it uprright.
Then I detach the old tubing from the set. (Assuming that it is just a cartridge change). I then unscrew the connector and remove the old tubing and the old cartridge out of sight (as I have once accidentally put the old tubing on it accidentally, and then realised when I was putting all the wrappers in the bin!!).
I then stop the pump, put it in to change cartrdige and let the piston wind back. Whilst it is winding back, I then attach the new cartridge, the connector, and the tubing together. When it has finished winding back I then put in the new cartridge, I do not try to line up the bottom of piston to the bottom of the cartridge, as I always put in 315 and just press the up button until it gets to 290.
The machine when it has been ticked to say the self testing and stuff has been done and is ok then autmatically goes to priming.
My rep and DSN got me to bang the bottom of the pump on the table when I was first taught to prime, and I always continue to do that to this day on my kitchen worktop until all the bubbles are out-even though there isn't one single one when I loaded the cartridge!! Generally the bubbles start to come out when between 4-8 units have gone through on the pump. I watch all of these until they are out and then connect to the set. I have the rubbery pink cover over mine, and banging it on the worktop isn't as hard as if the pump is out of the rubber cover. I know some people bang it against their other hand, but I was taught on the worktop holding the tubing in one hand and the pump in the other whilst gently tapping.
AND REMEMBER TO START IT AGAIN!!!!
I then always reprime at 4 hours afte a cartridge change, normally doing my changeover of cartridge before tea at 7pm, and then stopping, priming (afte disconnecting from the set) when I go to bed at 11pm, and then it is very, very rarely that I ever have to look at it again until either set change or the next cartridge change.
Just take your time, with the instructions. I couldn't find the instructions on how to take the cartridge out, and of course I only got shown how to put it in on my training. Allow yourself about an hour for the first one, but you may well find you will do it quicker. The third time you do it, you will be much quicker.
You aren't worrying un-necessarily- being a pump parent cannot be easy, especially with the fact that you are doing it for your child and you don't want them to have problems.
Are you confident with rising basals a little in the morning 7,8 and 9am if your daughter keeps going higher about 10am? They only need to be very little adjustments at a time....
Well done Martina, almost a week being a parent pumper, and you sound really positive....
I get everything ready first-the new cartridge and the tubing.
I generally fill the new cartridge first from room temp insulin, and there is a cap in the packaging of each new cartridge so then I just put the cap on it and stand it uprright.
Then I detach the old tubing from the set. (Assuming that it is just a cartridge change). I then unscrew the connector and remove the old tubing and the old cartridge out of sight (as I have once accidentally put the old tubing on it accidentally, and then realised when I was putting all the wrappers in the bin!!).
I then stop the pump, put it in to change cartrdige and let the piston wind back. Whilst it is winding back, I then attach the new cartridge, the connector, and the tubing together. When it has finished winding back I then put in the new cartridge, I do not try to line up the bottom of piston to the bottom of the cartridge, as I always put in 315 and just press the up button until it gets to 290.
The machine when it has been ticked to say the self testing and stuff has been done and is ok then autmatically goes to priming.
My rep and DSN got me to bang the bottom of the pump on the table when I was first taught to prime, and I always continue to do that to this day on my kitchen worktop until all the bubbles are out-even though there isn't one single one when I loaded the cartridge!! Generally the bubbles start to come out when between 4-8 units have gone through on the pump. I watch all of these until they are out and then connect to the set. I have the rubbery pink cover over mine, and banging it on the worktop isn't as hard as if the pump is out of the rubber cover. I know some people bang it against their other hand, but I was taught on the worktop holding the tubing in one hand and the pump in the other whilst gently tapping.
AND REMEMBER TO START IT AGAIN!!!!
I then always reprime at 4 hours afte a cartridge change, normally doing my changeover of cartridge before tea at 7pm, and then stopping, priming (afte disconnecting from the set) when I go to bed at 11pm, and then it is very, very rarely that I ever have to look at it again until either set change or the next cartridge change.
Just take your time, with the instructions. I couldn't find the instructions on how to take the cartridge out, and of course I only got shown how to put it in on my training. Allow yourself about an hour for the first one, but you may well find you will do it quicker. The third time you do it, you will be much quicker.
You aren't worrying un-necessarily- being a pump parent cannot be easy, especially with the fact that you are doing it for your child and you don't want them to have problems.
Are you confident with rising basals a little in the morning 7,8 and 9am if your daughter keeps going higher about 10am? They only need to be very little adjustments at a time....
Well done Martina, almost a week being a parent pumper, and you sound really positive....
