Daughter on saline, pump questions

Janerd said:

Hi everyone,
My daughter got her minimed 754 on monday and is currently on saline. She's getting on fine with it and I believe when we switch to insulin next week she will feel the benefit of the freedom it brings.
The only few problems and questions I have are as follows
1) bubbles in tubing. Although we have yet to experience them, i must confess that I'm slightly nervous for next week when we 'go live'. Is it possible to prime the bubbles out manually after everythings been set up or should we re do the whole set again? How do we do this?

No you don't have to go through the whole set up, just put pump into stop mode so that you can enter the prime function to prime the bubbles out, you do this so that when you'll looking back at your pump data it doesn't show up as a bolus

2) the issue of carrying spare infusion set and insulin seems to come up in the manuals and training documents. If the tubing needs changing for whatever reason is it possible to just change the tubing rather than insulin as well. I have not been too much hands on with the pump as my 15yr old daughter seems to be managing fine, I'm just learning from her at the moment and trying to help her become independent with it. Most situations with alarms etc seem to suggest re doing all the infusion set.

Yep, you can replace tubing/infusion sets without changing insulin, you just have to remember if you'll just changing the infusion set, just to the small bolus to fill the cannula, and if changing the tubing to prime the tubing if changing both need to prime and fill cannula procedure

3) Also (sorry to ramble on) as Sophie is using the sure-t set she needs to change it every 2 days so may not have used all the insulin, so can she again, use the old insulin cartridge already in the pump (providing there's enough for another 2 days)

Again yes you don't have to change cartridges if you've got enough insulin in it, if you find that her bg readings start to increase near the end of the cartridge then just fill the cartridge with a smaller amount

4) is it advisable to make up cartridges of insulin to carry as spare, some nights she will need to Change sets when she is sleeping over at a friends house. Please don't tell me she needs to carry bottles of insulin around!

It's not wise to keep insulin in the plastic cartridge for too long, but if she's filling up a spare cartridge so she's able to change at a friends house when she's saying over night this will be fine for situation like this

Any advice, answers, tips greatly appreciated
Jane & sophie

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I hope that it doesn't take too long to pin down Sophie's basal rates, and any adjustments in carb/insulin ratio's don't forget when sorting out the basal don't make too many changes at one go as you won't know what worked and what didn't, and pining down the basal becomes a lot harder.. While you pining down basal's don't get too hecked up about carb/insulin ratio's as you can't really fine tune these until the basal is correct..

When I started pumping on went straight onto insulin from the word go, many ways I'm glad of being dumped into the deep end so to speak.. As no faffing around with both insulin injections and the pump.. Getting used to not injecting insulin pens out to inject for food and press a couple of botton instead was very easy..

But getting used to not having to do my morning and evening Levimer injections really did take some getting used to, for several weeks every 11.30am and 11pm I would be looking to inject my Levimer..

Good news here there are a couple of products that you can get that may help..

You can get an spray adhesive that she can use under her patch can't remember it's name off hand, but I know that my friend uses it so will contact her tomorrow and ask what it is..

I've had a word with my friend.

She said the product is called Skin Tack here http://www.mghealthcare.co.uk/products.aspx (don't forget to claim tax exemption) She also suggests using Mefix tape over the cannula you can get this on prescription

A tip for Skin Tack is to carefully fold the swab and put back into the packet, and use it until it dries out and alcohol swabs will clean off the sticky stuff.

We use the skintac wipes and I have to say they are good.

Unfortunately with active children the site will sometimes come loose. This is one of the negatives of the pump for us, although the benefits far outweigh any disadvantages for us and I would never willingly put my kids back on injections.

Have a try with the wipes and if these work your GP might prescribe them on prescription. Also, overtime you will probably find other sites on her body which are more secure and less likely to come off.

Tomorrow I would ask your DSN if they got another batch of sets you can try, as it may be down to a dodgy adhesive batch causing a lot of the problems..

Cavilon spray is many used as a barrier spray either for under dressings due to patient being allergic to adhesive, also in the prevention of pressure sores often used in the elderly who are infirm and incontinent.

It produces an barrier which doesn't effect adhesiveness of dressings and does help with adhesion, in your daughters case it would help prevent sweat getting into contact with the adhesive on the dressing...

So if you haven't give it a try..

There is also actual films used such as Tegaderm which does the same sort of thing.

Are you sure that it's sweat interfering with the adhesion properties other causes are

Not allowing the infusion site to dry probably before a set change.
Residue from showering gels, soaps and moisturisers on the skin..

Ensure that your daughter is aware of the importance of ensuring any shower gel, soaps etc she's used is well rinsed off.

Then when you change infusion sets, use an Anti p ont the site (I would discuss with your team best one to use) then wipe with an antiseptic wipe ensure you allow to dry, then on with the cavilon spray or skin tac.. You could also try a Tegaderm film underneath if cavilon doesn't work well..

Other things you can do, is what is called a safety loop..

You make a loop with the tubing then tape one side of the loop to the skin then if the pump drops or the tubing gets snagged, the loop takes the force rather than the infusion set, another thing you add to this... Is taping the tubing down by the infusion connector, place the tape over the tubing and tape it next to the adhesive pad and not the pad it self, this help to omit any tube movement transferring onto the connector/cannula