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Needle port problems

kitedoc

Well-Known Member
Messages
4,784
Location
Adelaide, South Australia
Type of diabetes
Type 1
Treatment type
Pump
Dislikes
black jelly beans
Hi all pumpers! Having had 3 needle port problems in the past 10 days or so with occurrence of a suspicious high BSL which fails to respond to normal, then hefty correction doses and on one occasion I noted staining of the adhesive of the needle port and slight dampness as a bolus dose was going in, on the other two occasions it was only on removal and replacement of the needle port that the bent cannula was seen.
A) how are others are doing with numbers and frequency of these events ?
B) what you find are causes of problems e.g. bent cannulas and reasons for this, insulin leaking beneath the adhesive, etc? and
C) what works best to reduce the 'failure rate' e.g ? better insertion technique, better protection and maintenance of the site, one brand vs another etc ?
D) any other comments, future thoughts on improvement and earlier detection and any useful feedback from pump companies? etc

Some info about me: On insulin pumps for > 7 years and on insulin 52 years.
Current needle port used are the Inset II Unomedical which I used with my Animas Vibe and I continued on with when switched to the Tandem-Slim II pump, as both pumps use a luer-lock fitting at the pump-tubing connection.
My only site area is the abdomen with regular rotation of site placement and (usually) 3 days duration per site.
I wear the pump mainly on my belt but suspend it in a wallet pouch slung across neck and under opposite shoulder when shopping, wearing a rucksack with hip and belt system or when kite flying. At night the pump fits into my PJ pocket where the PJs shirt is turned inside out so that the pocket is inside.
I can only use 6 mm vertical needle ports as even the shortest angle-introduced ports cause the cannula tip to bend.
In hot sweaty conditions ( like this summer coming to Adelaide where will have maximum temps > 40 degrees C) I have to tape over the needle port site to prevent detachment, and sometimes even that fails.
I do tape a loop of tubing to the skin near the needle port in an attempt to prevent any accidental tugging from the tubing on the needle port. All your comments, ideas, criticisms etc all welcome.
 
I've had 3 bent cannulas and telephoned Medtronic. I was told it might be the skin was tough from lipoatrophy, or it could have been my technique. Medtronic were sending me a new inserter device but it never arrived. I had noticed the bent cannulas happened mainly in areas above my navel and after a shower/bath so have avoided these areas.
 
Thank you @Sweetheart66, That is most helpful. I am also looking a steel cannulas as an alternative to the plastic ones !!
 
I have noticed blood has stained the adhesive holding the cannula in on a couple of occasions and it had been a fight to keep my BGL down. The only other issue was my fault in my haste one morning I forgot to remove the plastic protector covering the needle. Is there any scar tissue from your days on MDI? Maybe see your pump nurse.
 
Thank you @Chowie, Good thoughts. I am actually considering the steel cannulas as an alternative. I, too have managed to try pushing the protector and needle/cannula through the skin !! Also I am taking on board what you and @Sweeheart66 say about scar tissue.
 
I find infusion sets to be one of my weakest links for successful pumping. Those things fail the most often for me. So I have a prescription to change my cannula daily. Sometimes I can get a cannula to last a good, long time so I leave it in. And on days like today I went through 3 of them.

I can kink a cannula. It means they are bottoming out and bending between the muscle and skin layer. A metal cannula can’t bend, but if you’re thin skinned you will feel it in the muscle layer. I’m thin skinned. I pray for the day when I can get a shorter infusion set. I’d tried to shorten them myself with an exacto knife, but they do not insert well after being cut.

Bleeders are another problem for me. After inserting an infusion set and pulling out the inserter needle, if it fills with blood I know I’m skrewed for that site. Sometimes it’s not so obvious like that and my bs goes high. When in doubt change it out. In pulling the cannula off it can give me a fountain of blood. I like to be prepared with a paper towel or a Kleenex tissue, because those things are messy.

Just plain Jane occlusions are a mystery to me. Again, I think a shorter cannula could help prevent them, especially when I skinny down during the riding season. It takes about 7 units of insulin in the tubing backup to get the pump to give an alarm. But for someone insulin sensitive like like me, it would take 14 hours with a .5 unit per hour drip rate. I’d catch in just a higher blood sugar reading before I’d ever get a pump alarm. When in doubt, change it out-I don’t wait for the alarm from the pump.
 
Here’s another soft cannula issue for long infusion sets for me. I’m finding that sometimes instead of kinking the cannula, the bent end sometimes breaks off inside me. That little piece does eventually come out, but it’s just wierd. It goes into me as a clean thing, so it comes out fine- but it happens.
 
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I’m on Omnipod, so haven’t had this issue, but I’m intrigued. Do you have to manually insert your cannula? Mine gets popped in automatically by the new pod when I activate it. I can check it’s in by looking through a little window in the end.
 
Thank you for both replies @Jollymon.
Thank you @Jollymon, I have not had any cannulae break. I could see it happening if when pulling the paper off the adhesive patch the whole needle port up some mms and the the plastic cannula needed to be threaded back on the needle.
In orde to shorten the depth of cannula under skin what if there were several layers of adhesive tape stuck on top of each other so that when the needle port was fired carefully into the hole in the centre of the layers (? circular target with hole in middle for the cannula) so that the cannula would be say 4.5 or 5 mm in rather than 6?? And with this scheme would metal cannula work better being more robust?
 
Hi @Mel dCP, I really, really would like to answer your question now but I need to set up the camera for close up shots, the mobile's camera is not good enough and being well past my bedtime and needing every second of beauty sleep I can muster, beg, steal, borrow and buy, I shall reply in the morrow.
But this is what they feel like::

 
Ouch! Sleep well x
 
As @kitedoc is catchup on his beauty sleep, I will share my cannula insertion experience.
The Animas (and from the youtube videos I have watched for Medtronic) have an insertion mechanism similar to the Libre. It is mechanical but relatively straightforward. You can get caught out if you don't have the insertion device placed flat on your tummy (or wherever you are putting the cannula) or if you are trying to insert it too close to a bone (yes, stupidly, I tried to insert mine into my hip bone once ... but only once). And I guess there is a chance for the inserter to misbehave because you are wearing the wrong socks.
The standard Animas cannula has no window but my 30 degree ones (they don't go direct into me but go in at an angle of ... 30 degrees) have a nice window so I can check the insertion worked ok.
In my early pumping days, I could always feel my cannula which is why I changed to the inset 30s.
I always feel a prick when it goes in and sometimes I think I must hit a nerve/pressure point as I feel the prick in a different place.

The only time I have experienced problems, the cannula had not gone in properly. There was no bent cannula just a shallow cannula which needed to be replaced.
However, I try to check and correct my BG pre-pump change and avoid any food for the next couple of hours after which I check my BG again and can sort out my cannula if there is a problem.
 
Thank you @helensaramay, for your wisdom. I recall using the 30 degree ones and still managing to have the last mm or so bent. I get a fairly distinct type of pain, a deep ache, if I hit muscle, rather like being punched in a muscle. That is why I went for the 90 degree ones and yes the placement on the skin of the device is crucial as is also making sure the device is cocked on both sides and thus fires off evenly rather than crookedly (photos coming up soon)!!
 

To shorten then cannula, I use an angled set and push it in at a shallower angle. I need millimeters shorter, not microns- tape isn’t thick enough.

Metal cannulas are really long for me. Being sharp, they know how to poke the muscle layer. But they don’t bend. They can’t break off. And if the site goes bad, you can peel up the sticker tape and reinsert them somewhere else.

If you want to try a different set type, calling Medtronic will get you samples.
 
I use angled Inset 30 . These are soft teflon type on an animas pump. Occasionally when I remove near the end is linked. But it has worked ok. This happens for me when I have held the inserter at incorrect angle. If I lay it down more it's ok. Suppose this in effect shortens it.
Like the tape (washer) idea.
 
With trepidation I am going to post some photos and drawings made with the needle ports. These are not for education or instruction purposes, just illustration.
There are parts named and I have coloured the cannulae blue. At present they are only the Animas 30 degree and 90 degree ports are shown below
First row L to R: 30 degree port; 90 degree port: looking at the skin side of the loaded spring device for the 90 degree port; device resting on tummy but slanted so is wrong - will not go in straight; incorrectly loaded device , note slant, correctly loaded device.


Other photos to follow !!
 
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Two more photos first showing what happens if your have thin tissue layers and the next how it might just be possible to do something about this , in theory anyway:
View attachment 29810
 

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Have you ever slept on a cannula all night and seen the consequences from it in a morning blood sugar number? It’s not good.
 
Jollymon said:
Have you ever slept on a cannula all night and seen the consequences from it in a morning blood sugar number? It’s not good.
Click to expand...
Yes, @Jollymon, I know what you mean, it is almost as though one needs a spring under the port device to take up the pressure and stop the cannula being pushed further in or bending!!! Or does one place a circular cushion around the site to save any pressure affecting the site?? Just a thought???
 
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