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Site and cartridge change.

lely

lely

Well-Known Member
Messages
208
Sorry for the endless questions.
Just over 24hrs on pump and inset site is feeling a little irritated. In hindsight I positioned it right on the waistband on my jeans which could be the issue. So I'm gonna change it tomorrow morning, bit judging by the amount of insulin in the cartridge that will need changing on Thursday.
Can I change inset and use line already on cartridge till Thurs or do I have to change line too at same time. And do I just use the fill cannula setting. It sounds obvious now I'm saying it but want to be sure.
 
I was told to change the cannula every 3 days max and to change the tubing every 6 days so when I change the cannula I will just have to fill that, but not sure about the pump you are on
 
Thanks Gaz-M. It's probably standard for all insets and tubing. I don't remember being told about changing the inset or tubing except for not doing in before bed incase there is issues and your asleep and miss them.
This is a minefield, I knew it was gonna be challenging but I'm boggled and full of questions.
My hubby says, "I remember when you just did suduko, no need for them with this lifelong puzzle". Funny.
 
@lely yeah I fully know what you mean, my bloods have been really low since yesterday afternoon but after a 0.10 change on a few time blocks tonight I have been alot better, no bloods over 7 and none under 5 but think a couple more need changing but DSN wants to do that as they do not want me getting ahead of myself. I forgot about the change at bedtime so good call on you for reminding me :) and hope its going good apart from the inset problem
 
@lely, I use insets and get through a 300u cartridge in about six days. I change the tube when I change the cartridge and just put a new set on the existing tube.
 
lely said:
Can I change inset and use line already on cartridge till Thurs or do I have to change line too at same time. And do I just use the fill cannula setting.
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How to put this ...

I am always gobsmacked when people mull over things like this as though a really smart and very insightful person at "the company" handed out these suggestions with the implicit threat that unless every jot & tittle is in its proper place then horrors will ensue. Trust me when I say, no, not really so much.

Yes, you should try to follow the guidelines. But remember that the guidelines are essentially just guesses at what might be a good routine to follow. Granted they are educated guesses, but then so are the "use by" dates on a milk carton ... or on insulin or infusion sets or ... well you get my point, no? ;)

I believe it is important to consider your specific context and personal experience in addition to the guidelines. I tend to think about changing my set in terms of how vulnerable each part happens to be.

  1. The base/cannula which is inserted under you skin
    This is the most vulnerable part in my opinion because it is well known that over time your body will attempt to "heal over" the cannula and insulin absorption will suffer. Actually the advice to change this every three days is based on how long it takes for a fictional average person to start experiencing absorption problems.

    The actual period of time measured in clinical studies differed from one individual to another. Some people can go longer than 3 days without having problems with their site. Others need to change at two days or even less. I don't really know, of course, but my gut feeling is that I tend to start having problems somewhere around 2 1/2 days after an otherwise successful infusion set insertion.

    What I suggest is that you do what works best for you. In particular, if you feel you need to change a site earlier than 3 days then definitely do so. Your infusion site must be working correctly or everything else about the pump is pointless. So don't try to drag out using a site if you have reason to believe it is misbehaving or if it is irritating you or causing pain. If the site was mistakenly inserted in a spot where clothing rubs against it, that may cause it to give you problems when you are not in a good position to deal with them. Preventive maintenance is a good thing.

  2. The tubing from the pump reservoir to the site base
    At this point I feel the "right thing to do" starts becoming less clear. Of course, if you are a DSN or an endo or a pump company, you know exactly what to advise. Change that tubing at the same time you change the infusion set. Or to put it another way, no one was ever reprimanded (or worse) because they told someone to be extra cautious.

    Do you really need to change it though? Beats the heck out of me. I definitely change to the new tubing if my site change lines up with a pump reservoir (cartridge?) change. But I also tend to change the tubing when I am only changing my site. Mostly I do this because I know I can be hard on my tubing. But the main reason I do it is because it makes me happier, not because I am convinced that not doing so is going to lead to problems.

    When I do switch to new tubing while continuing to use an existing reservoir, I use fill cannula to fill the tubing because I am guessing that is easier on the pump battery. But rewinding and repriming would also get the job done if that is what floats your boat.

    And if the site was only a day old then I might also just insert and then reconnect the existing tubing rather than fill the new. After all, how much stress could have been placed on the tubing in a day? Just be sure that you prime out any air gaps in the tubing before reconnecting it to the new site.

  3. The pump reservoir or cartridge
    I use a Medtronic pump which uses a reservoir so I may not be understanding how the cartridges work. But if I still enough insulin remaining for a day or longer, then I always attempt to continue using that reservoir. Again, I do this because it makes me happy and I've never had problems with doing it. I suppose there are some rare cases where the insulin could have been exposed to extreme heat and lost its efficacy, but these are, well, rare.
The above is my three cents about it for whatever it's worth. The truth is that there is a bit of fact but also of possibly a credulous excess of caution in the standard guidelines. I think the best practice is to follow the spirit of the guidelines and do what is best to keep your site working properly. But that is not necessarily the same thing for everyone, even though guidelines may be. :eek: :rolleyes:

Finally, I am sorry that this turned out to be more blathering than I originally intended it to be. Ooops. :wideyed: :oops:
 
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When people first start with a pump, everyone is nervous over filling the cartridges ok and inserting the sets so that's why most fill the cartridges with 3 days worth of insulin and then change set and cartridge so that they get used to inserting sets and filling cartridges. You don't however, need to change tubes every time a new set is put in and you don't need to prime the set before its inserted. The set can be inserted first and then just activate the fill cannula option on the pump. I fill my cartridges with enough insulin to last 6 days plus a bit more to prime the tube and fill the cannulas and change the set every 3 days.
 
iHs said:
When people first start with a pump, everyone is nervous over filling the cartridges ok and inserting the sets so that's why most fill the cartridges with 3 days worth of insulin and then change set and cartridge so that they get used to inserting sets and filling cartridges. You don't however, need to change tubes every time a new set is put in and you don't need to prime the set before its inserted. The set can be inserted first and then just activate the fill cannula option on the pump. I fill my cartridges with enough insulin to last 6 days plus a bit more to prime the tube and fill the cannulas and change the set every 3 days.
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I'm lazy and want to change as few things as possible as little as possible. So I take this approach. :)
 
I change the cannula every 3 days and the cartridge when it's empty. Waste not want not is my motto :)
 
CarbsRok said:
I change the cannula every 3 days and the cartridge when it's empty. Waste not want not is my motto :)
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Aside from knowing if you had prime or just fill cannula, the fact that I would have a used tube was bothering me. I don't like waste either.
 
Woke on a bg of 8 this morning 7am, had breakfast and changed inset, was 10 two hrs after breakfast by 11am it was 14 and an hour after 15.3 hard to know if it's the Basal rate or the inset has been done wrong done a correction and by 13.15pm it was 15.2 so I'm guessing it's probably the Basal as it didn't budge after the correction dose. well it's only day three, in the words of the old British rail ad. 'We're getting there'
 
lely said:
Aside from knowing if you had prime or just fill cannula, the fact that I would have a used tube was bothering me. I don't like waste either.
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When you replace the cannula you fill the cannula. As you haven't changed the cartridge then the tubing is already full so no need to prime the tubing. :)
 
lely said:
Woke on a bg of 8 this morning 7am, had breakfast and changed inset, was 10 two hrs after breakfast by 11am it was 14 and an hour after 15.3 hard to know if it's the Basal rate or the inset has been done wrong done a correction and by 13.15pm it was 15.2 so I'm guessing it's probably the Basal as it didn't budge after the correction dose. well it's only day three, in the words of the old British rail ad. 'We're getting there'
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It's always best to change your set before a meal or snack as this enables a bolus to be pushed through the cannula you will also see that all is working well a lot quicker this way. Always check your blood sugar within 2 hours to make sure all is well.
 
Just went to redo cannula, as bg had not been coming down. The cannula wasn't even in it was bent under the adhesive. Lesson learnt.
 
lely said:
Just went to redo cannula, as bg had not been coming down. The cannula wasn't even in it was bent under the adhesive. Lesson learnt.
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Just checking, but did you remember to take the needle guard off before you tried to insert the cannula?
 
Top marks for you. I didn't do it but realised about 4.15 so changed the inset again, 3 times in 1 day, filled cannula etc. And my bg was 12.3 about 30 mins. It had gone up to over 17. so I bolused again as I figured the machine thinks I already have IOB, which I don't coz it never made it. I won't make that mistake again. Newbie mistake. In the words of Homer Simpson ' Doh'
 
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