Priming the (Insulin) Pump (Part 8)

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Happy Thanksgiving! Eric’s holiday post finds him on Part 8 of his insulin pump series. He continues with the "Morning of the Site Change" thread this week. If you need to pick up where he left off in his ongoing serial about his site change, Eric suggests beginning by jumping in at Part 6 and Part 7. He’s promises that he’ll soon come up with some new titles!

Before I change my infusion site, let me first clarify what I mean when I use that term in these posts. I have a tendency to say “change my infusion site” or “do a site change,” when in fact I’m actually doing both a site change and a set change. Pretty much each time I take part in my every-three-days insulin pump ritual, both things happen. I say pretty much because while the insertion site that attaches to my abdomen is something I change every three days without fail, the infusion set—the surgical tubing and the reservoir/syringe that holds the insulin—will on occasion still have a healthy amount of insulin left, and, so, I end up cheating and leave it alone until the next time (but never any longer than that).

However, I’m proceeding as if this morning I’m changing all of it.

CDEs and big pharma suggest you wash your hands thoroughly before changing your site/set. It’s also suggested that you place all of your materials for your site/set change on a clean towel. (Which I do most of the time; please know that my failure to adhere to every safety precaution about pumping insulin is a future blog topic.)

With the insulin vial that I took out of the fridge before showering now at room temperature, I’m ready to go. In front of me is my insulin pump (disconnected from my body and still containing the old infusion set); a new infusion set that includes the needle safety system, the surgical tubing, and a site attachment; and an insulin reservoir/syringe with needle (needle gets removed and the reservoir ends up chambered in the insulin pump). I also have an alcohol swab in its single-serving package, its cousin the antiseptic wipe (with a tacky adhesive built in to help the infusion set adhere), and an AAA battery, because I want to replace that, too (I find the batteries usually last about two or three weeks, but closer to three than two!).

I change the battery first, using a penny to unscrew the watertight cap. When the pump plays its jaunty I’m-turned-on melody, I then unscrew the pump’s black cap that holds the insulin reservoir, untwist the Luer connection that attaches the surgical tubing to the reservoir and that has been threaded through the cap, separate these two, then dispose of the tubing and reservoir.

Next, I unwrap the reservoir/syringe (see some photos here), attach the needle, wipe the top of the insulin vial with the alcohol swab, and draw up about 200 units of insulin from the vial (tapping out any bubbles that form). Then I remove the needle, thread the black cap (blue in the photo) from my pump back through a new set of tubing, twist the Luer connection down tight, and begin the Pump Load Process from a menu on my pump. The pump’s screen asks me to “Load” the pump. I check that box and hit “Select,” and the spindle on which the reservoir rests will draw the reservoir down into the pump. Once that’s finished (it’s a slow mechanical process), I then need to tighten the black cap.

While the pump is tediously drawing the spindle and reservoir down into itself, I open up the antiseptic wipe and choose my next site. It’s very exciting, often a 3- or 4-inch journey from the previous site. Wiping the solution on my stomach or in that vicinity in a small circular motion, I ensure that the area I’ll be attaching the adhesive to is clean. I wait for the antiseptic to dry (don’t blow on it!).

Once dry, the adhesive area will be somewhat tacky, which means I can insert the needle/cannula. I unscrew its safety cap, put the purple, self-contained Cleo system on my skin, then push it down against the side of my stomach. There’s a quick stick from the needle, which darts into my skin then retracts back (spring-loaded), leaving behind the cannula that will sit just beneath the surface of my skin to distribute the insulin. I hold the entire Safe-Sert needle system against my stomach for about 10 seconds to ensure good adhesion, then tip it off slowly to make sure the adhesive has a good stick.

It’s time to fill the surgical tubing with insulin, so I begin the “Fill Tubing” process and watch the end of the tubing for a few drops of insulin to squirt out. This is where the needle will attach to the infusion site on my body, and I want to ensure there are no air bubbles in the tubing. When I’m satisfied all has gone well, I click the Cleo Flex-Attach to the adhesive dressing and site “nub” (for lack of a better term), turn back to the pump, and check the “Fill Cannula” box.

I’m now ready to set my site change reminder for another 72 hours of pumping bliss and return happily to pumping insulin—which means, for me, about 10 blood glucose checks each day, as well as boluses for every meal or snack.

Overwhelming? Nah. If you find yourself saying, “I’ll stick with injections,” let me tell you this: Don’t base your decision on whether or not to switch by what seems to be a complicated, drawn-out procedure with an insulin pump every three days. It isn’t. In fact, far from it. It’s so familiar to me now after just a few months I can do the whole site/set change in less than five minutes. In fact, I’m thinking maybe there should be an Insulin Olympics. People can enter the Site Change Decathlon—draw insulin from a vial, bubble-free; remove and clean the old infusion site; prepare a new infusion site; insert the needle into new infusion site; remove surgical tubing from its package; attach tubing to reservoir; load reservoir into pump; fill surgical tubing; attach set to site; and, finally, dispose of site-change trash.

It’d have to be regulated. There’d be categories for different pumps, of course. Each performance would be timed. Aesthetics would be critical. Presentation is everything. Begin training and planning your routines now. Mine will be timed to music, I’ll have someone sew a costume, and heck, maybe I’ll enlist my wife and we can perform in the Couples Site Changing part of the event.

Figure skating or insulin pump site changing? I know which one I’d watch.

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