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Inserting Infusion Sets

Considerations for Infusion Set Insertion

So you’ve got a cartridge filled with insulin and you’re ready to insert the infusion set (according to the instructions in the pump user manual)… but what else should you consider?

Tubing Angle:

Different insulin pump users have different preferences for the angle from the infusion set at which the tubing sits. We encourage you to experiment with different tubing placement angles to see which works best for your child, keeping the following considerations in mind:

For a site around the waistline (belly, bottom or thigh), if the infusion set is inserted with the tubing coming straight up or straight down, some insulin pump users find that the tubing is more likely to get snagged on a hand or pant material when pants are being pulled up or down. Further, if the tubing comes straight out to the left or right (horizontally), it tends to be a bit more difficult for the individual wearing the pump to access the connector on her own (to connect or disconnect the pump tubing).

For arm or thigh sites, running the tubing vertically along the arm or leg may work best.

Tips from the Trenches

We have found that, for infusion sites on buttock area, about 10 degrees up from the horizontal position works best for my teen son: at that angle, he’s able to easily access the connection clip to connect or disconnect the pump, and clothing is less likely to get in the way. ~Danielle

Some infusion set models (that is, Orbit infusion sets) rotate 360 degrees while they are connected. In this case, you don’t have to think twice about the tubing angle at insertion time – you can easily rotate the tubing to a convenient position after insertion… handy!

Timing Insertion of a New Infusion Set:

Many diabetes health care professionals recommend against changing an infusion set before bedtime. If the site does not absorb well, or the cannula gets kinked on insertion, there are many unmonitored hours overnight during which things can go from bad to worse. Ketones could develop and progress to dangerous levels during a typical night’s sleep.

Or the opposite effect may prove problematic overnight… Many insulin pump users report that their infusion sets work particularly effectively during the first several hours of a new site. This increases the risk of night-time lows, at a time when your child is unattended and unaware as he is sleeping.

For this reason, here are a few good rules of thumb:

  • change the set at least 4 hours before bedtime
  • check blood glucose 2 and 4 hours after a new set is inserted, to make sure everything is going as expected.

Tips from the Trenches

For better or for worse, we often change our son’s infusion set after he has gone to sleep, and sometimes as we are about to go to sleep ourselves. Even though our habit is directly opposite to the recommendations of many diabetes health care professionals, we started doing things this way because our son got very anxious about set changes. To avoid this upset, and because the end of the day is when things slow down enough to have time to do a set change, we typically change his sets in the late evening hours. When we have changed a set before we go to sleep, however, we always get up a few hours later to check his blood glucose and make sure the new set is functioning well. ~Michelle

Avoiding Accidental Removal:

After the infusion set has been inserted, it will be much less likely to be accidentally pulled out if you secure the tubing to the skin using a piece of medical tape. (We like paper first aid tape, as it’s softer – but there are many types out there to try.) Simply arrange the tubing in a “safety loop” and then tape the tubing down in that configuration. Then if the tubing gets snagged on clothing, a knob, or a finger, the tape will fight back, or the safety loop will come undone thereby absorbing the force and leaving the infusion set in place.

The above information was significantly modified, with permission, from The Alberta Children’s Hospital Diabetes Clinic information handouts.

The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic..

This material has been developed from sources that we believe are accurate, however, as the field of medicine (in particular as it applies to diabetes) is rapidly evolving, the information should not be relied upon, as it is designed for informational purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please consult your doctor or appropriate health care professional.

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