Infusion Site Management Guide
Introduction
"A lot of people starting out on the pump don't realize that problems with
infusion catheters are the number one cause of unexplained high blood glucose.
Using the right type of catheter and skin tape can greatly reduce this risk,"
from,
Smart Pumping, edited by Dr. Howard Wolpert, American Diabetes
Association, 2003.
"Successful pumping is dependent upon successful infusion sets. Set change frequency of every 48 hours reduces the risk of needle/cannula micro-occlusions that result in decreased insulin delivery to the patient, but do not create sufficient back-pressure to trigger occlusion alarms. Similarly, when blood glucose levels reach 300 mg/dl without explanation, one must assume that there is a needle/cannula micro-occlusion and change the set immediately. Insertion technique is critical: (1) select a sufficiently long needle/cannula, (2) pull skin taut to provide resistance, and (3) insert set manually. Automatic insertion aides can, in some patients, create an 'apple core effect,' resulting in a tissue plug at the distal needle/cannula and early onset occlusion." Margaret M. Ulchaker, MSN, RN, CDE, CNP, NP-C, BC-ADM
"Trouble-shooting labile/elevated blood glucose levels in the pump patient should always invoke consideration of inconsistent insulin delivery due to infusion site problems. After optimizing dietary factors, appropriate compensation for variable exercise, in addition to tweaking the multiple basal rates and meal/snack boluses, the insulin pump health care team may be at a loss to explain persistent glucose lability. While a pump mechanical problem is possible to explain inconsistent insulin delivery, the majority of the problems are related to infusion site issues. Careful attention to all the elements outlined in the monograph will be of major assistance to the insulin pump health care team in tracing the source of infusion site related glucose lability." John P. Sheehan, MD, FACE, FACN
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Infusion Site Management Guide (Acrobat Reader Required)
