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Re: [IP] How to insert infusion set (Silhouette....long)

Hi Kelly,

This is how we do an insertion on Erica.  She is 11 yrs old, thin,  and
has been using a Silhouette for 6 months now.  Geez, I hope I remember
everything...it has sort of become automatic now so I might omit
something.  Feel free to email me if it doesn't make any sense :)  I am
hoping fellow IPers will pick up on anything I might have missed.

-  we prepare the site by using a numbing agent called EMLA (avail in
Canada without a prescription although a prescription for it might allow
your insurer to cover it).  Some people use a few ice cubes in a baggie
for a few minutes, some use ELA Max, and we have on occasion done an
insertion without any type of numbing.  We put a pea sized drop of EMLA
on her skin, and cover it with  a piece of Tegaderm, smoothing it down
all around the EMLA.  Tegaderm is sort of like sticky thin saran wrap.
This keeps the EMLA intact in a compact area, & it spreads out to about
the size of a nickel.  Tegaderm is available at your pharmacy, but if
you buy it in BIG boxes of 100, it is less than half the cost of buying
the small packages.  At our pharmacy, they bring it in in large boxes as
a favour to us.

-  while we wait for the numbing to take affect (in Erica's case 45mins)
I prepare for the site change.  I load a syringe with insulin and have
it at the ready for popping into the pump.  I put clean tissues, and
alcohol wipes on a paper towel for cleaning the site.  I drink a whole
pint of rum to give me the guts to do the insertion....KIDDING!  It does
look SO long, and intimidating, but with practise it gets much much
easier.  Honestly it does :)  We do not change the tubing/syringe with
every site change.  Erica goes 6 days on 150 units of insulin so every
second change (3 days) is the infusion set only, and we just hook up the
existing tubing/syringe to the new Silhouette.  There is no need to fill
the cannula with this site change as it already has insulin in it.

-  45 mins later, I remove the Tegaderm, wipe off the EMLA with a clean
damp tissue, give a wipe with alcohol or wash with betadine (everyone
has their own way of preparing the site, you do want it clean) and there
is a nice round spot showing where the EMLA was. Prior to doing this I
wash my hands THOROUGHLY and try to avoid touching ucky things,
especially with my right hand, which is the one I use for insertion.

-  Grasping the back end of the infusion set with my second
finger(middle) and thumb, I remove the backing from the  tape which is
directly over the introducer needle  and carefully hold it back with the
tip of my index finger (it will stick to you).  I try to hold the tape
at the very edge, as otherwise, you might ruin the sterility of the
tape, especially near the insertion spot.  I then remove the plastic
cover which is over the introducer needle.

-  I usually pinch up a good sized bunch of skin, giving me about an
inch of raised skin to work with.  In the middle of this, is the nice
white circle which remains after the removal of the EMLA.  That is our
target area :)    With the skin pinched, and inserting almost at the
middle of the numbed area, I firmly and steadily push the introducer
needle into skin.  We use a shallow angle, approximately 20 degrees.  It
almost feels like you are going parallel to the top layer of skin, but I
find it finds its way down quite nicely.  Maybe we are lucky.  When most
of the introducer needle is under the skin (it sort of stops on its
own), I let go of the tape which I was holding back with my index finger
and drop it down on her skin, smoothing it into place.  Holding this
tape in place on her skin with a finger from my other hand, I then pinch
the sides of the infusion set (which you are holding with your thumb and
middle finger), and pull out the introducer needle.  After doing that, I
gently take hold of the little tab which removes the backing from the
tape on the back part of the Silhouette (without bending it up too much)
and pull it off.  That done, I smooth that into place too.  Introducer
needle goes into a BIG sharps container.

-  After the pump is primed, first manually to get the insulin to the
end of the tubing, and then by bolusing or priming (depending on what
type of pump you have) to engage the driver arms and push the insulin
till it comes out the end of the tubing/connector, we hook her up.  We
have found, in our experience, that a bolus of 0.8 fills the cannula
which is left under the skin.  Other people may use more or less.  That
is what works for us and gives us good readings.  We bolus/prime  the
0.8, to fill the cannula, then feed her and bolus her for the meal.
This helps to flush away any tissue which may collect at end of the

-  We always check 2-3 hours after a site change to see that things are
working okay.

Somewhere it says to always insert the infusion set towards the middle
of the body.  We insert towards the middle and the sides and see
absolutely no change in absorption. We use the back, belly, and high
butt area, and they all work well although they don't all have the same
absorption so we have to adjust basal rates.  We stay a few inches away
from the waistline, the spine, and the bellybutton.

My husband and I practised on a firm sponge or something similar, to get
accustomed to the rhythm.  It helped.  What really helped, was that I
inserted a Sil in him, and he put one in me (he did the better job).  We
both wore one for a few days to see what our daughter was going to be
dealing with.  Basically, we couldn't feel it.

I hope this helps you out.  This has worked very well for us, but you
may find someone else's way of doing it easier.

Good luck!
Barb....Erica's mom

-  45 minutes later, we get ready for the site change.

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