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[IPp] site changes Re: pop-digest V1 #846



In a message dated 1/18/2005 10:53:29 AM Eastern Standard Time,  
email @ redacted writes:


We  have a prescription for EMLA cream, but he does not want to use the  
cream.
I am certain that we are not dealing with a pain issue, it is purely  a
psychological issue that does not seem to have an easy answer.  I  thought 
site
changes were supposed to become easier and not progressively  more difficult.

Any suggestions from the  pros?



I don't know that we are pros yet, my son has been pumping for almost one  
and a half years with his Deltec and silhouette  infusion sets.  We do  not 
 remove the old site until the new one is in. Then he takes the old one off at
his leisure.  The long needle was scary at first, but I  would put it in the 
 silserter when he wasn't looking and it seems less menacing once it is in there
(to him, anyway).  At the beginning I would do  everything ahead of time that 
I could and then called him in to load the  cartridge and insert the new site. 
We used Uni-solve to help remove the old  site, so it didn't pull at his 
 skin. We never used any numbing cream, our CDE had advised against it. These
days, he does about 90% himself, he  still has me push the button on the 
 sil-serter, but he is capable of doing it himself if he has to (he accomplished
 that goal at summer camp last year). He no longer bothers with the Uni-solve.
He is  11,  when on MDI had a fear of injecting himself ( not worried about 
pain,  just had a phobia about seeing the needle go in).  He got over that by  
using an injecting device, which hid the needle from his view.  Now our  site 
changes last no more than 5 minutes.  
 
Hope this helps.  All of this is so hard for them, we are constantly  humbled 
by how hard our son works to conquer his fears with this disease and all  
that he has to do for himself.  
 
By the way, we did try several different infusion sets at the beginning,  
because the one they started him out on, the quickset (goes straight in) was  
 very painful for him. The silhouette has worked very well as far as comfort and
reliability.  However, I would encourage you to try some others  and be 
 prepared to do some extra blood sugars and corrections as you test them out. If
another one is more comfortable for him and you are concerned  about security 
of the site itself, After applying your prep to his skin, put a  layer of 
 IV-3000 tape (with a tiny hole cut out for the needle to go through) on top of
the
skin and skin prep before inserting the infusion set. The  tape on the set 
will stick to the IV-3000 tape and it will not move!!  When  removing the old 
site the IV-3000 peels off very easily taking everything else  with it.  We do 
this for sports and swimming as an extra security  measure.  We also use the 
43" tubing so that if the pump gets caught and  falls, it won't yank on the 
 site. We had this happen a few times at the beginning, requiring site changes.
No problems ever since.
 
Each child has different skin, so you may have to try several   different 
 thing. We tried Tegaderm as the extra layer and it didn't work for us at all,
but others can't use the IV-3000.  The trial and error is  worth the effort.  
We asked for samples from our endos and had been given a  few samples from 
 others in our neighborhood who had reached out to us to give support when our
son
was diagnosed.  I was also able to get two tender  mini's through an ad in 
the Diabetes Forecast directly from the  manufacturer.  I haven't tried them 
 yet, but they are the same as the silhouettes with a shorter canula. I have not
inspected closely enough to  see if the needle is shorter too.  We are having 
some serious puberty  and growth issues right now and are having problems 
 with insulin resistance, so I am not willing to experiment with the mini until
we get him  stabilized again.
 
Good luck!
 
Alida
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