How to change an infusion site...in case you were ever wondering

Steve and I are skipping town for an undisclosed amount of time and my mom graciously accepted (ok...we didn't give her a choice) the call to watch our four children, one of these children being a raging diabetic.  Per request (she threatened not to take my kids if I didn't do it) here is a pictorial tutorial on how to change an infusion site for a One Touch Ping insulin pump.

Sounds riveting doesn't it.

Enjoy!

 First things first, take the pump off the cute diabetic.

The pump (with image of home screen)

The cute diabetic

Actually...the cute diabetic can remove the pump himself.  Just ask him to do it.  Bribing him with a diet Ginger-ale might help too.

 Next, ready your equipment.

from left to right:

insulin cartridge (in handy dandy sterile packaging)

novalog vial 

alcohol swab

uni-solve swab

I.V. prep

infusion set and tubing insert (in manly blue color)

Open insulin cartridge and assemble for filling with insulin.

 Blue handle clips onto bottom of cartridge to create plunger and needle screws into top.

When assembled, pump plunger up and down a few times to loosen...but do not twist.  (Not sure why, I've just always been told to do that and I'm a rule following kind of girl!)

 Clean top of novalog vial with alcohol wipe, insert uncapped needle into novalog vial, invert entire vial/syringe combo and draw up approx. 70-80 units of insulin.  Make sure vial is free of air bubbles.(getting air instead of insulin is not a great idea)  Carefully recap needle and then unscrew needle/cap combo from cartridge.  Remove blue handle too.  You may place protective cap over cartridge until you are ready to attach it to infusion set tubing. 

But guess what mom!

 I'm going to do this last step for you and have 4-5 vials ready to go before I leave.  That way you can skip this last step...and thank goodness, I wasn't sure how I was going to draw up insulin and take pictures at the same time- it's a two hand kind of deal!

 Next you need to remove old cartridge from insulin pump.  

Unscrew black cartridge cap from pump and gently pull out old cartridge.  You will need to unscrew old tubing from cartridge and remove black cartridge cap.

You may throw away old cartridge and tubing...but DO NOT throw away cap.  You are going to need it!

 You now need to rewind the pump.  

Go into Main Menu, scroll down and highlight Prime/Rewind and push OK.

 Highlight Rewind and push OK.

 The Go Rewind line will be highlighted...it will remind you to make sure the infusion set is removed from diabetics body.  BIG trouble if you do this without disconnecting first...but you followed my steps with exactness so this won't be a problem!  Push OK button.  (Oh, almost forgot.  The OK button is the very bottom button on the right hand side of the pump.  The OK has been worn off from use.  The only thing left is a remnant of the O)

 This is the screen you will get when pump is rewinding.  It makes a funny whirring sound while this is happening.

 When pump is rewound and cartridge is full on insulin you are ready to move onto the next step of attaching cartridge to tubing and infusion set, and loading cartridge.

 Remove all outside wrappers and lid from blue infusion set/tubing combo.

What you see here is the end of the tubing that attaches to cartridge, spiral wrapping that covers the sticky part of the infusion set and blue needle cover.  (look close...it's there.)

 Carefully and very gently unwind tubing (don't pull too hard or infusion set will be removed and you will have to do this step over with new set)

Slip black pump cap over tubing with screw threads facing the cap end of the tubing.   Screw tubing cap onto filled cartridge after removing protective cap from cartridge.  (There are a lot of caps to keep straight, I know)

 Place cartridge into rewound pump cap side up and screw black pump cap tightly onto pump.

The pump actually puts you on this next screen automatically.   Push OK button when Continue is highlighted and pump will load cartridge. 

However, if too much time passes between rewinding and loading cartridge, the pump window will return to Main Menu.  No worries!  You just need to scroll down to Prime/Rewind under Main Menu and push OK.  Then, scroll down and highlight Load Cart. and carry on.

 This window will appear and lovely whirring sound will commence.

 When loading is complete, the Prime window will pop up.

You will need to hold pump, tubing and attached infusion set above sink and push OK button when Continue button is highlighted.

The Prime step is how we fill the tubing with insulin.

 You will next press and hold the OK button down and keep it down until priming is done.  It takes a few second to fill the tubing with insulin, but you can let go of the OK button when 3-4 drops of insulin come out of the blue needle cover on the infusion set.

 Next you will need to 1. gently pull off the blue needle cover and 2. carefully unwind protective covering off infusion set.  Don't touch the site under the protective covering...it's extremely sticky and you could pull out the site on accident and have to start all over.  (been there...done that)

 Next pull back the white back end of the infusion site to arm the set. 

 Open Uni-Solve package only on one side and carefully squeeze out liquid onto old infusion site.

This will disolve sticky stuff and allow diabetic to remove site in a few minutes.  Don't pull of old site until it is loose and ready to come off.  If you do, it will pull off skin and leave nasty sores.

Place old site in trash once removed.

 Open IV prep, remove pad and carefully clean skin where new site is going to be placed.

Allow skin to dry completely.

 Now the really exciting part!!!!

Place armed set directly on cleaned skin with tubing hanging out facing towards diabetics upper body.  (this makes it easier for diabetic to grab and remove set in future.)   Place thumb and forefinger on indentation on either side of blue set.  

Get ready...

Get set...

Fire!

Squeeze simultaneously both indentations on blue set.  This will fire mechanism and place infusion site. Yes, this causes a needle to go into diabetics skin and places a small plastic tube called a cannula.   He may or may not holler in protest.  It really depends on the day.

 While placing finger on tubing, very carefully pull fired infusion set STRAIGHT UP!

(I couldn't do this while taking a picture, so all you got was the finger still in place after the set was pulled up.)

The cute little blue and white set will be left stuck on skin and the nasty needle (it might be bent if you didn't pull straight up) will be removed still attached to the fired infusion set.

If...for some crazy reason the blue and white site is not attached securely to diabetics skin after set is pulled straight up, you will need to start over.  (Depressing, I know)  You can reuse newly filled insulin cartridge, but will need to get a new infusion/tubing set.

Unclip pump. (make sure it is completely removed from diabetic's body)

Remove filled cartridge and go back to rewind step of the whole process and do it all over again. (If I only had a hundred dollar bill for every time this has happened to me!)

 That little plastic tube called a cannula now needs to be filled.

Go back into Prime/Rewind function under Main Menu and highlight Fill Cannula and push OK.

 You will need to dial in .3 units of insulin. 

Now, highlight the Go button and push OK.

You are FINISHED changing an infusion site!

You are amazing!

These sites need to be changed every three days, when insulin gets down to less than 10 units (can tell how much is left by looking at home screen), or when blood sugar is too high and you can't figure out why.  Most likely, the site has failed and he needs a new one.   

Mom, I know you can do this.  I think you are fantastic and I truly appreciate you taking care of my sweet (sometimes saucy) children. 

I'll bring you something nice back from my vacation!

Love you!