Infusion Sets 2013
| Consumer Guide Charts Infusion Sets 101 |
Here’s the thing no one tells you about infusion sets: Sometimes the
adhesive fails to, well, adhere. Or it sticks but slides. Or it comes
off before you’re due to change your set. It can happen to CGM sensors,
too. “During one of my half marathons, [my continuous glucose monitor]
fell off,” says Greg Florian, 33, a runner with type 1 diabetes. “I felt
it, but when I looked at my site, it was being held on by just the
[sensor]. It’s not an ideal time to lose your CGM.”
The good news
is that as annoying as poor adhesion can be, it’s fairly easy to fix.
Of course, what makes someone else’s infusion set stay in place might
not work for you. But even athletes doing the most demanding
workouts—including water sports—have discovered tools that ensure safe
insulin delivery.
Prep the Skin
Dirt, oil, and moisture can
reduce adhesion, so step No. 1 is to clean the skin with an alcohol pad
or IV prep wipe (which leaves behind a tacky surface) where you’ll wear
your infusion set. Then dry thoroughly. From there, you have two options
for increasing the stickiness of your set: layering adhesive or a
skin-prep product on the skin to make it stickier before you insert or
adding adhesive once your set is in place. Which you choose is a matter of personal preference.
A
cheap and easy trick is to use an antiperspirant after you clean the
site, says Jan Wall, MS, RD, LD, CDE, project coordinator of the
diabetes program at the University of Arkansas for Medical Sciences.
Skip deodorant; it’s the antiperspirant feature you really need, and
chemicals used to mask scent can be irritating. And use a solid or
spray, not a gel or cream. Apply to the skin where you plan to insert
your infusion set, and wait at least 10 minutes for the antiperspirant
to dry before inserting the set.
| CGM Sensor Dos and Don'ts | |
What works for keeping your pump’s infusion set in place isn’t always the best technique for CGM sensors. | |
| Do | Don't |
| When applying an antiperspirant or a skin-prep wipe, leave a patch of clean skin into which you can insert the sensor. | Cover the skin in antiperspirant or tacky skin prep and then insert the sensor; it can cause the sensor to fail or compromise the accuracy of the readings. |
| Cut a sensor-sized hole in any pre-insertion adhesive covering you put on the skin. | Insert your sensor through adhesive coverings such as IV3000 or Polyskin. |
Products such as Skin Tac and
Mastisol, which are applied to the skin and create a tacky feel, are
used in a similar way to antiperspirant. They form a barrier between
clean skin and an infusion set’s adhesive to keep a site in place
longer. In fact, they attach so well that some people use other
products, such as Detachol, to gently remove the adhesive.
Another
option is thin, flexible “tape” that sits on the skin and attaches to
an infusion set’s fabric adhesive pad. If you’re using a pump, you can
insert your infusion set directly through the sheer covering once it’s
stuck to your skin. Brands such as IV3000, Polyskin, and Tegaderm are
diabetes-educator favorites. The key to making them last? “As you take
the adhesive backing off, be sure you’re pressing out any air bubbles,”
says Wall. For extra staying power, use a product such as Skin Tac
beneath the covering before inserting an infusion set.
Regardless
of what pre-insertion product you use, keep a close eye on how your
skin reacts. If one causes irritation, another brand might do the trick.
Bradford Gildon, a 28-year-old triathlete with type 1 diabetes, relies
on pre-insertion products to keep his pump in place during races,
especially when he’s in the water. While he’s found a product that works
for him, the first he tried aggravated his skin. That said, Wall says
that skin irritation isn’t a problem for most people, provided that they
change their site regularly.
Cover It Up
The same dressings
you’d use over your skin—IV3000, Tegaderm, Polyskin, and the like—work
on top of your infusion set’s adhesive pad as well. If prepping the site
doesn’t work for you, consider adding extra adhesive once your set is
in place.
Whether you’re using a pump or CGM, be sure to cover
only the adhesive pad, not the plastic “dock” or tubing you’ll need to
disconnect. Doing so leaves room for air, moisture, and dirt, which in
turn leads to a less sticky site.
“The flatter you can get the
[product] on the skin, the less moisture you will get from water,” says
Tom Kingery, 37, a triathlete and runner with type 1 diabetes. “If you
can prevent outside water from coming in, then it’s going to help a
lot.” To keep his patch pump in place, Kingery cuts a pump-size hole in a
sheet of adhesive, which he places over the device, reinforcing the
pump’s adhesive patch without touching the pump.
Athletes who
want extra assurance that their site won’t slip may employ other methods
on top of added adhesive. Spandex sleeves, which Gildon uses, or Velcro
bands can keep an infusion set on your arm from pulling out.
Make a Move
Generally
speaking, one area of the body isn’t stickier than the rest. But
depending on your lifestyle, infusion sets may be dislodged more often
from certain sites than others. “Consider where you’re wearing it,” says
Wall, noting how a belt or waistband could brush against a site and
knock it out of place—changing clothes or dropping your trousers during a
bathroom break are prime times for dislodging a site. Typically, sets
rip out when the tubing catches on something (such as a doorknob) or
when you drop the pump and it swings on the tubing from the site. Secure
the excess tubing (tuck it in your waistband or pocket) to avoid such
snags. The best area for keeping your set stable may change based on the
day or your activity. Surfers, for instance, may avoid their arms
because crashing waves can more easily tear away an infusion set from
there than from the abdomen or back.
Examine Your Technique
Sometimes,
seemingly inexplicably, an infusion set or CGM sensor may become
dislodged despite your best efforts to tape it in place. The issue may
not be adhesives at all, but your insertion technique. “If your infusion
set is not inserted properly—for instance, if it’s inserted at the
wrong angle—it could slip out,” Wall says. A person using a site at the
back of the hip, for instance, might not be able to reach around well
enough to insert the needle properly or to keep an insertion device flat
and steady.
Whatever the reason for your set’s slippage, keep in mind that your first attempt may not fix the problem. “You may need to try a few things,” says Wall, “and see what works for you.”



Comments
Comments are subject to review and will not be posted immediately. If you have an urgent medical question, please consult a health care professional. If you have a question for the staff of Diabetes Forecast, please send it to replyall@diabetes.org.CGM sensor insertion
Thank you for the information on keeping cannulas and sensors in place. The number one reason my son gave up on the insulin pump was because, no matter what we tried, the cannula and its bandages would sweat off during sports. It was a lot easier to just use syringes. He was using the pump in 2009-10, so I'm hopeful that new products have helped eliminated this problem. We are contemplating getting a CGM but are concerned that we will have the same problems we had with the pump. I have a couple of questions: 1)How would you recommend protecting the small site for the CGM sensor from getting antiperspirant on it? 2) How do you keep track of where that spot is so you can find it when ready to insert the sensor?
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