Infusion Site Sticking Problems

As we know, infusion sites are "prime real estate" and care is required to maintain a good number of effectively absorbing areas. Absorption of insulin becomes very limited in the presence of swelling due to infection and or scar tissue. People with frequent site issues may be infusing more insulin than they need. Glucose levels may increase initially due to lack of absorption and then as a result of inflammation and eventually, scar tissue. 


For those who have been using a pump long term adhesion may be less of an issue but site rotation can become more limited as a result of using these preferred sites. Our aim in this discussion is to share some tips which have helped solve infusion site issues.

So let's talk about infusion sites! Some of the variables which relate to whether your site will last 3 days or 3 hours include:

  1. location of the site is best in areas which are as protected as possible from being dislodged by moving alone. The sides of the body are more vulnerable to site dislodgement from movement and being caught on things than sites closer to your core.
  2. Body hair can affect the longevity of an infusion site. If you can , use areas with the least amount of hair. Use products to remove hair instead of a razor to avoid later itch at the site. Apply hair removal product to the area a few days before placing the infusion site to decrease the likelihood of skin irritation under the new site. 
  3. Skin preparation process and adherence products (Skin Prep and Liquid Spray Bandage). To maintain a site for 3 days, the site area should be clean and air dried with the use of site preparation products unless you have sensitivities to these products. About one in 5 people seem to have skin sensitivities. If you have signs of skin sensitivity such as red itchy marked area where the tape was, or angry raised looking areas, speak to your diabetes care provider. Use the process of elimination to evaluate which compound is causing the problem if more than one product is being used. Sensitivity to one product does not translate to sensitivity to all. Some pump manufacturers provide samples of various site prep products.

    Skin Prep MMT-175

    Skin Prep MMT-175
    Spray Liquid Bandage MED 070487

    Spray Liquid Bandage MED 070487
     
  4. Site change routines. Many people stretch their dollars worth out of a good infusion site. In general, the older the person and the longer duration of diabetes can extend their infusion sites longer than 3 days where children cannot. This is likely due to the blunting of the immune response to the cannula in adults than in children who's sites usually start failing after 48 hrs as their body actively rejects the cannula. In all ages and stages, when a site becomes painful or uncomfortable to touch it's better to change it out. The pain means infection or irritability which result in the development of scar tissue. 
  5. Technique. There are many kinds of infusion sets in optional lengths and angles. It may be that there is some trial and error needed to find a product right for you. For example, some brands have stickier backing than others! 

For some people the backing of their infusion set alone will carry them through to day 3. Success is often based on the site prep product used. Allow to dry to at least "tacky" before applying the site. Use anti - perspirant spray if needed on the area a few hours before the site prep pad is used is one trick which helps improve adhesion in the summer.

An occlusive dressing such as IV 3000 ( looks like plastic wrap) can be used against the skin and does help anchor the infusion set which is inserted directly through the dressing or a small hole in the centre. This "sandwiching" technique helps hold the cannula securely. It will also prevent "set migration' when the site stretches over time and can cause a kinked cannula. 

iv3000

In the case of tape, more is not better. The added tape means the whole site becomes more vulnerable to dislodgement. Some people use a site prep pad to circle the perimeter of their infusion set occasionally to encourage the edges to stay down. Always go by your blood sugar no matter how beautiful or ugly and beat up your site looks! 

Rarely, allergies to the cannula itself occur. The process to get to this point in troubleshooting is long painful and frustrating usually because it isn't the top of mind reason. The way to rule this out is to try a steel needle-based infusion set. This solution has been miraculous to those who were considering coming off of their pump due to this issue.

If the preceding techniques or products have failed, there are a couple of other products that may help secure the infusion set in place.

Skin Tac Adhesive Wipes

Skin Tac  Adhesive Wipes

Mastisol-01

Mastisol-01

written by Jill Milliken


Jill Milliken RN is a Diabetes Nurse Educator in private practice who has been developing educational programs for people using insulin pumps since 1999. Ms. Milliken contributor to Pumping Insulin (Walsh) and Diabetes for Dummies for Canadians.