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Changing the Set.

Changing out an insulin pump infusion set is a methodical moment for me. I do things in the same order almost every time, with the same mildly frenetic mindset.

  • Remove old set from my body so I can enjoy the “connected to nothing” feeling for as long as possible.
  • Take out a new infusion set and new reservoir.
  • Ferret out the open bottle of insulin from wherever I’ve stashed it last in the bathroom.  (Usually it’s in the medicine cabinet, but during the hotter months of summer, I tend to keep it in our bedroom, where it’s cooler.)
  • Line the insulin set, reservoir, and bottle up on the counter.
  • Unscrew the reservoir cap and remove the old infusion set and reservoir from the pump.  Throw the tangle of tubing into the garbage, making sure said tangle doesn’t dangle over the edge of the garbage can because otherwise Loopy and Siah will find it and drag it all over the house.
  • Open the packaging for the reservoir and take out all the little parts (except that one frigging thing that I don’t know what it’s for and I usually throw it right into the garbage – see below):

  • Rewind the pump.
  • This is the point where I mentally set some kind of timer, challenging myself to race against the time it takes for the pump to rewind.  While the pump is whirring, I rush to fill up the reservoir and connect it to the tubing.  I do this every, single time.  It’s as satisfyingly ritualistic as shaking the bottle of test strips before I check my blood sugar.
  • Thread the tubing through the battery cap and connect the luer lock, then insert the cartridge into the pump.
  • Load the new cartridge.
  • Prime the cartridge, trying to stop the prime before more than a single drop of insulin escapes from the needle in the infusion set.
  • Hold the tubing up to the light and inspect it for bubbles.
  • After the pump is primed, again the mental timer is set.  This time, the challenge is to unpeel the sticky backing from the infusion set and find a place on my body that’s suitable for insertion before the screen on my pump goes blank from inactivity.
  • Insert the new infusion set, prime the cannula (sort of holding my breath while it primes because I’m never certain that the first introduction of insulin won’t burn under my skin).
  • Tuck the tubing out of sight and clip the pump to my clothes.
  • Fin.  (As in “the end.”  There’s no marine life actively involved in this process.)

This process takes less than two minutes to complete, but if it’s interrupted in any way, I’m thrown so far off course that it takes me five minutes to recover.  The method of this madness is that it’s one, fluid mental movement and any upset to the process makes my brain disengage to seek the comfort of something shiny.

It’s an intricate process involving several steps, precision handling, and the safe housing a powerful drug.  And if I have to change the battery at the same time …

 

16 Comments Post a comment
  1. We have the same pump. We NEVER loosen the battery cap unless it’s time to change the battery. Kerri, I need to know what this is for! Does it help the battery last longer? Or something more major?

    09/8/14; 8:56 am
    • Shit – I meant reservoir cap. Not battery cap. I just edited. Forget I said battery. :: waves arms hypnotically :: Foooooooorget!

      09/8/14; 9:12 am
  2. Allie Favazza #

    That little plastic garbage part is for capping the cartridge in between removing the needle and securing the new tubing. I never use it either, I always just leave the needle tip on until I’m ready.

    09/8/14; 9:01 am
  3. FYI: that little plastic weirdo thingy in your reservoir package is to screw on a pre-filled reservoir if you wanted to carry that around instead of an extra bottle. I have used it when I have like ~10u left in my pump and am going for the day. I know I will need to refill but would rather not have to take out a giant needle in public/restaurant.

    The more you know!

    09/8/14; 9:11 am
  4. xiltron #

    “connected to nothing” Hahaha, yes. Awesome feeling!

    “Look, look, no pump and I’m still alive!” *connects pump again 2 minutes later*

    09/8/14; 11:02 am
  5. Laddie #

    When I started using the Ping almost 2 years ago after always having used Medtronic pumps with their proprietary reservoirs, I dutifully read the instructions for filling my Animas reservoir and put the little weirdo thing on every time. I think you either tweeted or blogged about the little thing a while back. After reading that, a lightbulb went on in my head that of course I should just leave the needle thing on until I was ready to attach the tubing. Duh!

    09/8/14; 1:06 pm
  6. haha @ that last part about the battery!
    over the weekend i had to calibrate my CGM, change my battery AND do a set change. I was so overwhelmed!

    09/8/14; 1:46 pm
  7. Peggy #

    One thing that cuts my time way down is to prefill my cartridges and keep them in the fridge. I usually fill 5 at a time. I have been doing this for 14 years and never had a problem 😉

    09/8/14; 7:21 pm
  8. Haha I do the SAME thing with the “attached to nothing” feeling … I’ll even time it to make a quick bathroom trip – just to be able to go without having to make sure I don’t catch my tubing on anything. Although, mentally, I’m still looking for the tubing…. so maybe it’s a moot point. But I still do it – just ’cause I CAN. lol #iamarebel

    09/8/14; 9:17 pm
  9. Meghan #

    The little cartridge cap also serves, for me anyway, as something to bite down on while inserting the new infusion set. Just in case it hurts. Just like the syringe cap used to do when I was on shots.

    09/8/14; 9:20 pm
  10. So interesting to see what idiosyncratic things I do are also done by others, how we come to the same place without talking about these things…like the not connected to anything moment, like the race against the rewind. At one point it seemed to me that these steps that we can do on autopilot (as long as we’re not interrupted, as you point out Kerri) are still rather complex, especially as I tried to hold all of the post-change detritus in one hand to carry to the trash (minus the sharp), so I counted how many different pieces/things I have to touch to change a set, all, of course, in the right sequence–I came up with 23.

    09/9/14; 7:33 am
  11. We often used the lid (we just switched to Medtronic) because of the frequent calls from school, friend’s house, etc. “Mom I’m out of insulin. Can you bring me more?”

    09/9/14; 8:57 am
  12. Kris #

    Wow! I do a lot of the same things, and I’ve always wondered if I was the only one! Haha!

    I like what Peggy said, I should totally pre-fill my cartridges! That is the one thing that makes me DREAD the whole process. I think I’m just lazy, “Crap! I have to get alllll the stuff out, insulin from fridge, cartridge from utility pantry, site from utility pantry, battery from WHO KNOWS WHERE!” (I hate when it all falls at the same time! But I hate even more when it’s ALL at seperate times in one week.) If I already had my insulin ready to go into the pump, I woulnd’t hate it so much, I think! I will be doing that tonight probably!

    09/9/14; 8:59 am
  13. Ed #

    When my wife had me sell all my “bachelor pad” furniture my entire infusion set changing routine was thrown to chaos. Vacation tends to do the same thing where I try and replicate the steps at home but normally it turns into running around like a chicken with its head cut off even though everything is in front of me EXACTLY as it would be at home.

    I’ve also been running into a series case of infusion set monsters recently; I seem to have lost my insertion mojo or something.

    09/9/14; 9:28 am
  14. Dale #

    The little cartridge cap also serves, for me anyway, as something to bite down on while inserting the new infusion set. Just in case it hurts. Just like the syringe cap used to do when I was on shots.

    10/16/14; 7:02 am
  15. Kelly #

    I have the same rituals. Race against the rewind and screen inactivity lol. Peggy what an awesome idea. Kicking myself for never thinking of that!

    11/16/14; 5:19 pm

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