Toddlers and Infusion set changes

[wellsfamily]

Hi Everyone! We started our saline trial on Wednesday (I am wearing one too,) and switch to actual insulin on Tuesday. Everything has been great EXCEPT for the site changes. Aidan (3, dx on 11/18/05) has had no problem wearing the pump 24 hours a day, and has not stopped him from doing anything. Our only problem has been changing the infusion set. It was a total nightmare, he was flailing and screaming, I was shaking etc... I finally poked him, he flinched and it came right back out. I took a break, put on some lidocaine, and waited an hour before trying again. It was a little better, and I finally got it in, but he was still screaming the whole time. I kind of anticipated this, as he screams for his injections too. Does anyone have any suggestions or tips? I really feel the pump is going to make our lives so much easier and can't wait for Tuesday, but I am dreading the infusion sets. Thanks,
Heather

[wendyc]

Hi,
Congrats on starting the pump! First, what kind of infusion set are you using? We use the the Inset Infusion Set which hides the needle. It is in it's own self contained unit, so all the child sees is this little pod like unit coming at them. However, there can be a problem with the tape not sticking if the alcohol is not totally dry. I did a site change yesterday, and didn't wait long enough, sure enough when I pulled it off, the set came with it.
I always tell my daughter that we will be changing the set in x minutes. I have everything prepared and ready to go. I have her get her favorite stuffy, put on a special show and have her lay on the floor. I then take her pump off, rewind etc. While I'm doing this I swab the new site and put the new set in. Then I just unplug her and do the rest.
It will take some time for the child to get used to it. I think my daughter doesn't like the inconvience of having to sit still on someone else's terms more than the discomfort! She has told me it doesn't really hurt. I think comfort is the key, making it as soothing a process as possible. Stickers always are a great reward, and I also had some little prizes in the beginning to help, little dollar store toys. We used those only for a few weeks.

Good luck, and don't worry, it will go smoothly:)

[game2fun]

Hi there,
When we first started pumping the site changes were a nightmare! Granted it only took about 1 to 2 wks and it got alot easier. But that first week or two, man I would start to sweat just thinking about it. We used the silhouettes at that time, they go in on an angle and have a LONG needle. I would use the numbing cream (lidocaine) and the longer it's on the number it is. So in the beginning I would keep it on a good 2 hours. Anything to help her w/ it. And she really couldn't even feel it. Not that the whole thing is physical IMHO. I'd just slap the cream on her and set the kitchen timer. Then I would have everything ready w/o her in the room and just come to her when I was ready for the insertion. I would come armed w/ distractions. My watch, my rings, jewelry, lipstick, something on tv that she isn't usually alllowed to watch, even the old reservoir to play with will work at distraction. Then I'd just go as fast as I could, which seemed like an eternity at the start. And actually, as I'm thinking back, I would hold off till my husband was home so we could work as a team. One w/ distraction and the other w/ inserting. Now, it is MUCH easier. I can do it alone and in a matter of seconds. So it does get better, honest. Hang in there,

[Ben'sMommy]

Hey!

My son Ben is 2 years old and uses the Paradigm 512. We use the Quick-set and quick serter. http://www.minimed.com/products/infusionsets/quickset.html

He's been pumping over a year now and only recently started to resist site changes. The insertions don't hurt him so I'm guessing it's all psychological.
We had a tough time getting around him. I think it's a bad idea to hold him down to get it on.
Ben has a teddy bear called Georgie whom he adores. So, Georgie got a site change! Ben found this hilarious and then wanted his own done.
Also, we keep a tube of bubbles in his site change bag and if he's very good he gets to use them.
This bribery didn't work instantly but now he realises that if he behaves and helps us he will get a reward.
I think it helps to involve them and let them feel like they are helping.
It's tough for them when they are so young. It's hard to imagine what exactly they think is going on.
But all we can do is tackle one day at a time and hope that it gets easier as they get older.

Hope this is of some help!

Carol.

[kiwikid]

We use a Rapid D steel needle for Rachels infusion set. I do her set changes while shes sleeping. About 15 mins after shes gone to sleep, I ice her upper butt with a frozen tube of sausage meat - I have tried several different 'tools' but the sausagemeat is easy to handle, easy to apply, and it stays frozen for a long while in case I'm held up for any reason.
After icing for about 5 mins, I wipe with SkinTac and pop the Rapid in. While shes sleeping I also remove the old set using a 'Remove' wipe.
We don't use EMLA because Rachel hates any sticky being removed. Taking the tegaderm off that covered the EMLA would be more stressful than it was worth.
We chose the Rapid D needle because it is so easy to use and because the possibility of the cannula kinking is NIL. To have to change the infusion set because of high numbers, just to see if it was possibly a problem with the cannula didn't appeal to me at all.

Jane (Mum of Rachel (4), dx'd at 11 months, pumping Jan 06.)

[EmmasMom]

Site changes were definitely nerve racking for me in the beginning. Of course after pumping for almost 8 months I feel the same way about shots now! I haven't given Emma one single injection since her first week on the pump last October... amazing. :D
We also use a minimed pump and use the quick-serter device. (I think most other companies have similar options as well) It makes the process a breeze because you don't have to worry about angles or depth, you just place it on the area you want it and push the button. It sticks automatically with no other taping or dressing required. I LOVE it. I can do it by myself on my wiggling 20-month-old.
It doesn't hurt her at all, and I stuck my self several times in the beginning to see for myself, I could hardly feel it, (I can't say that about the silhouette :( ) Now that she's getting a little older she does get anxious right before I do it, but as soon as it's in she claps her hands and says "all done"!! She has never cried, so I think the hard part for older kids is more psychological than physical. (We have never used anything to numb the area.)

I was afraid to use an angled set, because after watching my husband use them for years I knew it would be very difficult if Emma moved at the wrong moment or tried to fight me. I had read that they were more reliable so I was torn on what to do. I have to say that I have never had a kinked catheter, or had to change the site early due to problems with it. Only once in 8 months has it come out and it was because Emma ripped it out of her leg on purpose.

So IMHO if you have a wiggly fighting toddler a 90 degree cath w/ an inserter is a priceless!!!

[nantomsuethom]

Hi Heather,
Congratulations on getting your son pumping. I hope it gets easier for you all soon!

We use the the Inset Infusion Set which hides the needle. However, there can be a problem with the tape not sticking if the alcohol is not totally dry. I did a site change yesterday, and didn't wait long enough, sure enough when I pulled it off, the set came with it.

We were having this problem with the inset also. If you look at the back of the inserter after inserting it there is a little open triangle. We opened up a paper clip (also used a small piece of a metal hanger), we press it gently into the triange while pulling off the inserter, we have not lost a site since.:)

Does this make sense to those who use insets??

Good luck!

[wendyc]

Thanks for the tip, we'll give it a try. Pressing down on it 3 times after insertion just doesn't always give snug fit.

[wellsfamily]

Thanks everyone. We are using the comfort short which do go in on the 45 degree angle. They suggested this, as Aidan doesn't have much fat. The pump trainer , though, said that she thought he might be able to use the straight in, and I will ask tomorrow at our appt. Only 2 more shots left, I can't wait!!! Last night's change was again a disaster. I finally got it in, and then my finger got stuck on the tape and pulled it out. I felt so guilty all night. I am just hoping it will get easier each time we do it. Do your kids experience any discomfort or soreness afterwards? He is saying it is sore if I touch it.

[kiwikid]

There shouldn't be any pain at all. Only once have I had to change a site early and you know pretty well straight away whether its okay or not. Our pump trainer (also Type 1 and pumping) did say that a new site can seem a bit sore until you get the insulin flowing through it, then it can come right.

[hold48398]

Our endo highly recommends the Comfort Short for young kids because they simply stay in the best. So, this is what we will start on tomorrow :). Mia actually holds really still, so I think it's just a matter of practice before the process is really smooth. If you haven't already tried to put a set on yourself, I highly recommend that you do. When I tried it, I too was a bit "sensitive" on the site right afterwards but the feeling faded in no time.

Good luck, we are right there with you!!

[Eoin'sMam]

Hi Heather

eoin is 2 and has been on a pump for 3 weeks now and is not too impressed with the set changes either.....but having said that at least it's only once every 2 - 3 days and not 4 times a day as with the injections

We use Cryogesic spray to numb the site before inserting the set...it completely numbs the surrounding area for a few minutes...so no pain..just a cold sensation.. It's made things a little easier

Best of luck with it

Lou

[wellsfamily]

Thanks again! We are officially pumping! Started this morning, and all is well. This is a great day for us!
Heather

[lisamomtotwins]

Thanks again! We are officially pumping! Started this morning, and all is well. This is a great day for us!
Heather


congrats & good luck!!! :)