pics of removed Cleo set, two questions

*Shannon · #1 02-20-2009, 10:20 PM

Hi, everyone. We did site change #6 on Janie tonight. So far all her changes have been fine, no issues. We use the Cleo 90 sets.

Last site change she decided she likes pulling out the old site, so she did it tonight as Mark and I were getting the tubing ready for the new site. I didn't see the cannula as it came out. After examining it a few minutes later I was concerned. The cannula looked a little bent, but I didn't know if it came out that way, or if Janie messed with it while removing it. From now on I will remove it and examine it afterward. When you get a bent cannula, is it clearly kinked, or just kind of bent off to one side? The site on her bottom looked a little more red than usual, also. This is what the cannula looked like:

I also noticed that there was some blood on the adhesive. There was no blood in the cannula that I could see:

After finishing the new set we took her BG, it was 404.

I checked ketones and she was .5, that's within normal ranges, but she rarely gets ketones, that was a concerning reading for her.

We bolused her for correction and dinner and had her drink a lot of water. An hour later she was 204, so the new site is working.

11:20a 122
1:32p 175
2:13p 205
3:40p 307
4:00p 313
7:11p 404
8:29 204

I get the bent cannula impeding the flow of insulin, but the blood on the adhesive I don't get.

Wait a minute, hold the press! She had a cookie at school, that's why she tested at 2:13p... I just asked her a again how big the cookie was... looks like there may have not been a site problem, that sucker was huge! I bet we just under bolused for the cookie. Although, we did correct the 3:40 307, though I didn't do a full correction because the pump has been suggesting corrections too aggressively. Crap, I don't know what happened.

Does the cannula look bad to you? What do you think about the blood on the adhesive? Could that have just been from the skin getting irritated under the adhesive?

Thank you so much for any insight!

Kelly · #2 02-20-2009, 10:47 PM

Really depends if she played with it afterwards. If it came out like that it would be bent and impeding insulin delivery. Anna has had one once that got puylled out, as in canulla bent on top of skin, blood on adhgesive and a mark where the canulla was against her skin. Could this have happened? Glad you picked it up and fixed it quickly.

Abby-Dabby-Doo · #3 02-20-2009, 10:49 PM

There is a difference between kinked and bent.
In your mind picture a straw bent over and it stays there, that's kinked in my opinion.
Something that is bent, insulin can still get through
I'm sorry your photo is a little far away to tell if it's bent or kinked- but it appears bent to me.
This is a photo of a kinked site where insulin is barely seeping through.

Edited to add: Do you think the blood is from the insertion?

Connie(BC)Type 1 · #4 02-20-2009, 10:57 PM

The blood could be from the set at the insertion site moving, which is why they suggest anchoring the tubing, to prevent inadvertant tugging at the site

*Shannon · #5 02-20-2009, 11:37 PM

Kelly, Lanae and Connie - thank you for posting.

Kelly - it did look like the cannula may have been laying on her skin. I guess I assumed there would be some apparent damge to the adhesive if the cannula has popped out completely.

Lanae - I think the cannula is bent, not kicked. I guess the blood could have been from the insertion, it was a bit more painful than the others said Janie. Would the adhesive draw the blood to it's outside rim?

Connie - We haven't been anchoring the tubing, but I think we are going to start doing that.

Thank you, ladies!

Abby-Dabby-Doo · #6 02-20-2009, 11:40 PM

Quote:

Originally Posted by *Shannon

Would the adhesive draw the blood to it's outside rim?

I think the adhesive would prevent it from seeping out. Did you use something else on the skin to keep the site on?

mmgirls · #7 02-20-2009, 11:41 PM

I have had Cleo's come out like that. They worked fine and did not know that it was "bent' until It was taken out. It has happened maybe three times over more than a year of Cleo's.

*Shannon · #8 02-20-2009, 11:52 PM

Lanae - so far we've been successful with just using an alcohol wipe to prep the skin, no IV Prep or additional adhesive.

Jennifer - it's good to know that it only happened a few times over a year.

There's no way to know if her high was caused from not bolusing enough from the cookie, or from a bad site... at least I do know more things to watch for. Although... she did start to develop ketones, so that points more toward a bad site.

Seems like there is always an "although," eh?