Discussion in 'Parents of Children with Type 1' started by mom24girls, Sep 5, 2011.
OOPS 1998, but if it was 1988, I still wouldn't give up the pump, I can't imagine a break
Oh, that's slightly shorter. Still pretty impressive, though! I need a break every couple of years, even if it's only a week. Much as I love the pump, I kinda hate it a bit. I need to take a break occasionally to remind me that the bits I love completely outweigh the crappy bits.
(Sorry to the OP for the thread diversion.. )
Our hospital's policy is to remove pumps, unless there is someone with the patient to manage it (I haven't looked at whether adults can keep theirs, only whether my 4 year old could have his... ) It has to be a written order from the admitting physician to allow it.
I would assume if surgery was involved, that the pump would have to come off. Who will run it during surgery? I'd also worry about losing a site - the positioning for surgery once the patient is under can be interesting. When I was doing my surgery rotations, watching patients get prepped for orthopedic surgery was interesting - I can't imagine a pump site making it through that whole process!
In 12 years and many trips with 2 daughters, pump has not been taken away. I have been asked to suspend it. In fact, last June, I was told that the new protocol for DKA was to leave the pump on for the basal, and then use the IV for the correction insulin. seemed to work great! (Zoe was sick with a bad virus and had 2 failed sites..got us into some deep trouble!) but got to see the new protocol in action.
also, I would have to wonder, a ortho surgery, chances are she will have an x-ray or several during surergy. I know I did when I had surgery done. I couldnt walk for 2 days after neck surgery, not becouse of the surgery, but becouse I had such major lower back spasms from the positioning I was in during the long surgery. the surgery was nothing compared to the pain I was in with my back out.
You also have to consider access during the surgery. The anesthesiologist is responsible for maintaining the patient's entire system while the surgeon works. Unless you have a pump that you can run by remote, he doesn't have access to it because it will be in covered by a sterile drape.
I am not familiar with the ins and outs of surgery and pumping, just had a few surgeries and used the pump, so I may be missing something.
But why would someone need to operate or monitor the pump during surgery?
There's only three reasons you'd need to touch the pump, right?
1. If she's eating during surgery.
2. If she needs a correction -- in which case if they didn't want to do a correction through the pump they can still just give an injection.
3. If she needs a basal adjustment -- and if the pump is disconnected, and she's back on MDI, they couldn't do a basal adjustment anyway. So they don't have to adjust basal, just do what they would if she were on Lantus, but the pump gives them the option to adjust basal if they want to use it?
I think it would take some thinking to make sure it didn't get in the way and it wasn't an infection hazard of some sort, but surely those things could be worked around. I know I (TMI TMI!) had to have a catheter during surgery, and they managed around that.
I like being able to move freely back and forth and don't think pumping ever needs to be a dealbreaker, but it seems to me that folks in hospitals who want to remove a pump -- or particularly who want to 'take' the pump-- are operating under some fairly large degree of ignorance and inflexibility.
One other reason and probably the one that creates the most liability for the hospital:
Her blood sugar starts falling rapidly and they want to shut off or decrease her insulin.
Yeah, I agree with this.
But in that instance the quickest and easiest way to deal with a low BG is IV Dextrose. Basal adjustments take too long to remedy a falling BG.
This is a big deal, but I kind of put this under basal adjustment. If she's not on the pump, she's on MDI, and if her bg falls rapidly they can't decrease her insulin anyway. So they don't get themselves anything by taking off the pump. If they leave it on and want to use it to decrease the insulin, they have an advantage. If they leave it on and don't touch it, they're not any farther behind than they would be with Lantus.
Now, if the option is continuous drips of glucose or insulin during the surgery into an IV site, well -- I guess if they are familiar with that method they might see it as superior to leaving the pump on. But golly, I wouldn't even want to begin to think about how to get an IV going just because of a nondiabetes surgery. . . seems like a lot of trouble when a small syringe would do the trick.
I agree dextrose is fastest, but the hospital still wants the ability to control the insulin because ultimately they are responsible for the patient. If they aren't trained on the pump then they don't really have control over the insulin.
I can see taking it off for surgery/ICU, but getting it back on as soon as it's feasible.
I want to thank everyone for your thoughts. This is has been a great discussion and has given me a lot to think about. I have been in touch with my daughters team and we have made arrangements for her to have the surgery without being admitted.
But how are they controlling the insulin if the patient goes to MDI? The insulin is long acting and already working in the body, can't be controlled? Do they put patients automatically on IV insulin for surgery?
I'm glad it's working out. This has been a great question. I'm thinking it might be a good idea to (or have our young adult kids) talk to our endos on recommendations on how to handle this type of situation in the future. My son had outpatient surgery and we had a letter from our endo that the pump must stay on. Never hurts to discuss this with the medical team in case there's an emergency surgery.
What's going to happen if our kids down the road have an "artificial pancreas"? Are the hospitals going to be able to manage care? That's alittle scary to me at this point thinking it through. I would hope they could - but I guess we prepare to go back to shots if need be from that cure?
I think there may be some confusion over this artcle. The authors work at Forest Park hospital, not JCAHO. The article discusses how Forest Park developed their own internal policy on the use of insulin pumps. The policy shown in the appendix belongs to Forest Park's, it was not written or blessed by the Joint Commission. I do not see any references to JCAHO standards allowing the use of insulin pumps in the hospital.
The reference to JCAHO is about how to avoid insulin medication errors:
We had previously implemented policies recommend- ed by the USP, Institute for Safe Medication Practices (ISMP), and JCAHO, noted earlier, to reduce insulin errors, including a requirement that units be spelled out on all orders, not using trailing zeros, standardized insulin-drip concen- tration, and the use of rate control devices for insulin drips.
Am I missing something?
I can't speak for the original poster and her hospital, but typically a patient would be put on IV insulin for surgery, not a long acting.
Edited: Forgot to say during surgery
Oh, I see.
Gotta say that sure seems like doing it the hard way. Also seems like it would be more dangerous to dose for since it's a whole new way of getting insulin. Even just a few syringe injections seems preferable to an IV. But then I guess I don't understand the advantage of IV insulin. Thanks.
my father was hospitalized many times, he never got IV insulin. They put him on lantus and novalog MDI. This is the case in 3 of the different hospitals I have had him in. In each case, I complied with them and took the pump home with me. I was not able to stay and do the pump for him, he could not operate it on his own.
also failed to be mentioned here, theft of the pump. Pure and simple, I wouldnt admit my dad with a 7 grand diamond ring on his finger, much less a 7 grand pump on his side. The hospital sure isnt going to accept responsibility for its loss. I always took the valuables home, his hearing aids his wallet, watch and pump.
by the way, true story, when working as an aide, a little old lady had gotten sick, they took the sheet she vomited on, and rinsed it in one of those hopper type sinks with a huge flush thingie-its an industrial thing found in hospitals and nursing homes... They flushed her dentures down the hopper! gone in an instant. (thank God this wasnt me...)I can only imagine a pump getting caught up in the sheets-tossed to laundry, or worse, the bio-hazzard bag! You couldnt pay me enough to dumster dive a pump from that mess.
My son went in for an emergency appendectomy year and half ago....we went 5 rounds with the floor physician about not taking the pump off. It was hospital policy...hmmm no....we were there to be in charge of the pump...we were working with the nurses just fine for the 12 hours prior before the Dr. made her ultimatum.... In the long run Regular is a different insulin. I don't know how it works and I know how Humalog works...in the end it was fine....But we had to sign away that they nurses were not responsible for his insulin needs...
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