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What do you think? - Sent home from nurse at school

Discussion in 'Parents of Children with Type 1' started by momandwifeoftype1s, Feb 7, 2011.

  1. momandwifeoftype1s

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    Connor uses a Novolog Novopen Jr. for fast-acting insulin. His new-ish school nurse sent this home today. What do you think? What is your reaction? Have you ever seen a Novolog pen cartridge with a "stopper that balloons"? I just sent the manufacturer instructions to her because she didn't know about priming the pen before giving an injection. Now I don't know what to make of this new cartridge/pen issue. Any thoughts? Thanks!

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  2. jules12

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    That is a weird one. Sounds like you may have to go in and do a demostration or at least see what she is talking about - I know this isn't really a possibility if you use the pen correctly but could she be trying to put air into it like you do a regular vial of insulin????
     
  3. momandwifeoftype1s

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    That is what I'm thinking. The interesting thing is that Connor doesn't have any syringes at school since he only uses the Novopen. How can she put air in with a pen needle tip?

    There is another child with type-1 diabetes at Connor's school who uses a syringe and vial of insulin.
     
    Last edited: Feb 7, 2011
  4. Lee

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    I remember seeing this before -I think it happened when we would prime without a pen needle on.
     
  5. momandwifeoftype1s

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    So, she's dialing up two units without the pen needle attached? Or, she's putting the pen needle tip on, dialing 2 units with the interior purple cap intact, then dialing the insulin dosage up and injecting insulin. Either way is not really priming, and I'm concerned since I sent the quick manual, the full manual and an audio/visual manual in e-mail. I've also been there observing for 2-3 days/week since I've noticed a concern with the care that Connor is receiving at school. :(

    That would make sense from what I've seen when I'm in the clinic. Thank you, Lee. I think that is what's going on.
     
  6. TheFormerLantusFiend

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    That's what happens if you dial up and press down without a needle on, or with a needle that's bent on the bottom so it's not puncturing the top of the penfil. It means there's a lot of pressure inside.
    Screw a needle on, a drop of insulin will come out right away, but it will normalize. No worries.

    I used to keep mine pressurized like this on purpose on the theory that it would get rid of the air. I'm not sure it worked. My brothers and other people playing with the pen have also done this to it, and also once or twice with a needle where the part that's supposed to screw onto the penfil apparently bent and hadn't gone in.
     
  7. momandwifeoftype1s

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    Have you ever had a gusher of insulin explode from the cartridge after you put the pen tip on with all that pressure? An uncontrolled stream of insulin? How could the membrane get so mangled on the top of the cartridge without ever being used? It was a brand new cartridge with 100 units in it. Any thoughts? Brian (DH) and I have never seen anything like this. We're thinking it's a priming issue. Brian's going to call to talk to the nurse in the morning, because I'm getting nowhere.

    I'd really like the school nurse to follow the manufacturer instruction manual for using the NovoPen. How do I approach this topic again without alienating her? Sigh...
     
  8. TheFormerLantusFiend

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    Nope. It'll only be a few units. At that point it makes the plunger harder to press down. I have had once or twice a littler bother force it at which point the top of the cartridge seems to break and the units squirt out- but oddly enough the top still worked after that.
    Somebody on the teentalk forum wrote (years ago now) about a museum security guard who forced her cartridge to explode like that too. In her case the guard ruined the whole cartridge.
     
  9. Flutterby

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    sounds like air was added.. or it was dialed and 'delievered' without a pen needle.
     
  10. momandwifeoftype1s

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    I guess the only way I'll know for sure what is going on is to go back to school again tomorrow and have her show me how she is priming the pen and changing cartridges. Shouldn't a school nurse (an RN) know how to do this stuff? My stomach is already in knots thinking about having to go back to the clinic to have this conversation - again. I just don't want to keep sending in new cartridges of insulin and having them wasted from user error. If she doesn't know how to change a cartridge, she can refer to the manual, call her supervisor or our endo's office, or call me and I'll go over and help. I just get a mangled cartridge after school hours with a note to send a new one tomorrow. Fine, if I didn't just get one sent back home that was destroyed by the nurse. The cartridges do not come out of the blister pack like that, so I'm agitated by the waste. Grrr...
     
  11. Lee

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    It isn't waste..and try it at home. That way you know what she is doing. She is a fountain of knowledge, but if this is not something she deals with everyday - insulin pens - then a few mistakes are to be expected.

    I promise, it is just a prime with no pen attached.
     
  12. momandwifeoftype1s

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    Well, Brian (a frugal guy) says to keep it and he'll find some way to get the insulin out to use for himself. So, I guess it will go back in the fridge for him to try for himself. I'm not going to use Connor as the guinea pig, but Brian is welcome to give it a shot.
     
  13. Lee

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    Honestly, there is nothing compromised about the insulin if it is not expired. Seriously, just try it in a pen, try priming with no pen attached, and you will see the bubble. We saw it all the time, and used the same cartridge.
     
  14. momandwifeoftype1s

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    I'm probably just had it with so many mistakes being made that you don't know about. It's hard when our nurses keep changing so often. I'll try to be more patient and remember what it was like when I was new to diabetes myself. I guess I just expected that this was something basic covered in nursing school. No? Hmm...I guess I'll try to approach this with a better attitude.

    Ever just feel mad and something like this just makes you reach the boiling point? I know it doesn't seem rationale, but it's a series of things that have made me on edge. Every day is a new situation to have to deal with. I think I'm just angry about the inconvenience of diabetes and having to deal with these issues all the time. It's never ending and exhausting.

    Ok, vent over. I'll take a deep breathe and re-approach in the morning when I'm rested and (hopefully) more calm.
     
  15. TheFormerLantusFiend

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    I have showed a number of RNs my Novopen Jr and while some of them had seen an insulin pen before, none of them had ever seen a Novopen Jr, and a couple thanked me for showing them how to use it (when I've had an IV in, I've talked nurses through using the Novopen Jr to inject me).
     
  16. momandwifeoftype1s

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    No, it's not expired. The problem (which is hard to see with my lousy close-up photo) is that the membrane has pieces of it sticking up and it's not intact. It's not just a bubble. It's been pierced and pried up in places. I don't really understand how it could get so full of holes and tears? Brian says he'll use it, so as least it won't go to waste. I don't want another cartridge coming home tomorrow with the same problem. There's nothing wrong with the insulin. It's the user. So, back to school tomorrow to see if I can help with changing the cartridge and priming. Again... I wish we could just keep our previous nurses. They got it, and didn't have all these issues all the time. Or - if they didn't get it, they'd call and ask for further explanation. I guess I was spoiled.
     
  17. TheFormerLantusFiend

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    I'm not sure I got that the first time. In that case, I've only seen that once, after somebody had forced the insulin through without a needle. It still worked, but it definitely made me uneasy using the rest of the cartridge.
     
  18. momandwifeoftype1s

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    It doesn't look sterile to me. I'll use a new one for Connor. Brian can decide for himself when he's back in town. Thanks, Jonah!
     
  19. Heather(CA)

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    I'm kind of a control freak so I think I would train her in person how to use the pen properly. That would probably nip some headaches in the bud kwim?
     
  20. Heather(CA)

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    That's my girl :)
     

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