Posts tagged good hygiene

Site Change Complete With Pics 101.

Lance And His Insulin Pump.
Lance And His Insulin Pump.

 This post and pictures are dedicated to my dear friend, Kez, who has been so incredible  throughout the past month. Having had Type 1 Diabetes for the best part of his young life, he truly understands the nature of the condition. He barely ever mentions his own nightmares where Diabetes is concerned; he is more worried for Lance. He’s a true gentleman-an original Harry Winston pink diamond glimmering in a bargain bin brimming over of cubic zirconia.

Kez has been enquiring and asking lots of questions about Lance and his insulin pump. As we reside in different states, I thought I would take some pictures of the ENTIRE site change procedure. (There aren’t too many people who actually want to hear about the pump and its workings, so I decided to pay homage to my friend for being so incredibly supportive, and I figured that I may as well do this properly and show you EVERYTHING!)

This post is also dedicated to my Lance, whose patience and even-tempered nature never ceases to amaze me. You are a true inspiration to others, with or without Diabetes.

Meet "The Pump."

Meet "The Pump."

This is Lance’s five week old Medtronic Minimed Paradigm Insulin Pump. It’s a few cm’s shy of  the size of my mobile phone, and weighs slightly less. ( I don’t own a brick, either-it’s a top-of-the-line Sony job.) It’s available in blue, purple, clear or smoke. Lance chose smoke, as he felt that he would tire quickly of the coloured ones.
 “Smoke is classic, Mum..it will be less obvious than a bright purple one, and it will look so
much more classy.”
 (Would you like some caviar and Cristal Champagne with your insulin today, oh Sir Lance-a-lot?) 😉
All jokes aside…On With The Show!!!!
First up…
Cleaning Hands With Antibacterial Gel

Cleaning Hands With Antibacterial Gel

 The first rule of changing a set is to have a clean area to work on, and thoroughly clean hands. As well as using soapy, hot water, I go that one step further and use an anti-bacterial quick drying gel.

What You Need To Change An Infusion Site.

What You Need To Change An Infusion Site.

Before I begin, I ensure that I have EVERYTHING that I will need to complete the set change.
I have Lance’s pump, his used, almost empty insulin reservoir that he has removed from his stomach. (This kid has no fear of pain! He just tears off the tape, which is sticky as..there’s no comparison!!) It makes me shudder at the thought of removing it. The closest thing I can compare it with is an eyebrow wax performed by a apprentice beauty therapist who is ripping the wax off in stages. 
I have two alco-wipes, which throughly clean areas that must be germ-free, a new, sterile reservoir, which simply resembles a fat, short barrel of a syringe. It has a blue, removable needle which draws up the insulin. There is also a new “set”, which consists of thin, clear tubing, with a lockable cap on one end, and that tape one the other, along with a removable needle. We’ll go into that more later. 🙂 There is also a cleaned Medtronic Quik-Serter and a vial of insulin.
A 3mL vial of Novorapid-So Little Insulin For Such A Big Problem!

A 3mL vial of Novorapid-So Little Insulin For Such A Big Problem!

Speak of the Devil! Here is the tiny little tube that will dispense three days worth of insulin to Lance. Even then, there is ALWAYS some left over. It’s difficult to fathom that everything revolves around such a tiny amount of insulin! The vial is shorter than my ring finger!! We use Novorapid, by Novo Nordisk.It sure knows how to punish excess sugar in the blood!!

 

Cleaning The Rubber Plunger Of The Vial-Hygiene Is A Must!
Cleaning The Rubber Plunger Of The Vial-Hygiene Is A Must!

 

Yep, I’m giving the rubber top where the needle is inserted the once-over with an Alco-wipe. I am meticulous about cleanliness, considering everything I touch or breathe on has the possibility of contaminating Lance’s site. OCD much?
Filling The Syringe With Insulin.

Filling The Syringe With Insulin.

Okay, this is the part where you take a deep breath and hope that you don’t get a case of Shaky Hands Syndrome. I turn the vial of insulin upside down, insert the syringe (unable to be seen due to the blue plastic thingy-me-jig) and pull the plunger at the bottom, to fill the reservoir ( a fancy, American name for syringe) with the entire contents of the insulin. Once I have ensured that there are only “champagne”size bubbles present, and no trapped air to be seen, I remove the blue plastic thingy simply with a twist, put the empty insulin vial in my rubbish heap and ever so carefully, twist the plunger anticlock-wise until it comes off, and you are left with something that looks like….
Attaching One End Of The Tubing To The Insulin Resevoir.

Attaching One End Of The Tubing To The Insulin Resevoir.

THIS!
I have also connected the lockable cap to one end of the reservoir. This is usually the stage where people cotton on, and say “Ahhh, I think I’m catching on here…” The tubing is also visable in this shot, and the part that ends up stuck on and in Lance’s tummy.
Where The Insulin Lives.

Where The Insulin Lives.

The Reservoir full of three days worth of insulin has it’s own special home in the pump. You simply push the reservoir into the space, and twist anti-clockwise until it won’t twist anymore. (What’s with all the anti-clockwise twisting, you may ask? I know..Australians are a mob of clockwise turning folk..) I never realised just how much until my associations with Duplo. (OH! The Pump has a name, in case I have forgotten to mention!)
Drumroll please….
Introducing…. Duplo. I think there’s a hidden metaphor in there somewhere, along the lines of Duplo is the easy, user friendly version of the more complicated and high maintenance Lego. Get my drift?
Checking The Insulin Flows Through The Tubing.

Checking The Insulin Flows Through The Tubing.

So, after all that anti-clockwise twisting, the reservoir is safely locked into its home.
The Pump Pushes The Insulin FreelyThrough The Tubing.

The Pump Pushes The Insulin Freely Through The Tubing. At this point, I have to choose an option in the Main Menu called "Prime". This means I have to hold the blue ACT (short for Activate) button down, until I can see insulin flowing through the tubing, and a few droplets emerging at the end. ( I can usually smell it coming before I see it.)Droplets Of Clear, Pungent Insulin Appear! It Worked!

 

Not the best of shots, (HA! A Diabetes joke!) but I assure you, that the priming has been successful.  Two photos down, I am aiming the needle towards the camera, but you can’t see bupkus.
Introducing The Medtronic Quik-Serter.

Introducing The Medtronic Quik-Serter.

This blue plastic device that resembles a modern day egg cup, is actually a brilliant little device called a Quik-serter. (Everytime Lance sees the box in which the Quik-serter lives, he makes the same comment..”The Medtronic people are really smart for making such a great pump, but they can’t even spell “quick” right!!“) It basically does what its name suggests. It inserts everything quickly, with minimal fuss and pain. Definitely worth the $57 price tag!
Taking Off The Shiny Paper To Reveal Super Sticky Tape!

Taking Off The Shiny Paper To Reveal Super Sticky Tape!

I have painstakingly removed the plasic-coated paper without touching a millimetre of the stickiest medical tape known to man.
Almost There!

Almost There!

We’re at the business end of the procedure, now. The quik-serter has the adhesive side up, and is securely pushed in to avoid it falling tape-side-down on the floor, and heaven forbid, contamination and or brain bleed taking place!!
Loading The Quik-Serter.

Loading The Quik-Serter.

I have now pulled down the white part of the Quik-Serter, which in effect, loads it, almost ready to use!
The Needle Is Now Exposed.

The Needle Is Now Exposed.

I have now removed the light blue plastic cap, that protected the needle and captured those insulin droplets at the priming stage. Now, all I need is the child model to demonstrate!
Avoiding The Old Site.

Avoiding The Old Site.

Child model is not very happy. He wants to watch The Simpsons, and he’s slightly on the higher end of things. (14.3mmol/L to be exact.) I expose his tummy to look for a fresh site that is all healed and unmarked. It’s a tough job-but I managed to find one. You’ll notice the reddened round circle with the hole in the middle–that was where I put Lance’s last set. I apply a little anti-biotic cream to the spot where the cannula lived for almost three days. Sometimes, Lance complains that “it’s uncomfortable” after it’s been removed. The antibiotic cream (prescribed by our wonderful family doctor) really dries up the opening and you can literally watch healing taking place. The reddened area is from that dang tape! It will settle down in a few hours.
Cleaning The New Site.

Cleaning The New Site.

I’m cleaning the whole area with an Alco-Wipe. Lance has to hold his shirt up until it dries. A lot of people blow on it to encourage it to dry quickly-this is a huge NO-NO. You could be breathing any type of bacterial infection into an area that has to be completely germ free!!
The alcohol takes only 30 seconds or so to dry. Finally, we get to see some action!
This is the part where you move quikly (hehe)&have chocolate ready..

This is the part where you move quikly (hehe)&have chocolate ready to distract yelping child....

A teensy amount of anxiety builds at this stage; sometimes I can get a spot that causes no discomfort at all, yet others, poor Lance is hollering, jumping on one foot and clutching his stomach like he’s just been the recipient of a bullet or four. I position the quik-serter onto the new site, and press two white buttons at the same time…you will here a “click” plus…  “Ow, ow, ow, ow, get the needle out, get the needle out!!!” When the white buttons are pressed, it forces the quik-serter to punch the cannula underneath Lance’s skin by a thin, long needle. I then press the top, round part of the quik-serter, which releases it from the area. Then you are left with something looking like this….
OUCH! (Just For A Teensy Second..)

OUCH! (Just For A Teensy Second..)

Fabulous! A successful site change!! I press down the tape to ensure that it is completely stuck down. (I was unable to get a shot of the removal of the needle. As it was, I hit a tender spot, and Lance was not a happy chappy.) Luckily,once the needle is removed, the initial sting only lasts for a couple of minutes. Lance’s tummy is a bit of a battleground, to put it mildly, after thousands of shots. However, he has “performance anxiety” about using his legs or the “upper outer quadrant of his glutimus maximus.” At this stage, I’m happy to let his tummy heal up but continue to choose suitable areas, rather than have him distressed every two days about having a site change. It’s important that most of Lance’s site change experiences are positive, because I know that as much as he admits he feels better with the pump, he would happily recommence multiple daily injections if I suggested it. It’s just because it’s all he ever knew, before Duplo emptied the bank!
Pumped And Ready To GO!

Pumped And Ready To GO!

Duplo is now ready to be attached to Lance’s pants, and is about to start dispensing his basal rate of insulin. I have to enter 0.3ml of insulin to be primed again, so that it’s right at the entry point of the cannula, ready to start pumping away the  insulin inside of him again.
Lance definitely chose appropriate PJ's this evening-he is quite the Superman.

Lance definitely chose appropriate PJs-He definitely is a Superman. 🙂

“Me? An Insulin Pump? I haven’t a clue what you’re talking about.”
Only the sharpest eye could possibly make out that Lance is wearing an insulin pump. The best part is that the average person has no idea about the delicate procedure Lance just went through.  
And that’s the end of the story…I’ve got this procedure down to 7 minutes without referring to reference books or watching the step-by-step DVD. Lance is usually so incredible and accepting of his pump; he’s slowly realising that living each day without being attacked by his Mum with a needle each hour or so wasn’t the quality of life he deserved.
  He has learnt to count carbohydrates, and bolus for however many he eats.
And  yet, from time to time, I forget that my son is only seven years old. When it actually sinks in, I cannot believe that he is already his own person, with his own opinions and beliefs.
He is happy, loving, intelligent, empathetic towards others’ and has lived almost all his life with Diabetes.
He considers his problems to be secondary to that of kids’ in hospital, or if our neighbour arrives home with a headache. Or if I have had no sleep.

 I guess I have Diabetes to thank for his incredible character traits.

Hope you enjoyed sharing a smidgen of our day, Kez!

 

 

 

 

 

 

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