Friday, February 05, 2010

We're Pumping! :)

I think it's strange that I find myself most contemplative and verbose on the blog when I'm tired (starting on the insulin pump is like bringing a newborn into the house- i.e. steep learning curve, less sleep, constant attention/changes that you don't understand...)- but when things are exciting (like when we got the grant a few weeks ago) I type about three sentences worth of exclamation points and I'm done. :) I can be such a spaz when caffeinated or well-rested, and yet so deep and reflective if lacking sleep. :)

Anyway- first site change with the pump occurred today. I tried to plan it so that I would be able to send A to school and then change the infusion set when he got home from school. That way I wouldn't be rushed to do it this morning when I was trying to get both boys ready for school. His blood sugar was high all morning because of the adjustments the doc has been making to try and fine tune the amount of insulin he gets through the pump. Because of that, his pump was running low on insulin by lunch and I had to do my first official site change in a fancy closet of the nurse's office at school. love it. It actually went really well. I'm slow but effective. I think I just need to remember the feeling I had while doing it for the first time- so that when my mom and mom-in-law do it for the first time I'll be that much more sympathetic toward them.

If you're curious, or want to watch my kids for any period of time, here's my mental breakdown of the list of things to do (this is for you, Mom). If this is completely mundane, scroll to the bottom and see the photo of this 'amazing, almost artificial pancreas' type of thing... :)

  1. Select the insertion spot, rotating sides of his bottom each 3 days, and doing a small W pattern, so that the needle is in a different spot every time you rotate sites. Clean the site with an alcohol swab.
  2. You don't need to suspend action/function on the pump because the site change will take only about 20 minutes (I'm sure we'll get faster at it when we have more experience).

  3. Put a small grape sized amount of lidocaine cream on the spot you're going to use on his bum, cover with press and seal so that it numbs the spot and doesn't get all over.

  4. Detach pump from the kid and take off extra tubing, remove reservoir from pump by turning a 1/2 turn counterclockwise.

  5. Use detachol/adhesive remover to try and take off the stickers/covers off of his skin.

  6. After gently pulling off the big IV dressing sticker from the insertion site, peel up the edges of the sticker around the needle.

  7. Grab the wings off the insertion/needle and pull straight back to remove it.

  8. Clean the sticky gunk off the site. :)

  9. Open a new reservoir from the sterile packaging.

  10. Clean the top of the insulin vial off with an alcohol swab.

  11. Push the blue reservoir mount thing (hold onto the blue part while you do this) on top of the vial until it clicks.

  12. With the vial on a table, and the air/reservoir on top, push the 100 units of air from the reservoir into the vial.

  13. Flip the vial and reservoir combo over while holding the plugger in and let it pull a little insulin in by it's own pressure, then pull it to 100 units.

  14. Tap any bubbles to the top. Push them back into the vial gently using the plugger.

  15. Unhook the reservoir from the blue holder thing with a 1/2 twist counterclockwise.

  16. Attach the tubing/infusion set with a 1/2 twist onto the same end.

  17. Check for remaining bubbles. Remove all bubbles by tapping and making them go up the tubing. When all bubbles are up the tubing (you can push a little bit of insulin up to push them out) then go to next step.

  18. With all bubbles out of the vial, unscrew the plugger and discard.

  19. Hit Act on the pump, go down on the menu to Prime and select 'Rewind.' Follow the instructions it gives to rewind the pump.

  20. After rewound, insert the reservoir and turn a 1/2 turn clockwise to tighten/lock in place.

  21. Make sure both sections of the tubing are connected (but also make sure that you're keeping the needle end sterile).

  22. Hit Act on the pump again and select 'Prime'- select Manual prime. When you're ready, hold down the act button until a droplet of insulin comes out the end of the needle. You'll want to remove the clear needle protector first so that you can easily see it come out.

  23. Check the tubing for ANY small bubbles. If there are bubbles present, do the manual prime again or the auto prime and select a few units of insulin so that the insulin pushes the bubbles completely out of the tubing.

  24. After you're sure there are no bubbles in the tubing, set the primed pump and infusion set down on a clean surface, making sure to keep the needle sterile/facing up.

  25. Remove the press and seal wrap from his bum, wipe off the lidocaine cream (30 minutes time is ideal for the numbing to occur). The lidocaine makes his skin kind of white where it's numb, so be sure to aim for the white spot for insertion.

  26. Clean the white spot with an alcohol swab, starting in the center and spiraling outward to cover the surface where the sticker will attach.

  27. Pinch/hold the wings of the needle patch and get ready to insert. Peel the stickers off the back of the needle piece.

  28. Make sure that the tubing is aimed toward the upper outside hip where the pump pack will be so there isn't a lot of extra tubing pulling on the site.

  29. With the wings pinched, insert the needle straight into the numbed/cleaned area and press down lightly on the stickers to keep it in place.

  30. Prepare to mount the other sticker up above where the waist band of his pants hit. Leave a little tubing slack between the insertion site and the other mounted sticker so it doesn't pull when he moves or pulls down his pants.

  31. Use the large IV dressing sticker and place it over the infusion site/needle site and a bit of the tubing. After pressed in place, remove the hard plastic cover so that only the 'skin' of the sticker remains.

  32. You can lock the pump (if you want) and then place it back in the pump pack, carefully tucking in any extra tubing.
  33. The pump is fully set up and functional!!! You did it!!

I'll probably come back and edit this once I get it down pat, so that I can make sure to include any other helpful hints. :) Here's a photo of the pump, tubing, pump pack (that he keeps it in on a belt around his waist) and the two stickers. The one above the belt is a connector piece where he can disconnect the pump so that he can take a bath. The on one his hip down lower has the needle in it that stays under his skin all the time. :)


windyday said...

Sarah you are such a brave mama with a very brave boy. May the Lord continue to overflow you with HIS joy and peace. Maybe you could arm whoever is caring for A with a video to watch... of you walking through each of those steps. WOW

Brenda said...

Hi Sarah!
What a complex contraption... & quite amazing. I believe that although complicated now, it will prove to make things much simpler in the long run.
YOU are beautiful - in every way.

Peter and Nancy said...

It's incredible to think of all the ways your life changes when you become a parent . . . and I'm sure you had no idea you would become an insulin pump expert. You did a great job explaining everything -- and your great attitude is just wonderful.

Terra said...

How is Andy doing with all the extra "stuff" on him? I'm sure having more consistent dosing is awesome, but having to carry a pump and a needle in your bum is the downside. Do they still do implantable pumps? Maybe for older kids.

Anyway, you are doing awesome with all of this!

David and Sarah said...

Wow Sarah! My husband has juvenile diabetes, but didn't actually contract it until he was 31 years old. He always says that it would be much more difficult to deal with diabetes in a child (regulating eating, insulin, etc.). May God be your strength as you trust Him even in this.

I was looking at Andy's "before" (discovery of diabetes) picture, and was so struck by that look. David (dh) lost 30 pounds before we discovered that he had diabetes. So grateful that you found out what was wrong with Andy and that he is so much healthier now.