Insulin Pump Infusion Sets
September 17th, 2010
The wrong infusion set can ruin pump therapy for you.
are the overlooked critical element inpumping.You’ll find 10 features of sets on this page that might make orbreak your pumping experience. All too often people assume that the expensive hardware of the pumpisthe most important element. But…if the insulin isn’t making it throughthe tubing to you, OR if you aren’t comfortable wearing the tubing, ORifthe set keeps ripping out then the pump is of little use toyou.
Asa diabetes educator I encourge clients to tryas many types of as possible. As a pumpermyself, I follow the same advice and try whatever comes out. Considerasking forsamples from the pumpmanufacturers. Keep in mind the following factors which could “make orbreak” the pumping experience for you. If you don’t know what a setlooks like and the name of its parts, check here so the comments belowwill seem clearer to you.TK
Features that could make or break pumping for you:Angle of insertion:
Thisangle of insertion is the biggest difference between all infusion sets. can be divided into twocategories: those designed to have the cannula or needle inserted at 90degree (straight down) or those to be inserted at 30 degrees (technically 30-45degrees, but most people insert at 30-35 degrees). The 30 degree setsusually have more material to stick to the surface of your skin and areharder to rip out by mistake. However, the 30 degree sets use up abigger part of your injection area because the cannula inserts on along angle. This means rotation of sites can be just slightly moredifficult for some. Sometimes people switch to a 90 degree set for awhile just to help with using less of a footprint, so to speak. Mostof the 30 degree are quite similar so no need to tryall of them. If they look the same and look like they disconnect thesame, then they likely are almost identifical even if made by differentcompanies.
Soft cannula or metal needle:
Thecannula is thesoft tiny tubing of the insertion set that stays in your fat tissue. Itis placed under the skin with an insertion needle. The insertion needleis removed after the cannula is inserted. A cannula islike a small teflon tubing that gets softer and more flexible whenwarmed by your body. Some sets still use a metal needle instead of acanula. Most people use a cannula forcomfort, although some still do have a preference for a needle. Again,try not to rule one or the other out until you’ve had a chance totry them. Length of cannula:
Thirtydegree have a longer cannula than than 90degreeinsertion setsbecause of the angle they enter the tissue. Typically they come in 17mmlengths. Some brands have a shorter 13 cm length. Remember, thesesets do NOT go in straight down. They go in at angle, so ultimatelythey end up being no deeper than the 90 degree insertion sets.
Ninety degree are often available in 6 mm and 8 or 9 mmlengths. Now, before you assume that shorter is better, do considerthat shorter sets, particularly 90degree ones, rip out easier. There are ways around this though.Typically the 6mm 90 degree infusion sets are for children, leaner people orfor inserting in places that have muscle closer to the surface like insome people’s arms and legs. But, I am not a child and anyone who knowsmewould laugh if they heard me try to call myself “lean”, however, I douse a 6 mm 90 degree set at times because I find the 9 mm kinks even ifusing an inserter. I use a second skin tape to keep the 6 mmfrom easily ripping out. (Actually, I use a clear square waterproofbreathablebandaid with the padding ripped off and a hole cut in the centre to goover the hub of my Cleo set. Cheaper and more easily available.) Length of tubing:
The tubing is what connects the pump to you. Tubinglengths vary by an inch or so between brands but are generally 2 feet(60 cm) or 4 feet (120 cm) give or take. Consider where you are inserting your sets to help you decide on a length.If inserting in the arm and you want to keep the pump in your pant pocket, thenyou’ll likely need some longer tubings. Also, people who sleep with thepump under their pillows tend to like long tubings. Type of disconnect:
Thedisconnect is the part of the tubing that comes undone so you candisconnect to shower (or play, ummm… well, you know) and reconnectafterwards. Some disconnects are awkward and others less so. Also, it depends on where your insertionsites. Thisisreally a personal preference but a very important aspect of all insulinpump infusion sets. I particularly like the Cleo 90 degree set forits disconnect.It allows me to connect the tubing to me from any direction I chooseeven after I have inserted the cannula. I use the Cleo on sites that arenormally hard to reach as it is so user friendly for insertions anddisconnects.
On the other hand, I use 30 degree sets often because they are cheaper,but I use them on sites that I can easily get a grip on, so I can takethe tubing off and on. Luer lock or proprietary:
Theluer lock is where the tubingconnects to the pump (not to you). withluer locks are generally cheaper (generally, not always) and can beused on most pumps with theexception of Medtronic Minimed pumps (this is 2008 so you have areference point). The newer Medtronic pumps can only use specificMedtronic that do not have a luer lock, buthave their own proprietary connection. If something new and wildcomesout that is not made by Medtronic, well, chances are you can’t use iton your Medtronic pump. However, I have read that there are luer lockadapters for Medtronic pumps but not purchased through the company. Icannot comment on the use of those as I have not had any clientsuse them.
Ease of insertion:
Ifyou’ve ever put in a 30 degreeset you know there is a loong insertion needle. You can make themistake of going in too deep or not deep enough (quitgiggling ladies). There are now 30 and90 degree sets that come with insertion devices. That said, they maynot all be friendly to use devices. Unomedical (marketed also underAnimas) have a new 30 degree inserter set. Sometimes theinserter is a separate device to be used time and time again. Sometimes the inserter is included as part of each and every insulin infusion set, to beused once and discarded. See the notes below about disposal. Most companies selling insulin pumpinfusion sets offer a model that can be used with an inserter device sobe sure to check if this is something you need help with. Ease of disposal:
Iput this here because this is whatturned me off of an Animas 90 degree insertion set. After insertionusing their disposable built in inserter, the needleremained exposed. If I was so inclined, as told by the rep, I couldeasily pluck the needle out with a set of plyers and insert the needleinto a sharps container. The HUGE plastic inserter could then go in thegarbage. Yup. Right. I got my hubby’s plyers out twie. I wasn’tthrilled with the process. I was less thrilled thinking how I was goingto carry one of these suckers as a backup set in my purse given thehuge size. I suppose this is why I fell head over heals for theCleo. The Cleo retracts the needle so it can be discarded in thegarbage – and it’s smaller. But… please, some people love theAnimas 90 degree set. I encourage you to get samples before thumbingyour nose at any set. You are not me (be happy about that.) Cost:
As much as I am currently intoenjoying the Cleo, I do not use it exclusively because, frankly, it costs too much. Ten ofthem cost almost fifty dollars MORE than a set of 5 tubing and 10cannula (combo pack) of the 30 degree sets. So, in the end, most of my setsare the cheaper ones with about a third being the more expensive (which Ipick the most awkward insertion sites for since the Cleo is nicelydesigned for that). How flat it is against the skin:
Some onceconnected lay pretty flat against the skin (eg. most of the 30 degreesets). Whereas some of the 90 degree sets are less flat. What does thismatter? Well, if you are wearing clingy pants or dress or the like, youmight prefer a flatter profile. Also, if you are clumsy like me, youmight bump, slam, slide or cream into things. I’ve lost a few 90 degreesets that way (but not now that I keep my second skin bandaids on top.)So..if you’re a sexy dressor or a clumsy sod you might want sets thatlie pretty flat against the skin.
Inthe end, I must say that the clients I have seen have their favorite for various reasons that suit their personal needs, body and lifestyle. Do try to obtain samples by calling reps or the 1-800# of insulin pump companies.I had a friend who called to ask for samples. After some time, shecalled the 1-800# again since she had not yet received them. Thecustomer service rep must have felt badly, for she sent off an entirebox of (over $170 dollar value) for my friend to try. Which goesto show, it never hurts to ask.
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