Today’s pump user is afforded a high degree of ease and comfort in maintenance of this type of therapy. Gone are the days where the only options were messy antiseptic solutions and inappropriate bandage tapes. Over the years, a number of special products have been developed to make wearing an insulin pump a relatively problem-free experience.
As exciting and helpful as these products are to all of us, successful pump use will always depend primarily on proper care and protection of the infusion site.
Site Selection and Rotation
Site selection ensures predictable insulin absorption. It is important to choose a site that is free of undesirable tissue changes such as hardened areas, bumps, or tissue buildup called “hypertrophy.” All of these conditions are caused by overuse of a particular area. Try to choose areas not previously injected. The abdomen is the preferred site for any insulin administration as it has the most predictable absorption.
Rotation of pump infusion sites is crucial to consistent control. Wearing a site for too long may cause a loss of adequate absorption because the site has become “old,” even though there may be plenty of insulin left in the pump syringe and no apparent sign of infection at the site.
The skin must be clean and dry before inserting an infusion set. Skipping the cleansing step could potentially cause a serious infection that might require a course of oral or intravenous antibiotics and a surgical intervention as well. Applying a tape or dressing before a site is dry could contribute to problems with tape sticking adequately. Most pump users do not develop infections wearing an infusion set for a reasonable period of about 2-3 days. They usually prepare the site with a mild antibacterial soap such as Dial. This can be used alone or with an alcohol wipe. Some people with delicate skin prefer to omit the alcohol step as it is too drying to the skin.
For the pumper who needs a little extra protection, there are several stronger antimicrobials available. Some of these are briefly described here and all are generally available from pharmacies.
Hibiclens (Stuart Pharmaceuticals): An antimicrobial wash similar to Phisohex. Now available in individually wrapped pads.
Betadine (Purdue-Fredrick, Inc.): A medicated antibacterial agent. Available as a wash or ointment.
The Sof-Set dressing contains a mild antibacterial agent. The addition of an antimicrobial ointment over the needle at the insertion site followed by the dressing may afford a degree of protection against bacteria.
Tapes and Dressings
The following are brief descriptions of some of the most functional and popular products available at the present time. Unless otherwise indicated, they can be ordered through the manufacturer, pharmacies, or medical supply houses. Some of the manufacturer’s phone numbers have been included.
Polyskin (Kendall): A transparent dressing that is compatible with most skin types and is reported to stick well. Available from MiniMed Technologies.
Tegaderm or Tegaderm HP (3M): A clear tape dressing similar to Polyskin. Promoted for people with allergies and tape-sticking problems.
IV 3000 (Smith and Nephew United): This product is one type of OpSite. It is also a clear dressing specifically designed for IVs and pump sites. It is reported to have excellent adhesive properties for the very physically active person.
Compeed (Bruder Medical Products Division): A non-transparent bandage with an absorbent component and exceptional adhesion.
Hypafix (Smith and Nephew (800) 876-1261): A white tape with a good adhesive. Designed for sensitive skin. Uses include covering infusion sets, taping down dressing edges, and securing safety loops.
HyTape (Hy Pink Surgical (800) 248-0101): A pink fabric tape in several widths with the same properties and uses as Hypafix.
Transpore (3M) or Dermicell (Johnson and Johnson): A clear roll tape good for securing safety loops.
Silk Tape: This tape comes in two widths, sticks extremely well, but it is not transparent.
Paper Tape: This tape is usually reserved for people who have extremely sensitive skin and cannot tolerate other products. Some examples are Micro-pore and Duropore.
These preparations will help prevent irritation and sensitivity problems in most users by placing a barrier between the skin and the tape or dressing’s adhesive. They have the added benefit of helping a tape stick better. Be sure these barriers have completely dried on the skin before applying the tape or dressing.
Skin-Prep (United, Division of Howmedica (813) 392-1261): This Product is a protective dressing that is wiped on the skin prior to inserting the infusion set. It contains alcohol so also acts as an antibacterial. After letting it dry, proceed with the dressing of choice.
Shieldskin (Mentor Company): This product is similar in properties and uses as Skin-Prep.
Skin Tac “H” (Mason Labs, Inc. (800) 523-2302): A liquid adhesive that is brushed on the skin before applying tape.
If plastic parts of the infusion set are the problem, a two-tape or “sandwich” technique can be used. After cleansing the skin in the usual manner, one piece of a clear dressing is placed on the skin. The infusion set is inserted right through this tape and a second tape is placed directly on top of the first. This may also serve as a more occlusive cover for the infusion site.
For people who experience a great deal of discomfort when inserting a set, there is a product called Emla Cream. A topical pain killer, it is applied one hour before insertion.
Tape Tips (the booklet) is available free of charge from MiniMed Technologies. Call (800) 933-3322.
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This article has been adapted from Tape Tips (the booklet) published by MiniMed Technologies.
Some additional information for this article has been added by Leigh Steed.