Jane complains of a burning pain at the abdominal insertion site as soon as the cannula is inserted. It doesn’t subside, so she removes the set and re-inserts at a new location.
During his sleep, Bob scratches the insertion site and later awakens to a wet, sticky sensation at the insertion site. He is surprised to discover a large amount of blood on his sheets and an unattached infusion set.
At camp, Kathy carries a box of supplies into a cabin and bumps into a table, hitting her pump. Several hours later, she checks into the infirmary complaining of nausea and tells the nurse her glucose level is reading “high.” She had given at least two correction boluses to lower her rising glucose level. She is surprised to find her ketones reading “large.” Kathy smells insulin during the infusion-set change and discovers a crack at the luer end of the insulin reservoir.
Trauma to an infusion site may cause some discomfort. It is always wise to look at the site whenever there is discomfort, a sensation of moisture on the skin or the odor of insulin.
Pain can be caused by trauma to nerve endings, blood accumulation under the skin or a cannula or needle tip coming in contact with muscle tissue or the membrane covering a muscle or other internal tissue (fascia). This could also be a warning of an infection or the start of an abscess.
A bleeding insertion site does not absorb insulin well. A blood vessel may be punctured or nicked during insertion. Blood can back up into the infusion set and tubing. The body’s response is to wall off the area to stop the bleeding. Discomfort is usually caused by this process. The blood has no place to escape and will exert pressure on the surrounding fat or tissue cells. When the set is removed, the blood has a narrow outlet to spurt out through the skin. Any pressure built up behind this blood pocket will add to the force behind it, creating a “gusher.”
Keep tissues or paper towels handy when doing a site change. If blood is draining, apply firm pressure to the area for five minutes with the tissue or towel. When the blood flow has stopped, apply a cotton ball to the area and secure it with an adhesive bandage or clear site dressing.
Accidental set removal can cause tissue trauma and potential bleeding at the insertion site. Force applied to an insulin reservoir extending outside the pump itself can crack or shear off the protruding luer end.
What to Do? Precautions You Should Take
Check infusion site integrity frequently during the day and whenever waking at night. Evidence of blood is a warning to check your glucose level and change the site. Discomfort at the site can be a warning to check and change it. Remember: Occlusion alarms do not always occur with these incidents. Protect your pump and secure insertion sites during work and physical activities.
If you suspect there might be a site infection, contact your diabetes care team and have it checked.