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An insulin pump and infusion set. The infusion set is shown loaded into a spring-loaded insertion device (the blue object). A reservoir of insulin is shown attached to the set.

An infusion set, showing the insertion needle.

The infusion set loaded into an insertion device.

An example of site rotation, showing the progression along the upper buttocks (a popular choice for young children with very little body fat).

The upper side of the above infusion set, showing the quick release. The outer collar is rotated to the blue arrow and removed.

An infusion set is used with an insulin pump as part of intensive insulin therapy. The purpose of an infusion set is to deliver insulin under the skin. It is a complete tubing system to connect an insulin pump to the pump user: it includes a subcutaneous cannula, adhesive mount, quick-disconnect, and a pump cartridge connector.

Using an infusion set

Firstly, the user must attach a reservoir of insulin to the set and connect it to the pump. The set is then "primed" - the pump pushes insulin quickly through the tubing and the cannula to ensure no air is in the system before insertion. Note that it is vital that the infusion set is not inserted into the skin when the set is being primed (as this could result in the accidental delivery of a large dose of insulin). The user then peels off the paper protecting the adhesive pad and carefully inserts the needle beneath the skin.

The cannula is usually made of flexible plastic, which allows it to move without causing discomfort to the patient. The needle is pushed into the layer of fat below the skin, taking the plastic cannula with it. The needle is then removed, leaving the cannula in place. Insertion should be done in a fairly swift movement to avoid the cannula "bunching up" around the needle. The needle is then removed, leaving the cannula below the skin.

A few pump users prefer an infusion set with a steel needle instead of a cannula. The cannula surrounds a steel needle similar to that found on a hypodermic syringe.

Insertion devices

Some pump users prefer to use an insertion device to insert their sets, rather than pushing the needle in by hand. These are spring-loaded and are designed to push the needle into the skin quickly and (usually) painlessly. The user simply loads the primed set into the insertion device, peels off the paper protecting the adhesive pad, places the device against the skin and presses a button. This may be an advantage for those with needle phobia.

Sites for infusion sets

Many pump users site their infusion sets on the abdomen, in a roughly semicircular area around and below the navel. Other sites include the upper leg, upper buttocks, hips, upper arms and lower back. Insulin absorption may vary from site to site, so it is important that patients are advised of the most effective sites to use by their diabetes adviser.

Rotation of sites

The infusion set must be replaced regularly, usually every 2-3 days. Insulin absorption becomes less effective the longer the set is left in place, leading to poorer control of blood glucose. For this reason, the site of the infusion set is moved when the set is changed. Often a number of favorite sites for the infusion set are used on a rotation basis.

Disconnecting the set

The set can be disconnected from the pump and tubing with a quick-release that leaves the cannula and adhesive pad in place. This is convenient when swimming or showering (since most pumps are not fully waterproof), or when engaging in any activity when it is not desirable to be attached to the pump.

Types of infusion set

There are several types, styles, and sizes of infusion sets available to allow an insulin pump user a choice to customize what works best for them. These vary in cannula length, cannula entry angle and in the length of tube connecting the cannula to the pump. For instance, an individual with little body fat may choose to use a set with a short cannula that enters the skin at a shallow angle, whereas an individual with more body fat may find that a longer cannula entering at right angles to the skin works best. Most infusion sets have a standard Luer Lock connector so that they will mate to most insulin pumps. However, this is not always the case: some pump manufactures use a proprietary connector, and so their customers must buy only their infusion sets.

For Additional Information

For help choosing an appropriate infusion set, pump users may contact their certified diabetes educator or one of the following support groups for insulin pumpers:

• http://insulin-pumpers.org/
• http://www.childrenwithdiabetes.com/pumps/links.htm
• http://insulin-pumpers.org/pkids.shtml

For more information, see the manufacturers websites:

• http://www.animascorp.com/products/pr_infusion.shtml
• http://www.infusion-set.com/
• http://www.disetronic-usa.com/dstrnc_us/rewrite/content/en_US/3.3:30/article/DCM_general_article_295.htm
• http://www.minimed.com/products/infusionsets/index.html
• http://www.cleoinfusionsets.com/
• http://www.mysimplechoice.com/prod.htm

Various infusion sets at a glance:

• http://www.codan.de/
• http://www.diabetesnet.com/diabetes_technology/infusion_sets.php

Chose the right infusion set for you:

• http://www.medtronic-diabetes.co.uk/ProductInformation/InfusionSets/whichinfusionset.html

Wikipedia content modification information:

• This page was last modified on 28 December 2007, at 19:19.

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