New Sticky

Every other day Johnny needs his site changed.  We call them "stickies" because, well... they stick to him.  A more accurate word for them would be "inserties" since they are actually inserted into his skin, but I think "sticky" goes over better for everyone.  These stickies are how his insulin is delivered to his body by the pump instead of the shots we used to give. 

Today was a New Sticky Day, so I took pictures to share with everyone.  Please forgive the quality as they were with my phone, then most of them were zoomed in.

 First we head over the the Diabetes cabinet.  Yes my corner cabinet in my kitchen  is 3 shelves, wall to wall Diabetes goodies.  We are shipped supplies to last for 3 months and with most of them being changed every other day, plus extras for "oppsies" that brings it to 50 sets of site changes.  Additionally we have 12 Dexcom sensors, alcohol wipes, barrier wipes, adhesive wipes, adhesive remover wipes and liquid, numbing creams, spare meters, 450 test strips (1 month supply), lancets, urine ketone strips, blood ketone strips, neosporin, and band aids.  (Our refrigerator has about 10 vials on insulin in it at any one time also.)

First thing is first, we need to numb the new site.  I use Press'n Seal squares with about a nickle size amount of numbing cream.I find a spot with enough fat that also is free of recent poke marks and scars to apply the Press'n Seal. Then we wait about an hour.

Once the hour passes, and Jocelyn is settled somewhere for a while we begin.  I gather the items needed.
From top left to right: adhesive remover wipes to take off his current sticky, alcohol wipe to clean the insertion point on his current sticky, neosporin to help the site heal.  We found out he is allergic to latex recently and of course do not have any latex free band aids yet, but it is on the list.  Next, is his insulin cartridge, vial of insulin (Humalog), "sticky", alcohol wipe, adhesive wipe, opiflex tape, scissors, and pump.

We use the adhesive remover wipe all over his old sticky.

Once removed I clean the insertion site (and my finger tips) with an alcohol wipe. (Not Shown)

I also apply Neosporin.

I open the sterile package that contains his insulin cartridge that is loaded into the pump.

I assemble the syringe to draw up the insulin.

I draw about 40 units of insulin.  I tap to remove are bubbles.

I start 3 piles.  Waste / Sharps / To Be Used.

 I then start the program to get Johnny's Pump ready for a new cartridge of insulin.

I open the new set.  This is the tubing that runs from the pump and is inserted into his skin.  We use Contact Detach, but used to use Inset30.  We had to switch because Johnny is allergic to the Inset30 cannula (flexible tube inserted under the skin). 

I attach the tubing to the insulin cartridge.

I run the program that loads this new cartridge of insulin.

This set is 2 peices.  The reason it is 2 pieces is so that we can disconnect the pump from Johnny but still leave his sticky on.  That is great for things like taking a bath, when the pump isn't needed for a few minutes and we don't have to re-insert a new site.  It just clips in or out very smoothly.

Then I prime the set.  This just means I force insulin throughout the tubing and out the needle so that once it is attached to Johnny it is full of insulin and not air.  For reference, I prime about 15 units of insulin.  So it is about 12 units of insulin just in the tube and needle (I let some squirt out).  He only gets 12 units a day currently.  I just want to show you how such a small chemical change in our bodies could kill us.  He would die with out these 12 units.

I then cut a small rectangle of medical tape to tape the sticky down.  I've learned that 3 year old can pull just about anything out if it isn't taped down.

So we begin the actual insertion.  I remove the Press'n Seal, and wipe off the numbing cream with a damp paper towel.

I open my I.V. Prep and my alcohol wipe.  The I.V. Prep makes the area extra sticky as well as cleans it.  The alcohol wipe is actually just for my fingertips because they get so sticky from the I.V. Prep.

I wipe a good sized area, maybe a 2 inch diameter.

Yes it is that sticky, I HAVE to clean my fingertips or the rest of the supplies would stick to me.

I remove the contact paper on all the adhesive parts of his sticky.

Sorry for the blurry photo but this is a picture of the steel needle that stays in him for the next 2 days.  Pretty thin and short.

 I press the needle into his skin where I put the numbing cream.  The other sticky is where we can disconnect the tube from if we so choose.

He get the tape placed over the entire site with the needle.  One time I taped down the tubing that runs between the two stickies.  I found out 2 days later when I took it all off that he was allergic to that tubing as well.  Ugh... It doesn't seem to get irritated unless it is taped down though.

Finally the pump is placed in his SpiBelt and zipped closed.  His pump is locked by the way, so even if he took it out, the buttons won't work.  Its pretty child proof.

 

 Including the numbing cream, stopping to fill sippy, stopping cause Johnny tells me his is nervous, stopping cause Jocelyn needs to be repositioned to stay happy, the whole thing takes me about an hour and a half.  I know it could be faster but it just isn't right now.  So that is 4.5-6 hours a week I spend on this task. 

The good news is that normally he doesn't mind it much.  But when we have to change the site with out numbing cream, because it came out on its own or something, that is when we have a few to a lot of tears.  For these pictures he was way to busy watching a LeapFrog DVD to care what I was doing.