Bleeding when removing infusion site

[cmdeans]

I have had an insulin pump for just over a week.  I've only changed my infusion site a few times, so I don't really know what's normal.

Today, when I removed the old infusion site, quite a bit of blood came out.  (It was running down my side pretty quickly.)  There has been no blood at all the other times and I was wondering if this is something that just happens occasionally or if I am doing something wrong.

Thanks,
Carol

[JDRF-Team-wak]

I am not a physician, but a volunteer and the mom of a type 1 diabetic on the pump also.  My daughter has had this happen, it is not a normal occurrence, but it does happen.  We were told that it could be the site was too close to a vein.  We were told not to worry about it, but to make sure the old site was clean, and to but Neosporin on it to keep infection away.   We usually put a dab of Neosporin on old sites as they help the site heal quicker.

Hope this helps. And good luck on the pump, we love ours.

[cmdeans]

thanks

[JDRF-Team-wak]

I forgot to ask, how often are you changeing your site ans which type of insulin are you using.  If you deveoped little red" pump bumpss" this will also heal them quicker. this  ususally happens with humolog.

[TonyAlmeida]

Ah!  The one thing pump manufacturers never list in their sales brochures or training classes!  :^)

These are called "Gushers" ... what has happened is that your cannula has either pierced a hair follicle or one of hundreds of tiny capillaries under your skin that you can't see.

This happens to everyone from time to time - but more so for leaner pumpers than the overweight.  Sometimes, there is no indication until you pull the old site out.  Sometimes, while you have the site in, you'll feel (what I can best describe) an slightly uncomfortable "pressure" when you bolus.

Things that contribute to gushers:

1. Taking a blood thinner like aspirin or sinus medication before changing out the site.

2. Changing your site right after a warm or hot shower which brings a lot of blood to the surface of your skin or in hot weather.

3. Pulling out your old site slowly .... do it quickly.  Pulling it out slow allows the cannula to accidently nick something on the way out.

4. Not pulling out your site the whole way and letting the cannula go back in, then pulling it out or accidentally "turn the site" as you pull it out.

What to do when you get a gusher:

1. Don't panic.  

Looks like a lot of blood, but it really isn't.  Your capillaries have "valves" every inch or so.  The blood welling up through the cannula hole is the blood that was caught between where the cannula went through the capillary and blocked the blood and the valve behind the blocked blood.

2. Let it bleed.

The mistake people immediately make is to apply pressure.  If you block the cannula hole where the blood is coming out, it will always seep under the skin and give you a big black bruise that'll take a couple weeks to go away.

Instead, let it bleed out.  You can lightly pad away the blood with a gauze pad or towel or whatever to keep the blood from staining your clothes, just don't block the opening.

It'll stop in a few minutes.  You won't die.  

3. Once the bleeding and seeping stops, you'll probably get a little scab over the cannula hole and then you can apply your neosporin antibiotic.  A little orange bruising my show up a later on.  This is normal.  For me, the orange bruises take about 8 days to disappear.  Forget about spending money on putting K Cream on the bruise to make it go away faster, the bruise will go away on it's own.  Neosporin helps a little.

Try to stay away from areas with a lot of body hair.

As for the little red bumps where the cannula went in, it happens with either Humalog or Novalog.  A lot of people want to blame this on the teflon cannula on the infusion set, but it's really just your skin getting irritated that you punctured it with something. Just a larger version of the little red dots you get on your fingers from lancets when you check your blood.

I don't call these Pump Bumps - Pump Bumps are usually caused by hardened nodules of insulin that crystalize under the skin.  Not common much anymore since the insulin we use now is more pure.  I call these Infusion Site Bumps - ISBs.  People with sensitive or acidic skin types will get these.  They're not too bad if you change infusion sites every 3 days.  You may also get these if your skin doesn't like the skin prep you use before you insert your site.  I used to use IV PREP then switched to Bard Barrier Film because the IV Prep irritated my skin.

[cmdeans]

Thanks for all the information.

I change my site every 3 days.

I do take a baby aspirin every day, and i think it was not too long before I changed my site.  

I also tend to change them very slowly, because I have very sensitive skin and the adhesive is so strong that sometimes it tears my skin.

Thanks again for all the helpful information!

[TonyAlmeida]

The baby aspirin isn't strong enough to do that - regular aspirin, sinutabs .... those are what you have to watch out for.

Pulling out your sites slow because of the adhesive on the infusion set .... that you can also do something about.  Purchase a box of Smith and Nephew Uni-Solve adhesive remover wipes. You wipe the adhesive dressing for the infusion site with these and it will loosen up the adhesive and make the infusion site easy to pull out without the adhesive tearing up your skin.

This, unfortunately, is one thing I think every pump trainer I've worked with forgot to explain to new pump users.