# Angled cannulas/sets - any advice please...



## curlygirl (Feb 22, 2016)

I have been having trouble with using the insight flex cannulas on my stomach area for a couple of months, although they are fine on my lower back area, and they have been very painful and blocking and bleeding a lot.

The pump rep today gave me some of the insight tender - a 13mm angled set.

I am not great with needles at all (at least on this forum I hopefully won't get the response I have had from people many times before of 'but you're diabetic' - as if that means that the fear of needles I had will have magically disappeared at the same time as my bodies ability to produce insulin did!) I learnt to cope with needles as they are necessary and since going on the pump, cannulas too, but the size of these ones and the fact that you have to see it so much is somewhat off-putting...

Anyway I have inserted one, but it felt difficult - by which I mean that the initial bit with just the needle seemed to go in ok, but once it was far enough along to have the tubing going in too, it seemed hard to push it in. I have got it in, but how do I know while I am doing it whether it is kinking etc?

Any advice or tips or reassurance from anyone who uses these angled-type of sets would be appreciated...
Thanks
Curlygirl


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## SB2015 (Feb 22, 2016)

If you think it may have kinked, you could test after about an hour.  If there is a blockage your levels will rise, and depending on the pump you may pick this with a raised level before the pump alarms due to increased pressure in the tube.  

However after spending a lot of times in the early days of pumping wondering whether I had got things wrong,  I now tend to simply change my cannula if I am not sure that it is right,  or if it hurts, or stings.  I just feel that it is not worth waiting as usually I find it was a faulty insertion.  I do realise that that is going to be an extra needle to deal with.

I am on the old Accu Check pump (Combo) so I am not sure whether the cannulas for the Insight are the same, but it know that there are a wefts on this forum who use your pump so they will no doubt be of more help

Would it be worth getting in touch with your DSN to go through an insertion? I know that the different angles feel very different to start with.  I also found that there were you tube videos online showing an insertion of each of the cannulas I have tried.

I hope that you get this sorted.


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## curlygirl (Feb 22, 2016)

Thanks for your reply SB2015. I was told when I started on the Insight that I should change my cannula/set prior to a meal so that it would show up quickly whether there is a problem, and I have stuck to this by doing it before breakfast. I know that if there is a problem with these new angled ones it will show up by testing too I guess, I just wondered if there is a way of knowing whether it had kinked as you were inserting it as well at all.
Like you said, sometimes you can tell straight away that they are not right, and I am used to knowing what this would feel like with the straight sets, but I am a bit lost having just started using the angled ones. The other thing is that I use the inserter for the straight 'Flex' ones, which on the whole catapults it in ok, but having to edge it in myself, I am worried that I could kink it more easily, although whether this is the case I am not sure...

Thanks.
Curlygirl


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## Pumper_Sue (Feb 22, 2016)

I've used the angled sets for years and only had one problem and that was my fault.
The ones for animas are called comfort shorts so know exactly what you mean about the size and feeling a bit iffy about them. As it's a steel needle going in you wont kink the cannula so don't worry about that at all. Just remember to take off the needle guard before inserting it.


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## curlygirl (Feb 23, 2016)

Thanks Pumper_Sue.
I obviously didn't kink the cannula as it worked ok, right up until it came out as I was pulling my top up! So far the sticky stuff on these 'Tender' ones does not seem as sticky as the ones I was using and was already peeling away at the edges after less than 24 hours. Just had to put another in, which I have done, but the feeling of having to give it several shoves to get it all the way in was still no nicer... Hopefully I'll get used to using them and it will get easier...
Curlygirl


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## trophywench (Feb 23, 2016)

That's exactly what has always put me off the angled ones Curlygirl ! - the needles look bad enough in the straight ones, and you know they are OK and have to be like that so the 'pointy' end is proud of the actual cannula while you are actually inserting it.  Plus of course as you say you have to insert them by hand whereas using the 'bonker' for the straight ones it just doesn't seem so traumatic, does it.

However if you think about it, how would it be, how would you feel, inserting a straight one by hand? - I hate having to do that too but sometimes on odd occasions I've needed to - I may have the spare cannula in my bag but I've never bothered carting the inserter with me.  Just one more thing to flipping lose, isn't it?   Why does it not fel 'orrible when one uses the inserter? - because, my dear Watson - it does the deed QUICKLY, that's why! and from my ancient memories of actual syringe jabs which confirms it - so I am gonna tell you that the FASTER you can do the whole thing, the better and easier it will be.

Get poised - take a deep breath - and go for it pdq whilst breathing out.

Then get micropore (or even two long Band Aids if you haven't got any to hand - and stick it on top of the cannula sticky !

I think if these were 'sample' Tenderlinks, then she probably hands out less than Flexlinks - so they might have been a bit elderly?  Since 2009 I only had ONE box of the latter where the sticky wasn't, so maybe these are the same and you just happened to get a poor one, or you had gone a bit 'clammy skinned' from being a bit scared?


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## SB2015 (Feb 23, 2016)

I briefly used the angled tender link cannulas.  I had a few that fell out and ended up using micro pore to secure a bend in the tubing leading from the cannula to the pump.  That stopped them coming out, but then I reacted to the sticky on those cannulas so switched to the Flexlink.  Apparently AccuChek use three different sticky stuffs on their three different cannulas so that we have different options.  I am still on the combo so not sure about the Insight.


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## trophywench (Feb 23, 2016)

Insight cannulas are very similar but where you attach the tubing to the cannula, is a very slightly different shape - so you can't use a Combo cannula with the Insight or vice versa.


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## curlygirl (Feb 24, 2016)

Thanks trophywench. I will try to insert one faster next time if I can and see if that helps - it just feels a bit like having to shove it at the moment, but that could be due to knowing the size of the needle underneath as much as that it is actually meeting resistance in my skin etc
I don't think these could be old sets as they only started doing the 'Tender' ones for the insight in September as far as the reps information went, but maybe they are just a batch of unsticky ones. I hope so as I have had to resort to sticking Elastoplast and rock tape around it to keep it stuck on...

Thanks SB2015, I might ask Roche about whether they use different adhesives on the 2 available ones for the insight when I next ring to order supplies.


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## trophywench (Feb 25, 2016)

You're right about then being new - I'd kinda forgotten that, it was info my brain didn't need to retain since I never use em!  LOL

(That's what happens as you age, the filing system gets full so the filing clerk chucks out the stuff he considers useless! - unfortunately he doesn't clear out the old stuff which is also useless now - so you are condemned to remembering something your ex-husband's Auntie said to you in 1969 for ever!)  (along with remembering who won the World Cup in 1966 - and the 1972 Munich Olympics ROFLMAO)


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## everydayupsanddowns (Feb 26, 2016)

Is there not a spring-loaded inserter for the Roche ones @curlygirl ? Might be worth asking. I've been using the angled Medtronic ones (Silhouette) for years as the straight ones gave me no end of trouble.

I can hardly remember the last time I had a problem with a set and it was every few weeks at one point on 90-degree ones!

Stick with it and check with DSN/Roche website to see if there's an inserter for them. The Silhouette kerplunker looks a bit like a medieval torture device, but it's easy enough to insert in my back one-handed as it has a button on the end.


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## curlygirl (Feb 26, 2016)

Thanks everdayupsanddowns. There is an inserter for the straight Insight 'Flex' cannulas, which is what I have been using up until now, but there is not one for the 'Tender' ones, it would be good if there was as I am struggling with them at the moment. The plan is to continue using the straight 'Flex' ones around the back where I would not be able to insert one of these new ones - and they seem to be ok round there anyway - but on my abdomen area try these angled ones as the 'Flex' ones are not working well at all there. I am going to ring Roche later today to order supplies so I will ask again just incase... I will also ask about the adhesive (or lack of adhesive more importantly) on the angled ones while I am ringing anyway.


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## Amberzak (Feb 26, 2016)

Hi Curlygirl. 

I am with you on the fear of needles front. These ones do seem more like needles. It takes me about 10 minutes to put a new one in. I hate doing it. 

But I do find the angled ones more comfortable when it's actually in. 

Good luck.


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## trophywench (Feb 26, 2016)

Mike they didn't have an inserter for the angled ones for the Combo either - and look how long THAT was on the market!

They haven't got ANYTHING for the Insight - the 'hard' belt clips don't last apparently and are awkward to use anyway, but at least less obtrusive and ugly than the hard one for the Combo came out of the ARK which was truly awful - Far Far too big -  which is exactly why I always used the skin and the belt clip/slide on that.  Which also made it warmer and softer to wear the skin in bed whereas the Insight is bloody cold if it percolates to the edge of the bed that my flesh doesn't reach to and warm up, and hard enough to wake one of us up should either of us lie on it.

God knows how but last night I apparently was trying to turn over but was stopped by my tubing so put my hand down my RH side to find the pump to take with me as I turned (cannula in top front of R thigh)  Couldn't find pump so got hold of the tubing a bit away from the cannula, reined it in a bit with my left hand so I could pull the still taut bit with my right hand - still more or less asleep, no actual thinking at all, it's second nature by now.  Pete, on his left side facing me, woke with a yelp!  Eh????

The tubing had got somehow entangled and I'd caused a tourniquet just where every bloke doesn't want one ...... and I made it worse when my R hand shot down towards the tangle still not knowing what it was tangled with, and just carried on taking this unrecognisable warm - 'pile' of 'loose skin' - WTF was that my hand touched then????  I soon knew, Dear Reader.  I assure you - I soon knew!

Ooopsie.......


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## curlygirl (Feb 27, 2016)

Thanks Amberzak. I am sorry you hate putting them in, but good to know you find them better overall.


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## curlygirl (Feb 27, 2016)

I am a bit lost for words to respond to your story TW, but I bet your husband found a few choice words at the time!


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## trophywench (Feb 28, 2016)

I don't think it needs a response Curly!  - and he did indeed ......  LOL


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## everydayupsanddowns (Feb 28, 2016)

Eek! At TW's story!

Do Roche sets use a luer-lock connection? Medtronic don't, but I think I remember from Pumping Insulin all those years ago that other manufacturers shared a connection type. Makes me wonder if you could use Animas (or a.n.other) angled sets with an inserter but that would connect to  Roche tubing?


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## trophywench (Feb 29, 2016)

No Mike - but the Combo uses a Luer where the tubing connects to the top of the reservoir, so that's where the 'Luer' reference comes from in your memory bank LOL.

The cannula end of the tubing has a 'click fit' connector, with the needle at that end of the tube concealed in a hard plastic tube around it, which clicks sideways into a hard plastic sheath on the top of the cannula leading to the actual cannula itself inside your skin.  To release the tubing, you squeeze on two bits of hard plastic each side of the needle sheath, hold onto the end of the outer cannula with the other hand, and pull the fitting away.

No idea if other pump tubing/cannula interface systems are the same as that. 

The Insight uses the same system as the Combo, but you can't use Combo cannulas with Insight tubing and vice versa as they are a tiny bit different shape.


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