# Pulling Cannulas Out



## Ruthie (Jul 1, 2013)

Hi All,

I haven't been around in quite a while so I apologise dipping back in to ask advice but...

My 4 year old has started pulling his cannula out, removing his pump from it's pouch, the pouch from its belt and spreading the component parts around the house,  everyday since last Thursday.  He has told me it's not him but 'naughty fingers'.  Has anyone experienced the same? Any advice would be gratefully recieved.  Unfortunately, Addenbrookes treat him so well that the 'going to the hospital' reasoning doesn't work with him as, apparently, he'd quite like it!

Thanks x


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## Redkite (Jul 1, 2013)

Lol at the naughty fingers!! 

My son was still on injections at that age, so I don't have direct experience.  Is he ripping the cannula right out or detaching the pump at the cannula site?  Could you put a dressing over the top e.g. a tegaderm, so he can't get at it so easily?  And do you have a cover for the battery cap and reservoir so naughty fingers can't accidentally unscrew them?

Does he talk about his diabetes, do you think he's trying to express some frustrations with it?  Maybe he could help choose a cool new pump pouch, and have a sticker chart with rewards for keeping the pump in the pouch?


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## Ruthie (Jul 1, 2013)

Thanks for the reply Redkite.  He's pulling it out of his leg.  I don't think he's realised that the reservoir unscrews, yet!   I did wonder about covering it with a plaster etc.   He is/was fairly relaxed about diabetes in general but I was wondering today if it is one thing too much at the moment for him.  They are in the midst of a fairly heavy programme of introductory visits to his new primary.  

He DKA's at the start of June following a prolonged high temp and had keytones of 3.4 on Sat morning for a few hours before we finally got control of them.  I think that he must have removed his cannula in the night as we woke up to the noise of him puking.  So, i am increasingly concerned really.  Keytones give me the heeby jeebies!


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## HOBIE (Jul 1, 2013)

Hi Ruthie. How about telling him he has set the buzzer off at the nice Docs & you got a phone call from head office to see why.   I know it would have worked on me as kid but really good luck with those tinkerbell fingers. He is an little lad growing up


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## Redkite (Jul 1, 2013)

Ruthie said:


> Thanks for the reply Redkite.  He's pulling it out of his leg.  I don't think he's realised that the reservoir unscrews, yet!   I did wonder about covering it with a plaster etc.   He is/was fairly relaxed about diabetes in general but I was wondering today if it is one thing too much at the moment for him.  They are in the midst of a fairly heavy programme of introductory visits to his new primary.
> 
> He DKA's at the start of June following a prolonged high temp and had keytones of 3.4 on Sat morning for a few hours before we finally got control of them.  I think that he must have removed his cannula in the night as we woke up to the noise of him puking.  So, i am increasingly concerned really.  Keytones give me the heeby jeebies!


Oh no, that's not good .  Have you spoken to your hospital team?  Could you use his bottom for a cannula site, as this may be harder for him to reach round and pull out the cannula?  I would definitely recommend covering it with a tegaderm dressing, although this will make it equally difficult for you to disconnect for bath time.  If my son had done this, I would have probably been quite cross with him and been very firm as to why he had to leave the cannula alone, but also with rewards for complying!  Hope it's just a phase....


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## Pumper_Sue (Jul 1, 2013)

Hi Ruthie, sorry had to laugh about the naughty fingers  Perhaps tell him naughty fingers might not have any treats if they become naughty again.
Have you tried using something like skin tac to hold the cannula in place? Only way to then remove it is to use some adhessive remover. Thus if he does try pulling it out he wont be to happy about it.
I also remember another parent many years ago making little pockets in her childs clothing for the pump. It was very cleverly done as the pockets were placed in the middle of the back area. Child couldn't reach the pump


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## Ruthie (Jul 2, 2013)

Thanks hobie and pumper_sue!  His DSN is sending us some spray to use before we site his cannulas as it's possible they're itching him.  Worth a shot!  It's one thing after another with little boys before you even add in the big D!


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## Pumper_Sue (Jul 2, 2013)

Ruthie said:


> Thanks hobie and pumper_sue!  His DSN is sending us some spray to use before we site his cannulas as it's possible they're itching him.  Worth a shot!  It's one thing after another with little boys before you even add in the big D!



sounds like Cavilon spray, Ruthie. It works very well for stopping the itch.


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## LaughingHyena (Jul 19, 2013)

I was looking round at pump pouches last night (getting my pump in a few weeks so trying to be prepared), there were a couple of places which had toy pumps and pump bands for teddies. Does he have something like that?

For my kids giving them the old asthma inhalers in the toy doctor set brought up a lot of conversations about how, why & when they are needed and what teddy didn't like about taking it.


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## Ruthie (Jul 21, 2013)

He has a medtronic lion, Lennie maybe? he calls in Raa Raa.  The pump fits in it but he uses it as  teddy really. Thanks for the tip, I'll look into a different pump pouch.

I'm at my wits end really. We've been spraying with the Cavilon spray and covering his cannula with those big see through plasters they cover up topical anaesthetic with and he's still pulling them out!  He just laughs at us.  I've been trying to calmly talk to him every day about his condition and why he needs to keep them in and when I test him and say what's your condition called he says it's bio-luminescence.  Flaming Octonauts!  This weekend I've also been bitten twice, pinched, kicked and had my hair pulled as he's been consistently high due to, at least in part, his cannula being fiddled with constantly.  Oh and lots of 'I hate you/grown ups' and Marlene-esque 'I want to be alone'.  He was 4 on Monday.


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## Pumper_Sue (Jul 22, 2013)

Ruthie, have you asked him why he pulls the cannula out? IE, does it itch or hurt?

As he is old enough to understand things also ask him what he wants, needle 5 times a day or his pump.


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## Redkite (Jul 22, 2013)

Ruthie said:


> He has a medtronic lion, Lennie maybe? he calls in Raa Raa.  The pump fits in it but he uses it as  teddy really. Thanks for the tip, I'll look into a different pump pouch.
> 
> I'm at my wits end really. We've been spraying with the Cavilon spray and covering his cannula with those big see through plasters they cover up topical anaesthetic with and he's still pulling them out!  He just laughs at us.  I've been trying to calmly talk to him every day about his condition and why he needs to keep them in and when I test him and say what's your condition called he says it's bio-luminescence.  Flaming Octonauts!  This weekend I've also been bitten twice, pinched, kicked and had my hair pulled as he's been consistently high due to, at least in part, his cannula being fiddled with constantly.  Oh and lots of 'I hate you/grown ups' and Marlene-esque 'I want to be alone'.  He was 4 on Monday.



Hi Ruthie,

I was wondering if the "naughty fingers" were still at work!  Oh dear.  Does your clinic team have a psychologist?  It may be worth asking for a chat with them, because it sounds as though this might be his way of expressing how he hates having diabetes, and ripping out his cannula is putting himself back in charge.  Have you considered having perhaps a 3 month break from the pump (don't hand it back!)?  He would have to have injections for snacks, meals and corrections, and couldn't exert the "control" over the situation the way he can with pulling out his cannula.  After a few weeks he might begin to see how nice it is to have a bolus through a cannula instead of all these injections.  I think you need to talk to your clinic team.


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## Hanmillmum (Jul 22, 2013)

I remember going through a similar thing (albeit short-lived) My daughter began this once she was tucked up in bed and would shout me up to tell me the news  She got very sick of having a quick replacement though and this was an incentive to stop (as well as a stroppy mummy too probably!!)
Sorry I can't offer anything else to the others suggestions, I do hope it resolves quickly, I can empathise with the stress of it.


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## Ruthie (Jul 22, 2013)

Thanks for your replies!

Yes, he says it's itchy, which is why we were given the cavilon spray.  To be fair, the sites do look redder than usual but I'm not sure that is a reaction to the cannula or to his constant scratching.  I emailed his DSN over the weekend and expect to hear from her tomorrow as she doesn't work Mondays.  In the email I enquired about the dept Psychologist.  My husband thinks it's because he's hot as often we find him completely nude but then other times it's just hanging through his shorts.

Oh and get this, last night he told me a giant squid made him do it!


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## trophywench (Jul 22, 2013)

Well tell him a giant shark has just eaten the giant squid and is now looking for a succulent little boy with naughty fingers for his next course ......

On the other hand probably best not .....


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## Pumper_Sue (Jul 23, 2013)

trophywench said:


> Well tell him a giant shark has just eaten the giant squid and is now looking for a succulent little boy with naughty fingers for his next course ......
> 
> On the other hand probably best not .....



Thanks for that my coffee has just ended up on the keyboard


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## LaughingHyena (Jul 23, 2013)

> He has a medtronic lion, Lennie maybe? he calls in Raa Raa. The pump fits in it but he uses it as teddy really. Thanks for the tip, I'll look into a different pump pouch.



I was thinking of a toy pump he could put on his teddy, something like this one

As I say when I gave my daughter an old inhaler and spacer for her to play with with her dolls she would act out both sides of the conversation, mummy wanting dolly to have her medicine and why dolly didn't like it. Gave us a few more clues than the screaming tantrums when we tried to give it to her!


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## Ruthie (Aug 5, 2013)

Hi! Just a quick update.  We have three play specialist appointments at clinic for the summer hols and they seem fairly confident that they can make some progress.

He and I are at my Aunt's and a sharing a room.  I walked in last night to find that he's pulled his pump out and then found the hypo treatments (I'm kicking myself for leaving them in the room but they were hidden in our clothes bag).  He bit his way into a carton of Ribena and drank the lot and then ate a whole bag of Haribo.  I feel it may be a long road....


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## LeeLee (Aug 5, 2013)

I can't help, but can offer sympathy... my little granddaughter came to stay on Saturday, and really didn't want to go to bed.  After the routine stuff, bedtime story and several songs, I closed the door.  Strange noises followed.  When I went back to check what was going on, she held out her hands and told me that they were being naughty, throwing Teddy round the room!


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## trophywench (Aug 5, 2013)

Ruthie, have you tried not LOOKING at his face when you attend to him after he's been naughty?

Young children do actually respond to this, as long as next time he sees you (I mean, you need a gap in between) you are just normal with him.

Thing is he has you over a barrel.  He knows you will check on him, and he wants you there fussing over him even though he knows you won't be best pleased, and he also knows because he's done it before and you don't actually punish him - so basically it's just emotional blackmail for your attention really.

I didn't want to go to bed, or I've woken up - and I'm bored and she (or they) aren't here to play with me..... I know what I'll do to get her (them) here ......  Just the same thing as LeeLees GD 's hands throwing those teddies about.


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## Northerner (Aug 5, 2013)

It's beyond me, but I hope you can work it out soon! Just an out-of-the-box thought, what about boxing gloves? If his hands are naughty they have to stay in the gloves at night? Or is that cruel? I'm not well-known for my parenting skills!


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## Redkite (Aug 9, 2013)

Ruthie said:


> Hi! Just a quick update.  We have three play specialist appointments at clinic for the summer hols and they seem fairly confident that they can make some progress.
> 
> He and I are at my Aunt's and a sharing a room.  I walked in last night to find that he's pulled his pump out and then found the hypo treatments (I'm kicking myself for leaving them in the room but they were hidden in our clothes bag).  He bit his way into a carton of Ribena and drank the lot and then ate a whole bag of Haribo.  I feel it may be a long road....


Just seen this, hope the play specialists can help.

Sneaking sweets etc. is normal behaviour unfortunately!  But we successfully introduced treat days, where sweets could be had with a bolus.  And he still has "sugary Saturday", where Coco Pops or similar are allowed for breakfast.  A total ban wouldn't be a good idea


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## Ruthie (Aug 15, 2013)

Just a quick update! 

We had our first play session today.  It was centred around a puppet called George who kept pulling his cannula out because it was itchy.  It was a good session!  We're also working on a social story that we can read to him about himself and his diabetes.


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## Redkite (Aug 15, 2013)

That sounds really positive, hope he enjoyed it!


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## Pumper_Sue (Aug 15, 2013)

Ruthie said:


> Just a quick update!
> 
> We had our first play session today.  It was centred around a puppet called George who kept pulling his cannula out because it was itchy.  It was a good session!  We're also working on a social story that we can read to him about himself and his diabetes.



Hi Ruthie, things are sounding positive, hope things stay that way


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## Ruthie (Sep 1, 2013)

We've only had one cannula out in 2 weeks.  George is on the Christmas card list!  AND he woke us up to tell us his pump was beeping at him (battery warning). I could have wept with joy!


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## Northerner (Sep 1, 2013)

Ruthie said:


> We've only had one cannula out in 2 weeks.  George is on the Christmas card list!  AND he woke us up to tell us his pump was beeping at him (battery warning). I could have wept with joy!



Terrific news! Well done George!  And well done all round!


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## Pumper_Sue (Sep 1, 2013)

Ruthie said:


> We've only had one cannula out in 2 weeks.  George is on the Christmas card list!  AND he woke us up to tell us his pump was beeping at him (battery warning). I could have wept with joy!



Wow, that's fantastic news Ruthie, so pleased things are improving


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## Redkite (Sep 1, 2013)

That's great news


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## trophywench (Sep 2, 2013)

Oh Phew! - I'm really pleased, hopefully he'll get to a stage where he doesn't remember he did it.


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