# Me or the cannula?



## Flower (Mar 2, 2020)

This has been bugging me for a while now and I just want to ask. 

At a pump meeting a few months back we were discussing how to iron out a few spikes in otherwise good control. I said that some of the spikes were due to cannulas failing- as in being kinked or just not working as I would expect. I was asked 'why do you think it's the cannula failing?' That threw me a bit - I pile enough guilt and blame on myself for serious complications without adding extra guilt for causing cannulas not to work properly.

Is it my failing entirely when a cannula fails to work ? I rotate my sites and some areas I avoid as they just don't absorb. Next time I'm asked about a spike do I just admit that I'm to blame entirely for kinking the cannula or failing to absorb insulin adequately through skin battered by injecting for 42 years - or just shrug and say 'that's diabetes for you'. I can see the point but feel like I'm a bad workman blaming my tools even though sometimes things do just go physically wrong with a cannula.

Has anyone else been asked this?


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## Pumper_Sue (Mar 2, 2020)

*I have had some shocking cannulas from Medtronic and told them they were not fit for purpose.*
*One of the boxes I had contained 9 out of 10 cannulas that were bent on the end when removed.
*
*When using an Animas pump I had 2 failures in 8 years. So no it's not you.*


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## grovesy (Mar 2, 2020)

I am not familiar with Cannulas for Insulin Pumps, but I am with  cannualas in viens and they often get kinked and dislodged. So my logic would be those for Insulin Pumps they would be like to do so at times to.


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## everydayupsanddowns (Mar 2, 2020)

What a peculiar question! I wonder if they chose completely the wrong words and ended up asking something different to what they meant?!

I’ve certainly had dodgy cannulas, padticularly in my first year of pump use, before I swapped to angled ones. Even when the failed ones weren’t obviously kinked, and didn’t sound an occlusion alarm, it was easy for me to tell because doses/corrections weren’t working properly for 6-12 hours, and then when the cannula was swapped things clicked back into working as expected again.


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## JohnWhi (Mar 2, 2020)

Not an answer, but I agree that the question beginning "Why do you think ... ?" would make me blow a fuse. I suspect it may be medical language for "I don't quite follow the full implications of what you are saying. Could you give me some more information ...". You then have to repeat the point made, in the simplest terms, with the evidence you have.


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## Flower (Mar 2, 2020)

It was an odd question or perhaps just a poorly worded question, I felt they were inferring it wasn't the cannulas failing but me causing the spikes. I did point out the number of corrections I'd tried that did absoultely nothing and which prompted me to change the infusion set.


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## Sally71 (Mar 3, 2020)

Well the only thing I’ve ever known to cause an occlusion alarm on my daughter's pump is the cannula, and I know this because once we've changed it everything runs smoothly again and any raised blood sugars come back down. We've never, ever had to do anything else to correct an occlusion; I suppose it could be that the bit of skin the cannula is sticking into could be swollen or just gets “tired” and stops absorbing the insulin properly.  Also when we have blood sugars shooting into the 20s for no obvious reason which won't come down again after a correction, changing the cannula only usually sorts it.  How you can tell whether it's the cannula itself or your body causing the problem I don't know, unless there is an obvious bend in it; they are so tiny though it's easy for something to go wrong and in my opinion the cannulas are the weak spot in the whole pumping set up.  Unfortunately they are necessary!


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## MrDaibetes (Mar 4, 2020)

These things happen and it's not your fault. Try and not beat yourself up over it, in through one ear and out the other I would say.


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## @CNS_IVnurse (Mar 11, 2020)

Flower said:


> This has been bugging me for a while now and I just want to ask.
> 
> At a pump meeting a few months back we were discussing how to iron out a few spikes in otherwise good control. I said that some of the spikes were due to cannulas failing- as in being kinked or just not working as I would expect. I was asked 'why do you think it's the cannula failing?' That threw me a bit - I pile enough guilt and blame on myself for serious complications without adding extra guilt for causing cannulas not to work properly.
> 
> ...


Hi I am a vascular access practitioner by trade and I have to and must say, cannula failure is not your fault at all ! gathering from a very little info above, seems like you have to have you cannula inserted using ultrasound guide - it can definitely see how deep you veins are and doing so, will be able to identify what length a cannula should be used on you. From my experience, usual cause of failure is the fact that very little length of the cannula is sitting in vessel because the veins are sometimes too deep and as meds are pump, the high pressure may cause dislodgement of cannula thereby instead of sitting in the vein, sits in the subcutaneous tissue.
I hope this is a little re-assuring for you.


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## Robin (Mar 11, 2020)

@CNS_IVnurse said:


> Hi I am a vascular access practitioner by trade and I have to and must say, cannula failure is not your fault at all ! gathering from a very little info above, seems like you have to have you cannula inserted using ultrasound guide - it can definitely see how deep you veins are and doing so, will be able to identify what length a cannula should be used on you. From my experience, usual cause of failure is the fact that very little length of the cannula is sitting in vessel because the veins are sometimes too deep and as meds are pump, the high pressure may cause dislodgement of cannula thereby instead of sitting in the vein, sits in the subcutaneous tissue.
> I hope this is a little re-assuring for you.


I thought with a pump cannula, it needs to be in the subcutaneous tissue, and NOT in a vein.
I still don’t think it’s your fault, @Flower, and wonder if his phraseology was a bit off, ie, was he really trying to say, ‘what is it about the cannula that you think is failing' so he can flag up a problem with them, and not, 'why don’t you think it’s just you'


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## Flower (Mar 11, 2020)

Yes the cannula I was referring to was a pump cannula that needs most definitely to be in subcutaneous tissue and not in a vein.


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## @CNS_IVnurse (Mar 11, 2020)

Flower said:


> Yes the cannula I was referring to was a pump cannula that needs most definitely to be in subcutaneous tissue and not in a vein.


apologies for misunderstanding.


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