# Why do my cannulas keep failing??



## AJLang (Jan 25, 2013)

Thought it was a bit strange when BG went up to 8 and then 12 by midday when everything had been going so well.  Had lunch with correction bolus - checked it two hours later expecting a very good result - 22 plus high ketones.  I can only assume a cannula failure - but why would it fail when I only put it in yesterday morning and it had been doing great until this morning.  I've pulled the cannula out but it isn't bent - could this be a problem with my tummy having had so many injections over the years?  I can't use my legs because they are much too lumpy and I can't reach my bottom because of shoulder problems   I've changed the cannula and done a large bolus - am I correct in thinking that I check again in an hour and if BG hasn't started to go down to correct by pen?  When the pump works it's fantastic but I seem to have so many cannula fails....I thought that I had solved this by changing every other day but obviously not


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## everydayupsanddowns (Jan 25, 2013)

I had a good few cannula fails in the first 9 months. At one stage almost fortnightly - as you say sometimes ones that have been working fine all of a sudden just 'went off' for no apparent reason, but corrections through that set didn't work, and the highs only resolved after a set change.

The first thing I wonder (because it was mentioned to me as a reason for not staying on Humalog) is whether you are getting any crystallisation in the tubing. Some people seem to pump Humalog fine, but it does seem to have a reputation for forming crystals. I'm not sure in that case whether you would expect to have a 'no delivery' alarm.

The next avenue to explore is the cannulas you are using. I started on 6mm Quicksets, which were generally OK, but I have not had *one* cannula fail in 3 months on Silhouettes and would have almost expected to if still using Quicksets full time.

Ask your DSN for some alternatives to try - steel/angled/different lengths etc. And see whether you can have 4 or 5 samples of each to give them a good run through, then try a box of the style you get on with best and see whether your 'failure rate' improves.

For me losing those cannula-related 20s every few weeks has made a MASSIVE difference to how I feel about the pump. 

If you are getting more than one failure in a blue moon, you need to look into alternatives as it will be undoing all your hard work on the pump!


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## AJLang (Jan 25, 2013)

Hi Mike

Thanks very much for the suggestions.  I will ask my pump nurse when I see her on February 7th although I know she has a strong dislike of the steel cannuals - she tried one on herself and didn't like how it felt.  I can understand what you mean about the humalog but, apart from when I have the cannula fails it has worked for me really, really well so I hipe that I don't have to change insulin.  It's so frustrating.


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## everydayupsanddowns (Jan 25, 2013)

Can't remember which pump you are on, but here were my thoughts about the various set options for Veo: 

http://www.everydayupsanddowns.co.uk/2012/09/set-changes.html


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## AJLang (Jan 25, 2013)

Thanks Mike I'm on the AccuChek combo.  I've just spoken to their technical support and they've said it sounds like a site issues - so I'm wondering if it is my stomach that is a problem because of all the years of injections but as I said above my legs are very lump - the joys of nearly 42 years of injections.  I will speak to the nurse on February 7th to see if I can try a different cannula size - maybe the 10mm might work because I am quite plump. It is so frustrating because apart from this I love my pump.


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## Pumper_Sue (Jan 25, 2013)

Hi Amanda, ask for a selection of cannulas to try. It sounds to me as if you have the wrong cannula for you. Of and sod what your dsn say's about steel cannulas. It's not her with the diabetes or the control issues


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## AJLang (Jan 25, 2013)

Thanks Sue - I just tried phoning her but the department isn't open on Fridays


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## AlisonF (Jan 25, 2013)

Can't you call Roche direct and ask them to send out some samples rather than faffing around waiting for your DSN? That's what I've done with Medtronic in the past when I've wanted to try a different type of set.


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## AJLang (Jan 25, 2013)

Thanks Alison.  That would seem to be logical but I've just spoken to Roche's technical support and they've said that because it's not a problem with the pump I've got to speak to my nurse about changing the size of the cannula/possible site issues.  It is so frustrating - and my guess is that the nurse won't have different sizes of cannulas/steel cannuals to give me - or maybe I'm just being pessimistic. I guess I will find out more when I call her back on Monday.


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## Pumper_Sue (Jan 25, 2013)

AJLang said:


> Thanks Alison.  That would seem to be logical but I've just spoken to Roche's technical support and they've said that because it's not a problem with the pump I've got to speak to my nurse about changing the size of the cannula/possible site issues.  It is so frustrating - and my guess is that the nurse won't have different sizes of cannulas/steel cannuals to give me - or maybe I'm just being pessimistic. I guess I will find out more when I call her back on Monday.



Amanada,
            just ring the order line and ask for samples to try. Forget techi support.


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## AJLang (Jan 25, 2013)

Thanks Sue - I just went back to Roche and tried the order line - they've said that I need to speak to the rep - which is good I've now got someone to ask.  I've left a message on her voice mail explaining that I would like some samples and asking her to phone me back.  All of you are so wonderful at helping me to sort this out because I was getting very upset and discouraged after my third cannula problem this month.


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## Pumper_Sue (Jan 25, 2013)

AJLang said:


> Thanks Sue - I just went back to Roche and tried the order line - they've said that I need to speak to the rep - which is good I've now got someone to ask.  I've left a message on her voice mail explaining that I would like some samples and asking her to phone me back.  All of you are so wonderful at helping me to sort this out because I was getting very upset and discouraged after my third cannula problem this month.



I'm shocked at their attitude.

I just ring animas and ask to try some different cannulas due to problems with the ones I am using and samples are sent. No problem at all.


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## MaryPlain (Jan 25, 2013)

Hi Amanda

I have a few Roche cannulas I can send you if you want - I used to use the steel cannulas but I had the problems you are having with those, and found that the flexlinks worked better for me. I've got lots of the steel ones lying around here doing nothing and you're welcome to a box or two if you like.


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## AJLang (Jan 25, 2013)

Hi Mary
That's lovely of you.  Thank you very,very much.

I've PM'd my details to you

Warmest wishes

Amanda


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## MaryPlain (Jan 25, 2013)

AJLang said:


> Hi Mary
> That's lovely of you.  Thank you very,very much.
> 
> I've PM'd my details to you
> ...



No problem.  By the way, are you using the introducer to position your cannula?  I have always used it and I don't seem to get any problems with the flexlink?


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## AlisonF (Jan 25, 2013)

Pumper_Sue said:


> I'm shocked at their attitude.
> 
> I just ring animas and ask to try some different cannulas due to problems with the ones I am using and samples are sent. No problem at all.



Me too with Medtronic


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## AJLang (Jan 25, 2013)

MaryPlain said:


> No problem.  By the way, are you using the introducer to position your cannula?  I have always used it and I don't seem to get any problems with the flexlink?



Hi Mary yes I do use the introducer and I love using that.  I'm looking forward to trying the metal ones but I'm also wondering if the 10mm Flexlink might work - I'm currently using the 8mm ones but I have a very rounded tummy.   I just want to find a cannula that works to stop these ad hoc high BGs?  Thanks very much for all of your help


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## Phil65 (Jan 27, 2013)

AJLang said:


> Thanks Sue - I just went back to Roche and tried the order line - they've said that I need to speak to the rep - which is good I've now got someone to ask.  I've left a message on her voice mail explaining that I would like some samples and asking her to phone me back.  All of you are so wonderful at helping me to sort this out because I was getting very upset and discouraged after my third cannula problem this month.



I'm really surprised that they won't satisfy your order, I have the same pump as you and I seem to be able to order whatever I like from Roche, I've never been told that I have to speak to a rep or anybody else for that matter. Like you I have issues with cannulas, it is the single most frustrating pumping  thing for me. I finally came to the conclusion that 10mm steel cannulas are the best for me, although I do still get failures, but less. Don't let your DSN influence you too much with your cannulas, you will discover which are the best for you in time. Maybe try a few different samples if your DSN has them?


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## AJLang (Jan 28, 2013)

Hi Phil 

They were happy to provide me with a box for each cannula size that I wanted to try but I didn't think that it was fair for the PCT to pay for complete boxes if I don't know which will work.  My nurse has even emphasised that when we order we should place 3 months at a time so that they don't have to pay for the postage charges that would be incurred with more frequent orders.  That's why I hoped that they would provide me with just a few of each of to try.  However I haven't heard from the rep yet.


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## Phil65 (Jan 28, 2013)

AJLang said:


> Hi Phil
> 
> They were happy to provide me with a box for each cannula size that I wanted to try but I didn't think that it was fair for the PCT to pay for complete boxes if I don't know which will work.  My nurse has even emphasised that when we order we should place 3 months at a time so that they don't have to pay for the postage charges that would be incurred with more frequent orders.  That's why I hoped that they would provide me with just a few of each of to try.  However I haven't heard from the rep yet.



.....Stop Amanda!!!!! This is your health you are talking about! Forget the cost to your PCT, you need to get the right cannula for you, not just putting up with it. As a heavy insulin user I use a new cannula every 2 days, sometimes daily and a cartridge of insulin will last me only 3 days, I don't feel guilty as it is what I need. Fair enough about ordering 3 months of spares to save postage......BUT only IF you know what you need! I hope you sort your cannula problems soon....I've had a bumpy ride with them and am still not entirely happy with mine


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## Northerner (Jan 28, 2013)

Phil65 said:


> .....Stop Amanda!!!!! This is your health you are talking about! Forget the cost to your PCT, you need to get the right cannula for you, not just putting up with it. As a heavy insulin user I use a new cannula every 2 days, sometimes daily and a cartridge of insulin will last me only 3 days, I don't feel guilty as it is what I need. Fair enough about ordering 3 months of spares to save postage......BUT only IF you know what you need! I hope you sort your cannula problems soon....I've had a bumpy ride with them and am still not entirely happy with mine



I think Phil is right, it's a pittance in the scheme of things. I'm surprised your pump DSN doesn't have some packs that she can give out one or two of each to people. Either that or take back any that you decide aren't right for you so they can be given to someone else in a similar position


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## trophywench (Jan 28, 2013)

Well apparently a standard parcel up to 2kg is ?5.30.

For interest one box of tubeless and one box of tubed 8mm Flexlink weigh 0.41kg but once they've added the big box and the mile and a half of tape they stick on every mortal thing, it's 0.51kg.

I have some old invoices from 2011 and although they show the costs of the items, P&P is shown as a blank - so I have always assumed it's built in to Roche's prices?

The invoices were addressed to my PCT, no idea why I got them, but now I only get the delivery note.

But in any case - I agree with Phil.  If I wanted to try other cannulas then I would expect to be sent 'a few'.  When they were short of Flexlinks somewhere along the line they actually said to me, do you mind if we send you boxes of 4?  They are our sample boxes.  And I got 5 boxes of 4 instead of 2 boxes of 10.  So I thought they must do this for all their cannulas.  Obviously not - unless you have to speak to the Rep to obtain em?


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## AJLang (Jan 28, 2013)

Thank youAt 9am I left a message for my pump nurse to phone me, because the department isn't open on Fridays, but appreciate she is busy.  However if neither she nor the Roche rep have phoned me by 5pm today I will phone the order line and arrange for a box of 10ml flexlink cannulas to be sent and I will also hve the steel ones which are on the way from Mary Plain.  You are quite right Phil I should be putting my health first and it isn't right that I should be going into the 20s every 10 days or so because of the cannula problem.  Especially not when I already have to deal with the erratic nature of the gastroparesis. Everything else seems to be working well and when I've had these problems they haven't been gastro related e.g. on Friday I hadn't even eaten anything! I've been changing the cannulas every two days to see if that will help and I am rotating my sites.  Thank you for getting angry on my behalf


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## AJLang (Jan 28, 2013)

Everything is now happily sorted out.  The pump nurse and Roche rep spoke to each other and then phoned me  I was given different options including different cannulas and 10mm flex-links. But the first option I'm going to try is changing my cannula everyday because I get on great with inserting the 8mm Flexlink and don't recall having any problems with it within 24 hours of insertion.  If that doesn't work I will be sent 10mm samples.  The rep was really, really lovely


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## MaryPlain (Jan 28, 2013)

AJLang said:


> Everything is now happily sorted out.  The pump nurse and Roche rep spoke to each other and then phoned me  I was given different options including different cannulas and 10mm flex-links. But the first option I'm going to try is changing my cannula everyday because I get on great with inserting the 8mm Flexlink and don't recall having any problems with it within 24 hours of insertion.  If that doesn't work I will be sent 10mm samples.  The rep was really, really lovely




Great result!  I have posted the spare ones I had to you, so if it turns out they don't suit, perhaps someone else would like them. If you do get on with them then so much the better!

Another thought I had was are you checking for bubbles? The only time I've had problems with cannulas I got an occlusion alarm, whereas bubbles are the silent enemy!

I also find that if I position a cannula too far out to the sides the insulin seems to take longer, even though there's plenty of subcutaneous fat there - so maybe it's just getting used to which sites work for you?


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## AJLang (Jan 29, 2013)

Hi Mary

Thanks very much.  The cannulas arrived today when I was out so OH is going to drive me to the sorting office to collect them on Saturday.  We did wonder about air bubbles but a number of times when I had the cannula problem we completely primed the tube, didn't change the cannula, bolused more insulin and waited two hours.  Each time the BG was about the same or slightly.  However once I changed the cannula each time within two hours the BG went down.  The pump rep said that fairly often pump users have to change their cannula every day.  I've also been rotating the sites all round but the problems seem to be random.   I can cope with changing my cannula every day....it's still much better than the seven injections that I was having and the overall control is so much better


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## Pumper_Sue (Jan 29, 2013)

Hi Amanda, very few would change a cannula every day.
The PCT would go bankrupt at ?10 percannula  Wishfull thinking on your reps part me thinks for a bonus.
99.9% of the time problems with cannulas are due to using the wrong type or length. The fact you say when you bolused your bg stayed the same just proves the cannula is working otherwise your blood sugar would have gone sky high.
I suspect a different length or an angled set will solve the problem.

Have a look at this link  http://www.accu-chekinsulinpumps.com/documents/ProfessionalsPocketGuidetoInfusionSiteManagement.pdf and read up on the cannula length for your body weight and size or lack of as the case may be.


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## AJLang (Jan 29, 2013)

Hi Sue thanks very much.  I've read through the leaflet. It appears that I am on the right size cannula for my weight and that the 45 degree cannulas aren't appropriate for my weight.  Also that the steel cannulas need changing every 24-48 hours, so not really much different from what I am doing.  I did find all of of the information in the leaflet very helpful, thanks very much.


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## MaryPlain (Jan 29, 2013)

AJLang said:


> Hi Sue thanks very much.  I've read through the leaflet. It appears that I am on the right size cannula for my weight and that the 45 degree cannulas aren't appropriate for my weight.  Also that the steel cannulas need changing every 24-48 hours, so not really much different from what I am doing.  I did find all of of the information in the leaflet very helpful, thanks very much.



From your previous post the evidence does indeed seem to point to either the site or the cannulas.  Although the leaflet says you're on the right one, if it's not working for you then there's no harm in trying something different, if you can. Let us know how you get on with the steel ones. One benefit I found is that they have a tail, which for me meant I could put them in my back a lot more easily than the flexlink because of not being able to see what I was doing! The other thing about the steel ones is that you prime the whole cannula before insertion which gives me more confidence than inserting and then priming with 1 unit as you do with the flexible ones.

I think the reason the steel ones have to be changed more often than the teflon ones is that the body tolerates them less well.

Good luck with it all.


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## AJLang (Jan 30, 2013)

Thanks Mary


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## Pumper_Sue (Jan 30, 2013)

Just another thought as well (brain strain) the combo has a luer lock connection, so this means you can use other makes of cannula with your pump, so worth considering if you can't find a Roche cannula to suit.


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## Phil65 (Jan 30, 2013)

Pumper_Sue said:


> Just another thought as well (brain strain) the combo has a luer lock connection, so this means you can use other makes of cannula with your pump, so worth considering if you can't find a Roche cannula to suit.



interesting.....didn't know that, the problems I've had with cannulas! ......should be called "cannularfs"


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## Pumper_Sue (Jan 30, 2013)

Phil65 said:


> interesting.....didn't know that, the problems I've had with cannulas! ......should be called "cannularfs"



Lol love that expression 

Not sure but think it's medtronic and the Dana pumps that do not have luer locks. Both do, do cannulas that have luer lock fitting though.


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## trophywench (Jan 30, 2013)

Gosh, which pump's cannulas are ?10 each!

Roche ones certainly aren't.


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