Description
An insulin pump is a small, computerized device that can deliver insulin every few minutes in tiny amounts throughout the day as subcutaneous injection. The pump is about the size of a deck of cards but can be much smaller. It is worn externally and can be discretely clipped to the patient’s waist belt, slipped into a pocket or hidden under clothes. Women wear it tucked into the front or side of the bra or wear it on a garter belt on the thigh. Insulin pumps deliver rapid or short-acting insulin 24 hours a day through a catheter placed under the skin.
Purposes of using Insulin Pump
- To provide precise insulin delivery, non-stop for 24 hours a day.
- To administer programmed dose of insulin unique to each individual patient.
- To provide replacement of slow-acting insulin for basal needs with a continuous infusion of rapid-acting insulin using insulin pump.
- To obtain tighter blood glucose control while reducing the risk of low blood glucose and severe hvpoglycemia.
Articles
- Insulin pump having following components:
- Button to program the quantity of insulin to be delivered.
- LCD screen to display what is programmed.
- Battery compartment to hold one AAA battery.
- Reservoir compartment for syringe/cartridge with insulin.
- Plastic syringe/cartridge with 300 units (3 mL) of insulin.
- Infusion ser which is long (60 to 105 cm), thin, narrow-lumen catheter that goes from the syringe in the reservoir to the infusion site on the body, usually the abdomen.
- Cannula for insertion into the subcutaneous tissue that connects to the catheter.
- Alcohol swab for skin preparation.
- Receptacle for used materials.
Procedure
Placing insulin pump on patient.
| NURSING ACTIONS | RATIONALE | |
| a. | Priming the pump Ensure that the patient is prepared (educated) adequately. | The patient must be psychologically stable and open about having diabetes because the pump is often a visible sign to others and a constant reminder that he/she is a diabetic. The rate of insulin to be infused is determined by the physician, based on the patient’s needs. |
| Obtain the pump programmed for particular patient. | Basal rate is small amount of insulin to keep the blood glucose in target range between meals and overnight for normal functions of the body (e.g,0.5-2.0 units/h). | |
| Ensure that the “basal rate “and “bolus dose “are programmed in the pump. | Bolus dose is additional insulin that can be delivered on demand “to match the food, drink, exercise or supplemental dose to correct a high blood glucose level. | |
| Explain and demonstrate to patient how to calculate the bolus dose based on settings. When a meal is consumed, the patient calculates a dose of insulin by counting the carbohydrate of the meal. | The ratio of insulin to carbohydrate is 1 unit of insulin for every 15 g of carbohydrate. The bolus calculator in the pump calculates the insulin when the patient inputs the number of CHO intake (e.g., 3 units for 45 g. CHO intake). | |
| b. | Placing the insulin pump Clean the insertion site thoroughly using antiseptic swabs. | Adequate cleansing leaves the insertion site germ-free. |
| With the insulin-loaded syringe in the reservoir compartment and infusion tubing connected and primed, insert the cannula with needle in the site to set the tip in the subcutaneous tissue and remove the needle. Fix cannula with tape or transparent dressing. | Secures the cannula and tubing in subcutaneous tissue for infusion of insulin. The cannula needs to be changed every 2 to 3 days to prevent infection at the site. | |
| Assist the patient to wear the pump externally, clipped to a waist belt, tucked in the pocket or clipped to the bra. | Safely hides the pump and tubing from easy viewing. | |
| C. | Care and safe keeping of the pump The pump needs to be placed safely when the patient goes to sleep. In bed, it can be placed near the body clipped to the pillow or bed sheet. | Avoids kinking of catheter or dislodging of cannula. |
| Disconnect the pump prior to showering or bathing, exercising or sexual activity. | The pump may get spoiled if water gets inside. |
Important Points to Remember
- Effective use of the pump requires commitment to checking blood glucose at least 4 times a day every day.
- Using carbohydrate counting and adjusting insulin doses needs to do based on blood glucose levels, carbohydrate intake, and physical activity.
- The patient has to enter the amount of carbohydrate to be eaten or record the glucose level and the pump will calculate the bolus dose of insulin to be delivered. A bolus is the extra amount of insulin to cover expected rise in blood glucose often related to a meal or snack
- If the pump stops while it is in the middle of delivering a bolus, it will not be resumed. A new bolus needs to be prepared for delivery.
- The patient should administer the required amount by manual injection, if an interruption is suspected, i.e., no response in blood glucose level after a meal bolus.
- Do not go longer than 1 to 2 hours without any insulin delivery.
Advantages
- Increased flexibility in lifestyle as delivery of insulin mimics the functioning of normal pancreas.
- Predictable and precise insulin delivery as the pump works non-stop according to the programmed plan unique to each individual wearer.
- Better glucose control and lesser risk of low blood glucose and severe hypoglycemia.
- Reduces the risk of wide fluctuations in blood glucose.
- More flexibility with what, when, and how much to eat.
- Ability to deliver accurately up to 1/10th unit of insulin.
Disadvantages
- Risk of infection at the cannula site.
- Risk of diabetic ketoacidosis (DKA) from pump malfunction, or absorption problems which may occur if there is an occlusion in the tubing, if supply of insulin runs out or if battery is depleted.
- As rapid-acting insulin is used, any disruption in the flow of insulin may rapidly cause the patient to be without insulin. This requires the patient to administer insulin manually if an interruption is suspected, e.g., no change in glucose level after a meal bolus.
- Blood glucose levels need to be tested more often as the insulin is short-acting and the patient needs to be constantly aware of his insulin needs.
- As single insulin type, such as rapid-acting insulin only can be loaded in the pump, it is more suitable for individuals with type l diabetes.
- Cost: Pumps are expensive and continuing cost of associated supplies, such as insulin syringe, infusion set, battery, etc may be more compared to other methods of administration.
- The patient must be psychologically stable and open about having diabetes, because the pump is often a visible sign to patient that he/she is a diabetic.
- A lot of time is needed to learn about the pump and management of diabetes, especially in the beginning.
- Users may experience scar tissue build up around the inserted cannula resulting in a hard bump after the cannula is removed.
- A larger supply of insulin may be required in order to use the pump. Many units of insulin may be wasted while refilling the reservoir or changing the infusion site and infusion set.
REFERENCE
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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