A Continuous Subcutaneous Insulin Infusion Needle Break

Our patient was 13 years and 2 months old, a white boy with type 1 diabetes diagnosed 2 years and 5 months before this adverse event (AE). He had no other significant medical history. His A1C was 7.6% 1 month before the insulin infusion needle break event. The patient had started on the t-slim insulin pump (Tandem Diabetes Care, San Diego, Calif.) 1 year and 6 days before the AE occurred. He was using the infusion set and lispro insulin. The contact Detach infusion set features a very fine, 29-gauge, 90° steel needle. With its additional adhesive pad, contact Detach provides extra security against needle dislodging. Its simplicity and security make it a good choice for active young children, pregnant women, and adults for whom soft cannula sets do not work well. The contact Detach set is available in 6-and 8-mm needle lengths and 23-and 32-inch tubing lengths (1). There were no reported previous pump AEs, emergency department visits, or diabetes ketoaci-dosis episodes related to continuous subcutaneous insulin infusion (CSII) therapy. The patient's BMI was 18.65 kg/m 2. The patient's mother reported changing the pump site, per usual, on 16 July 2014. When she went to remove the infusion set, the needle was not attached to it. The parents could not find the needle. The patient did not feel any pain or discomfort where the infusion set had been placed. At the time the 8-mm needle broke off from the infusion site, it had been placed on the upper left buttock area at a 90° angle with IV3000 1-HAND adhesive dressing (Smith & Nephew, Inc., Austin, Tex.) for 2 days. The site was clean, dry, and intact at all times, with no trauma to the area. The patient was brought to clinic for further assessment, at which time only a slight elevation in the skin could be palpated. There was a red mark where the needle had been inserted. There was no evidence of lipohypertrophy at or around the infusion site. There was no pain or discomfort to the patient while manually manipulating the site. X-ray confirmed the needle remained within the soft tissues behind the mid-sacrum. An outpatient surgical consult was requested. At the time of the operation, 12 days after the mother reported the broken needle from the infusion set, there was no visible scar in the patient's left gluteal area. However, the patient was able to identify …