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Infusion site bleeding ranges from minor surface spots to deeper hematomas. While most bleeding is manageable, prevention through proper site selection, rotation, and insertion technique is key. Monitoring your sites regularly and following ADA guidelines will help ensure safe and effective insulin delivery, reducing the risk of bleeding-related complications.

Understanding Infusion Site Bleeding in Insulin Pump Therapy

If you use an insulin pump, you may occasionally notice bleeding at your infusion site. This is a common issue that can happen to anyone using insulin pumps with either soft cannulas or metal needles. Recognizing the types of bleeding and knowing how to manage them can help you avoid complications and keep your blood glucose under control.

Types of Infusion Site Bleeding

1. Surface Bleeding (Minor Bleed)

Surface bleeding occurs when a small blood vessel near the skin is nicked during insertion. It usually appears as a tiny red spot at the infusion site. This type of bleeding is more common with steel (metal) needles, but can also happen with soft cannulas.

What it looks like: A small red spot with no lump or swelling under the skin.
Does it affect blood sugar? Usually not. Insulin absorption is typically unaffected.
What to do: Apply gentle pressure with a clean tissue until bleeding stops, then proceed with site use if comfortable.

2. Deep Bleeding or Hematoma (Serious Bleed)

A hematoma is a deeper bleed where blood collects under the skin, forming a hard, sometimes painful lump. This usually happens when a larger blood vessel is punctured.

What it feels like: A lump the size of a quarter or smaller, possibly warm or tender.
Effect on blood sugar: Insulin may pool in the blood collection, reducing absorption and causing unexpectedly high blood glucose levels.
What to do: Remove the infusion set immediately. Gently pinch the area to help reduce fluid buildup. If the fluid is red (blood), apply a warm compress to promote healing. Monitor your blood sugar closely, and contact your healthcare provider if highs persist or signs of infection develop.

Why Does Infusion Site Bleeding Happen?

Insertion trauma: The needle or cannula may nick a tiny blood vessel during insertion. Steel cannulas are more likely to cause bleeding than soft cannulas due to their rigidity.
Fragile skin or blood vessels: Older adults or those on blood thinners may experience more frequent bleeding.
Improper insertion technique: Inserting at the wrong angle, depth, or moving too soon after insertion can increase the risk of bleeding.
Repeated use of the same site: Skin can become fragile or scarred, leading to more bleeding or bruising.

How to Prevent Infusion Site Bleeding

Best Practices for Site Care

Rotate your infusion sites regularly: Avoid using the same area more than 2–3 times in a row to prevent skin damage.
Choose sites with adequate subcutaneous fat: Avoid bony areas or places with visible blood vessels.
Use an inserter device: Automated inserters can reduce trauma by controlling insertion speed and angle.
Prepare the skin properly: Clean and dry the skin, free of lotions or oils, to reduce insertion complications.
Avoid vigorous activity right after insertion: Give the site a few minutes to settle before intense movement.

Consider the Type of Infusion Set

Soft cannulas: Generally cause less bleeding and are more comfortable, but may kink or dislodge.
Steel cannulas: Provide stability, especially during sports, but are more likely to cause bleeding or bruising.

When to See Your Healthcare Provider

Seek medical advice if you notice:

Persistent bleeding lasting more than 5 minutes.
Large or painful bruises at the site.
Signs of infection: redness, warmth, swelling, pus, or fever.
Frequent or unexplained high blood sugars are linked to site issues.
You are on blood-thinning medication and experience bleeding.

Clinical Evidence and Guidelines

The American Diabetes Association (ADA) recommends rotating sites and practicing proper infusion set care to prevent complications such as bleeding and lipohypertrophy. Clinical trials have shown that automated insertion devices reduce insertion pain and site trauma, improving overall site health and insulin absorption (source: Diabetes Technology & Therapeutics, 2023).

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