Assess infusion site health and selection
STEP 1 — Gather Information
Inspect the infusion site for erythema, induration, lumps, lipohypertrophy, signs of infection (purulence, warmth, pain), and assess site rotation pattern (frequency, areas used). Ask patient about discomfort or difficulty with insertion.
STEP 2 — Rule In / Rule Out
Determine if the infusion site shows any signs of lipohypertrophy, infection, or significant irritation.
STEP 3 — Classify or Stratify
Classify the site as healthy, mild irritation, lipohypertrophy, or infection based on findings.
STEP 4 — Decide
If healthy, continue use and reinforce rotation schedule; if unhealthy, discontinue the set, treat infection if present, select a new site at least 2 cm from the previous site, and educate the patient on proper rotation and site inspection.
Clinical Guardrails / Mimics / Pitfalls
Do not reuse sites with visible lipohypertrophy or induration; do not ignore patient‑reported pain; avoid rotating only within the same anatomical quadrant; do not insert into scar tissue or areas of prior infection without full healing; do not rely solely on patient self‑report without visual inspection.
Concrete Clinical Example
A 28‑year‑old with T1DM reports tenderness at the left abdominal infusion site. Inspection reveals a 1‑cm firm lump consistent with lipohypertrophy. The site is classified as unhealthy; the infusion set is moved to the right abdomen, the patient is taught to rotate sites every 2–3 days and to inspect each new site before insertion.
Source: Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI: 10.1210/jc.2016-2534