For ALL I have an anesthesiologist for a neighbor. When I needed several anesthesia procedures in the past since being on Tandem’s CIQ and before when on brick pumps with Dexcom CGMs of various vintages, we created this handout.
References are for Tandem/Dexcom combinations. Other pump users should be able to find comparable items to replace the Tandem references.
Hospitalization or procedure - revised
Who are the people to work with for a procedure or surgery if you wear an insulin pump and Dexcom G6 Continuous Glucose Monitor (CGM).
· Surgeon or physician performing the procedure.
· Anesthesia staff (anesthesiologist [an MD] or anesthetist [specially trained RN] or person responsible for monitoring your vital signs (EKG, BP, Pulse, etc.) during the surgery or procedure.
· Endocrinologist who monitors you, your pump, diabetes, etc.
· Facility CDE, if any, should be able to support facility staff caring for you and be knowledgeable about the technology.
Work with your surgeon, endocrinologist, and anesthesia team. Every time I have a procedure, I start with my anesthesiologist. She arranges my anesthesia care with either an anesthetist or anesthesiologist or both for some long or complex procedures.
Starting about two weeks before the procedure, the anesthesia team works with the surgeon to identify the operative area both for incisions as well as imaging (ultrasound, etc.) areas. Remember, CIQ & G6 should not be exposed to x-rays, sometimes called a C-Arm. In some situations, lead apron shielding may protect the CGM & CIQ from x-rays. This is not discussed in Tandem literature.
This early planning with the surgeon and anesthesia allows for placement of the CGM properly and time the pump site change and location so the (1) site is fresh, (2) pump is full, and (3) in the best or agreed upon position. Make certain all sites are in locations consistent with best practices. A CGM on an arm may need to be removed because it interferes with blood pressure cuff placement. Use the longest tubing possible for pump site sets. Long site set tubing allows the anesthesia team to move the pump about their workspace. Thought, the anesthesia team usually is near the head during a procedure. Think about a pump site that would allow the pump to be near your ear.
On the day of surgery, the CGM should be compared to a STAT or rushed preoperative blood chemistry including a glucose. The CGM reading at the time the labs were drawn should be noted and shared with the operative team. Review with anesthesia the pump, including how to read the CGM from the pump, and treat elevations reported by the CGM. Having the primary anesthesia staff practice with a bolus of 0.05 units puts everyone’s mind at ease. Using 0.05 units for the practice bolus is so small as to be negligible in most individuals and is the smallest the Tandem X2 pump will deliver.
Assembled below is a collection of documents to support the way a health care team should do things with the CIQ enabled pump & CGM.
These links are for the documents recommended for printing for planned hospitalization or an outpatient procedure. It may be prudent to have up to 5 copies of some documents for placement and review by selected team members. Ask for a pre-procedure or pre-operative visit with the anesthesiologist to review how the pump works. Show and ask for a return demonstration of bolus administration. The ideal dose in this situation could be 0.05 units (the smallest CIQ will give). In an adult, this is almost a non-therapeutic dose.
Control-IQ Technology –
what CIQ & CGM do working together
View System Status with CGM
Administer a bolus
Load a Cartridge
AutoSoft™ XC Instructions for Use
Tandem Documents & Resources
If another site set is used, there are links on the Tandem site to use in place of the AutoSoft site set above.
If needed, the easiest way to get to the Tandem Documents & Resources is a browser search with the terms TANDEM DIABETES SUPPORT DOCUMENTS