Hi everybody, I'm new. And I'm full of air bubbles...anyone got any tips for preventing air in the resevoir/line?
I seem to have a problem with this.

Hi

My son is 4yrs old and has pumping with a Paradigm 522 since May 07. We get airbubbles too, not quite sure why. His PDSN has said it can be caused by temperature changes. She pumps too and therefore has 1st hand experience and advice for a lot of situations. Due to his age and therefore smaller insulin requirement we used to keep the vial in the fridge so we didn't have to discard it after a month. We stopped this and since keeping it at room temperature we seem to have the problem a lot less, although it still occurs. As a precaution now, if his BG starts to rise unusually high for no apparent reason, even if we can't see bubbles, we disconnect the set and prime the whole tubing again and bolus (via injection).

Hope it helps, any other causes for air bubbles would be nice to know.

One thing that I've noticed is drawing insulin into the reservoir to fast can also cause air bubbles.

A couple of thing that I do are first, after drawing air into the reservoir, aspirate the air into the insulin rather than into the air in the bottle (this does seem to help). When priming the pump, hold the pump with the tubing end of the reservoir up (also, after filling the reservoir, always keep the tubing end up (this should draw any bubbles to the top)).

Aaron,
Sorry, I don't know what you mean by this. Can you elaborate?
Thanks,
Linda B.

Tiffany originally posted about this technique in the topic about air bubbles in the thinset reservoirs (because these have a much greater problem with this - see Air bubbles in thinset reservoirs.

Basically, the idea is fill the reservoir with air, poke the needle through the vial, turn the vial upside down, then inject the air into the insulin (rather than into the airspace above the insulin).

Dear thecowoutside,

How do you currently deal with the air? I find air bubbles in the tubing and can see them in the resevoir from time to time (after following all of the advice procedures discussed in the forums). I would also like to know the cause of this. When I fill the resevoir, connect, etc. there are no air bubbles, they just seem to develop later. This has been my experience ever since I have been on the pump. I check my tubing and the resevoir for air every day and if I find any, I keep a close eye and when it gets to the point of insfusion, I just bolus it through. This is most definately annoying, and of course there is a question of accuracy for the amount but it seems to work for me and I don't have to change my set. There is lots and lots of advice for how to avoid the bubbles in the first place, but I have not found much discussion on what to do when it happens. I was thinking perhaps I was the only pumper who experienced this situation. I can certainly relate and I hope that you have less experience with air bubbles if you follow the advice given here. Glad you joined in and I'm sure you'll find lots of good information here.

Welcome to the forums, thecowoutside!

Bubbles, the antagonist of all pumpers The proprietary reservoirs of the Paradigm pumps are actually designed very well for avoiding/eliminating bubbles, but of course it's near to impossible to get rid of 'em all. Here's what I do:

- Warm the insulin up to room temperature. This will help to prevent bubbles from forming - if the insulin warms up in your reservoir you're guaranteed to get bubbles, and not those little tiny ones either (at which time it's a little harder to get rid of them).
- Pump the plunger of the reservoir up and down inside the empty chamber before filling it with insulin. This distributes the o-ring lubrication around so that there's no chance of air sneaking in through the bottom of the reservoir. (Note: Minimed says this isn't necessary but I've found it very helpful)
- As Aaron suggested, push air into the vial of insulin through the insulin itself. I don't know why it works, but it's a trick that an old friend who used Luer Lock reservoirs taught me. (Luer Lock reservoirs are harder to clear)
- Fill the reservoir slowly, and tip it at an angle while you fill.
- When the reservoir is full, get a pen and tap the heck out of it to bring any air to the top of the chamber. I tip the reservoir a little so that any moving bubbles don't get trapped in the bend before the neck, then I push the bubbles out (along with some insulin) back into the reservoir and directly into the insulin in said reservoir (so, the reservoir is still upside-down lol).

Refill and repeat as necessary.

Karen, when I get a bubble in the line I prime it out. I disconnect the tubing from my set and use the 'fixed prime' option until the bubble is cleared. This way, I'm not missing any insulin during infusion and the insulin that had to be primed out in order to remove the air is not included in boluses.

HTH!

Thank you Tiffany,

I am a new pumper (since october 3rd) and the calibration challenge plus the bubbles has my BS going up and down.

I was wondering if I could prime my pump to get the air bubbles out. There are no bubbles when I install a new set, but 24 hours later, I can see bubbles in the bottom of the reservoir, and, another 24 hour I see the bubbles in my tubing. I will follow your instruction for the reservoir initial filling. Of course, I will disconnect the tubing from my set and use the fixed prime.

This site is wonderful ! it help alot !
Louise

what brand of pump and r u using room temp insulin?

Hi and thank you everybody for your responses. I have been pushing the air out by priming after taking the pump off, of course! That seems to work well, and I am working on my technique. You all had very helpful advice, and I've taken some of it. Pulling insulin into the reservoir too fast definately has an effect, and I am learning to be patient! It is definately wierd that when I change my reservoirs, there are lots of air bubbles in the old one, and I don't understand how that happens.



I'm using a MiniMed Paradigm 512 pump and quicksets.

I think we have found the answer. Before filling the reservoir you need to degas the vial.
To see how watch here: http://www.youtube.com/watch?v=OwbelFCNGz4

My son used to get bubbles daily, been doing this 10 days and not a single bubble.

I can't believe it! I never heard of this, but it makes perfect sense. All these years I have wondered why bubbles appear in the reservoir. I have even asked trainers, no one knew it was from excess air in the insulin vial.
Thanks so much!
Linda B.

Interesting and I suppose it might help, BUT, I don't get any bubbles in my reservoirs or tubing (and I mean NO bubbles, champagne style or otherwise) using the method I've described on the forum. Sadly, I can't find that post, which was quite comprehensive in describing the method (very fast) I use.

Well, I tried to do this this morning when I put in a new reservoir & infustion set. My insulin vial was about 1/4 full, so I spent a lot of time sucking the air out. I think I must have created too big of a vacuum, because when I put the reservoir on the vial and got insulin into it, it started bubbling from the bottom of the reservoir (up through that o-ring), and I wound up with a lot of air in the reservoir.

I got all the air out, but it was really kind of a pain. I'm gonna try it again next week, and not remove as much air as I did this time. I really liked Larry's explanation in another post, and I wish Spike could find his original post. I'm real curious. I just get the champagne bubbles, but I take so little insulin (TDD < 25 units) that they can create a problem for me.

Tom

Aaron found my earlier post on eliminating bubbles--here it is:

1. Insulin at room temp...

2. Reservoir - twist plunger back a forth a couple of times to spread lubricant on orings.

3. with insulin vial right side up, inject air, so that a vacuum doesnt form when u withdraw the insulin. Invert bottle and draw insulin SLOWLY into reservoir so as not to "froth" it up too much inside the reservoir. It should take about 10 seconds to draw up. [edited from original post]

4. tap reservoir and purge bubbles back into vial.

5. draw more insulin in to replenish the reservoir. At this point there should be just a few bubbles left--if there are still more than you'd like, repeat this step. [edited from original post]

6. install tubing and while holding the res. vertically, tap it while gently pushing plunger enough to get a bit of insulin into the tubing. If you cant manage to tap the side of the reservoir at the same time, then tap first and plunge next. I do this without thinking now, but it requires a bit of dexterity that u may find awkward.

7. install res into pump, hold pump vertically, tap side of pump with opposite hand while you begin priming.

8. prime tubing until u see no more bubbles.

9. install your set, clear the screen if using a steel needle set, or give the fixed prime if you are using a cannula-type set.



You should have no more trouble with bubbles. If not, then some step I gave you is unclear. Please ask for clarification if needed."

This is precisely what I have been doing for the past 10 months, and it has worked pretty well. I still get the tiny "champagne" bubbles, though, and if they get in the tubing, they create a problem for me. I'm gonna try the "de-gasing" experiment again and see if it makes any difference. If not, I'm gonna blow it off, because it's kind of a pita.

Tom

Same here. I have been doing exactly this since I started pumping. My reservoirs usually look just fine when I put a new one into the pump but a day or two later, after the insulin has warmed up just a little more by being in the pump, I get some bubbles.

I have hardly anything left in the vial I'm currently using but when I start a fresh one, I'm going to start withdrawing as much air as possible from it first, and make sure I put it back in my kit with a slight vacuum inside the vial.

I also have been using under 25 units a day so bubbles can be a pain.

Same with me. When I first place the reservoir in the pump there are no bubbles. But when I remove the reservoir after 5 or 6 days (I use one reservoir with two set changes) it is full of very visible bubbles. Larry's explanation fits what happens perfectly - that the air has been absorbed into the insulin and then is released back out over time.
Linda B.

Same here, I still get some bubbles from time to time. With the 522 I can now prime them out though. I am going to try the 'de-gas' thing too. Spike, did you never have a bubble even with the old 506/507 pumps? That's pretty incredible!

Even after 2 or 3 days, the insulin in the tubing AND in my reservoirs are devoid of visible bubbles. I get the same good results from either Novolog (currently) or the Humalog, so it's not an issue of which insulin. My pump sits vertically on my waistband. I'm wondering out loud if somehow horizontal or upside down orientation of the pump could create more of an issue with bubbles in the tubing. However, like I said, I see NO bubbles inside the reservoir, either. LET ME MAKE IT PERFECTLY CLEAR...I didn't ALWAYS have this lack of bubbles. I used to have quite a bit of trouble in years past, especially with the luer lock type reservoirs used in the 508 and earlier pumps. Over the years, I developed a more refined, consistent approach to bubble removal and have attempted to describe it as accurately as I can. Perhaps a video would be better. All the steps are important, but number 7 is critical to full removal of any remaining bubbles in the reservoir, IMO. Also, SLOW drawing up of the insulin is critical--10 seconds or more, to draw up the first filling.



I had lots of trouble with bubbles with the 508. I don't like luer lock reservoirs, partly due to the difficulty in removing the bubbles. The convex top of the Paradigm's reservoirs helps congregate bubbles at the tubing junction. Far better design, in ways I'll not go into as the other issues are not bubble-specific, but rather safety related.

OK, I glossed over step 7. I will try that the next time. I also apparently draw it up a little faster than you describe, maybe (10 seconds sounds about right).

Thanks for the list!

Tom

Definitely take 10-12 seconds. Even 7 is too fast and will aerate the insulin.

I suspect that I require less than you because my TDD is in the teens. Nevertheless, what is imost important is the concept that this issue applies to others. I will watch both the video suggested and will check this post more frequently to see what your experience has been since your post stating you were going to try it again even though it's a PITA.

Thanks to all that have contributed to this thread! I most certainly appreciate the information that this user friendly site (IMO) is providing.

Well, this happened again this morning with a new reservoir. I wish the lady in the video had been a little more clear on how much air to withdraw - obviously, I am doing something wrong. Or, if the British dad could explain how he does it, I would be grateful.

I'm beginning to feel this may be more trouble than it's worth. Of course, this morning, I forgot about Spike's #7 - tapping the pump while priming. I'm gonna have to keep a pretty close eye on this one - I was in a rush and didn't get all the champagne bubbles out.

I may give this method one more shot - I'll change reservoirs again in 6 days.

Tom

I've tried this a couple of times. I do end up with the bubbles in the vial at the end (in this case I wasn't that worried about it because there wasn't enough insulin left to use in the vial anyway). I do think that using this method, you will always end up with those bubbles.

What surprised me was the amount of air I needed to draw from the vial the second time. You would think that there wouldn't be as much air on the second time you use this method - yet I needed to withdraw at least 8 reservoirs (300 ml) of air before there was a vacuum in the vial.

I, like you, am being to feel that it may not be worth the bother.

I tried it for the first time yesterday, and the same thing happened to me. What a mess! I wound up introducing air into the vial and the reservoir, all from the bottom of the reservoir. I had to wait till the next day to change reservoirs. Luckilly I still had enough in the old reservoir.

I am going back to my old technique. I always wind up with good size bubbles in the reservoir after using it for 6 days, but they never make their way into the tubing, so I am going to ignore them as I did in the past.

Linda B.

I'm not worried about bubbles in the vial - I get them in the reservoir as I am filling it. They bubble up through the bottom of the reservoir where the 2 little o-rings (or whatever they are) are at the bottom. It caused me a big headache this a.m. - I was in a rush and didn't get them all out. I may have to re-prime sometime this afternoon when I get home.

Tom

I didn't get any bubbles in the reservoir. Remember that you do need to let the vial sit for about 10 minutes before you attempt to fill the reservoir.

Up until now I've been using saline in my pump. I've found that when I have bubbles, it helps to draw a large amount of air into the reservoir and move that air around inside until it picks up all of the other bubbles. Then it's easier to expel all of that air from the cartridge. This is something my CDE showed me and it's worked pretty well for me.

As I start on insulin tomorrow, I gave it a go filling a pump cartridge from one of my Novolog penfill cartridges, since that's all I have right now. It was SO easy to do it this way! There's no air to start in the Penfill cartridge, so I only got a very small bubble of air that was inside the needle for the pump cartridge, which was also very easy to expel when I was done. I'm so impressed with how quick and painless it was compared to the saline fills I've been doing that I think I shall continue to fill from the Penfills. It's much easier to avoid air in the pump cartridge if there's already no air in the container you're filling from!

I guess you haven't yet encountered the strong "drawback" effect of creating a vacuum by the act of withdrawing insulin from a vial without FIRST injecting air into it. The suction it can create with a new vial can pull the plunger right out of your fingers. Full vials of insulin should have an entire reservoir's worth of air injected into the vial (with vial RIGHT SIDE UP), before upending the vial and withdrawing insulin into a 180U reservoir at the rate of 12+ seconds, to avoid creating a frothy mess of bubbles in the reservoir.

Yes, well, perhaps I should've stated myself more clearly. In a penfill vial, this isn't an issue because the plunger of the penfill cartridge automatically moves as you withdraw insulin from the cartridge. Because there's never any air in the vial, and air isn't needed to replace the insulin you withdraw (because of the automatic movement of the plunger), air in your pump cartridge becomes much less of a problem.

Thanks for the clarification, Kitty. I wouldnt think the average pumper fills their pump from pen cartridges, eh?

Well someone else in one of the other forums here was complaining about having to carry a syringe and insulin vial as backup, when s/he'd been used to the pen for so long. They didn't want to keep getting Penfill vials in addition to having to get regular vials and pay the copays for both. My solution is to just get Penfill vials and fill the pump from those, giving one the option to continue carrying a pen as a backup without having double the copays.

I wonder what the cost difference is between 1000U of bottled insulin vs insulin in pen cartridges. Do you know? I don't even know what the retail price is of my Novolog. I pay $20 a month regardless of amounts I get.

Well if you have insurance, the amounts don't matter at all, and it doesn't matter if your prescription is for one vial of insulin, one box of penfills, or 10 boxes of penfills. I've never heard of anyone having to pay anything other than their insurance co's standard copay amount, regardless of quantity.

I have insurance, but I don't have copays for RXs. I have a $2500 yearly deductible after which everything is paid at 100%. Even after I meet the deductible, I have to pay for my RXs and then submit a claim for reimbursement. I have a feeling this company would balk at the use of penfills to fill an insulin pump. Since I never used a pen, I'm OK with using vials anyway.
Just wanted you to know that some of us do have to pay for insulin!
And Spike, the retail price for Novolog is $99 / vial.
Linda B.

Yikes! Doesn't that represent what's wrong in our system? ie, NOT that we aren't all covered by insurance in the US, but that medical costs are outrageously, and unconscionably, too high?? There's just way too much profit in medications, like there is in cosmetics.

I think I've mentioned it somewhere before - the retail price for NovoRapid (what Novolog is called in Canada) is about $31 a vial. Do any of you know why insulin analogs are about 1/3 of the US price in Canada?

I believe ALL drugs are cheaper in Canada. That's why some people without insurance are now using the internet or making trips to buy their drugs from Canada, even though it is illegal to import them.

The drug companies explain the prices with claims that they have to get back the money that they spent on research and development, and that they also need the huge profit to continue R&D for new drugs.

Linda

Not all drugs are cheaper in Canada. Read here: http://www.ncpa.org/pub/st/st293/st293j.html

I have a question about bubbles in tubing. I've had no problems at all getting my reservoirs filled without air bubbles. However, I check my tubing about twice a day, sometimes more, and at least half of the time I check, there is a small amount of air in end of the tube that connects to my infusion set. Even after priming it out and making sure there is no air in the rest of the tubing, the air in that one spot will usually return.

Any ideas what could be causing this?

Do you make sure that your insulin is room temperature before changing the resevoir?
Refrigerator-cold insulin can cause bubbles to appear in the line even though you've made sure there were none, when you filled the resevoir.

Are you sure it's air and not just some discoloration in the tubing? I use a reservoir & tubing until it's empty and by the end of that time my tubing looks pretty beat up. I usually wrap it around the pump and often get it stuck under the clip. It can make it look like there's a bubble in the tubing. When I disconnect for a shower I do often have air in the very end of the tubing, where it connects to the set. Usually just holding the pump above my head with the tubing dangling pushes the insulin and expels the air, but sometimes I do have to do a fixed prime to get it out. I don't see how you could actually be getting air bubbles at the end of the tubing. Take a really good look next time to make sure it's not just a mark on the tubing.

Yes. I let a new vial sit out for a couple of days before I open it, and it never goes back in the fridge after that.



It's not. It's not always there. It disappears after I prime it out, and then reappears later, so I'm pretty sure it's not discoloration in the tubing.

That is strange. However, I don't think you need to worry about to much. The reason that bubbles are a problem is when the air is in the reservoir, it gets counted as insulin by the pump. For example, if you have 1 unit's volume of air at the top of the reservoir and you do a 2 unit bolus, the pump squeezes out only 1 unit of insulin, plus the air bubble. All the pump knows is to push out 0.02 ml (2 units of U100) of something.

However, this isn't your case. From what you say, the pump does push out 2 units of insulin. Even though an air bubble is developing later on, you're still getting the 2 units of insulin. The bubbles could cause an unevenness of delivery, but if they are small bubbles, the effect should be minimal.

Never the less, it would be interesting to figure out what's causing this.

Well, they're not champagne bubbles. It's a bubble that maybe fills the last centimeter or so of my tubing. I have no idea how much insulin that is, but what I'm worried about is that when I bolus, if the air bubble is .5u and I bolus 2u, wouldn't I only then be getting 1.5u of insulin?

There is an article about what causes the air bubbles in our Wiki. To find it in the future, click on the Wiki in the top bar, then click on insulin pumps and you will find it. To view it, click on the link below:
http://www.insulinpumpforums.com//index.ph...rticle&id=4

I visualize it like this:
You start with no air in the tube. An air bubble forms, displacing 0.5 units of insulin. This has no place to go except into your infusion set.
Later, you bolus 2 units. This pushes the air bubble plus plus 1.5 units.
You received your entire 2 units. However, 1/4 of it was infused early.

The more I think about it, the less this whole thing makes sense. I'm not doubting your work about what you're seeing. I just don't understand how it could possibly happen.

That is exactly what happens, it's why you should make every effort to prime that bubble out before it ever hits your site. It's nearly impossible to guess how much insulin an air bubble equals, I used to HAVE to guess this before disconnect sets were available.