Compiled by: Barb Chafe (Parent of a teen pumper)

Disclaimer!

Disclaimer:

The following are tips and tricks we have learned ourselves, tried upon the advice of others, or have read about and thought they were a good idea. Many thanks to the Insulin Pumpers for all their help! Individuals are, well, INDIVIDUAL! What works for Erica might not work for you or your child. The key is to keep learning and determine what is the best for you or your pumper. Any changes you might be thinking of making should be discussed with your medical team first. They are key to your pumping success.

For those of you not yet pumping, or lucky enough to not have been attacked by bubbles, I will explain. When bubbles get into the syringe that you fill and put into your pump, they make their way into the tubing and take the place of insulin. With a child who has a low basal rate, missing tenths of a unit makes her sugars rise. Little bubbles are not so bad, but those big ones can play havoc with those lovely sugars.

Again, this is something very individual. Some people don't even notice the little suckers are there. We wish we could bust all of them!! Bubbles or no bubbles, we would not do without pumping. Here are some ideas I would like to share with you.

1. Leave your insulin out until it reaches room temperature. (We use a mixture of insulins so we have to leave them both out until they warm up a bit)

2. Tighten all the spots where there is an attachment. That will help prevent bubbles from getting in.

3. After your syringe has been filled, allow it to sit for awhile so bubbles will rise to the top. Then you can push the darn things out.

4. Wear the pump upside down, then the bubbles rise away from the tubing. Love this one, wish Erica wore a belt!

5. Create a large bubble in the syringe by taking in some air then use that to 'suck' up all of the little bubbles. It is then easy to remove the large bubble (and all of the small ones along with it).

6. Make sure you get most of the air out of the neck of the syringe before flicking it, which breaks up the bubbles and spreads them around.

7. Don't shake your insulin vial.

8. When filling a cartridge/syringe, I have available a small syringe with the plunger removed. After I have the insulin started into the cartridge, I insert the syringe into the vial stopper as it is upside-down. This allows air back into the vial and helps to equalize the pressure. I direct the tip of the syringe away from the tip of the cartridge needle so as to not introduce air back into the cartridge. Of course you end up with a LOT of bubbles in the vial, but wouldn't you rather have them there than in your cartridge? ;>) 9. Using a cartridge for filling the syringe, rather than a vial, helps keep those bubbles away.

9. If you are using a pen cartridge to draw insulin from, I find that actually PUSHING the insulin into the reservoir by depressing the cartridge plunger helps to alleviate the bubbles.

Consider the following:

First of all, bubbles aren't magic. If the reservoir is filled with insulin already at room temperature, they're present because either they were _pushed_ into the tubing (from trapped air) or _pulled_ into the tubing (from a loose fitting).

1. Before filling the reservoir, pull (not all the way) and push on the plunger a couple of times to distribute the lubricant already inside. This will reduce the possibility of air leaks around the plunger while filling the reservoir in step 4.

2. Before filling the reservoir, twist the filling needle with the plastic cover on so it's *tight*. This will minimize air leaks through the needle in step 4.

3. Withdraw the plunger to fill the reservoir with air and then inject this air into the insulin bottle. If this step is omitted, the insulin bottle will be under a vacuum and air will be sucked into the reservoir from around the plunger in the next step.

4. Fill the reservoir from the insulin bottle with the needle pointed *up* so that air floats to the top of the reservoir. When the reservoir is full, withdraw it from the insulin bottle. Holding the needle *up*, tap sharply several times on the reservoir so that the air around the plunger is knocked to the top. Then, hold the reservoir up to a bright light and push the air (and any insulin trapped between air pockets) out of the reservoir. Stop pushing on the plunger when insulin starts to flow out the needle and no bubbles are left in the reservoir.

   This step is NOT included in the "Instruction for Use" of the Minimed 3.0 ml Reservoir (REF MMT-103). Instead, Mimimed advises you to get rid of the air after you connect the infusion set (step 6). However, it's much easier to manipulate the reservoir without the infusion set attached and I haven't yet filled a reservoir without seeing air at this point. IMHO, this is the single most important step listed for eliminating bubbles.

5. Holding the reservoir with the luer connection *up*, unscrew the (tight) needle with the plastic cover, and attach the new infusion set connector. Screw it on *tight*.

6. Holding the reservoir with the luer connection *up*, push on the plunger until the insulin comes out the needle. Once insulin starts coming out, there should be no bubbles visible anywhere at this point. If you see bubbles, get rid of them before going any further. Try to figure out how they got there. THERE IS A REASON.

7. Insert the plunger into the pump and (gently) push the driver arms against the plunger to minimize the priming quantity.

8. Prime the pump. 5 units should be sufficient. If insulin doesn't appear at the needle tip after 5 units, look for leaks and bubbles and try to figure out what went wrong. THERE IS A REASON.

1. Fill your syringe the night (or even an hour) before. You can leave the partial bottle in the fridge and don't have to bring the entire bottle to room temperature.

2. On a new bottle, hold the bottle upright and insert a syringe needle into the air pocket above the insulin. Create a vacuum by drawing at least two full syringes of air. This vacuum helps considerably in allowing bubbles to scuttle back into the bottle.

3. Withdraw and partially pump back into the bottle, several times.

4. Before you withdraw the syringe, don't be afraid to give the syringe a sharp blow with some object (e.g. the back of a comb, a pen, etc.). The sharper the blow, the more likely you will not only dislodge the bubbles but break them into much smaller bubbles which travel more easily and are less likely to reform and lodge.

Diesteronic Bubble-busters: I don't think I have experienced any bubbles in the tubing so far due to this method:

1. Make sure the insulin is warmed to body temperature (I place it between my inner shorts and stomach for 20 minutes or so).

2. When drawing insulin into the cartridge, let the plunger back very slowly while tapping the cartridge (make sure the filling needle is on the cartridge very tightly. If it comes off don't worry about it; just put it back on the cartridge. As you **very slowly** pull the plunger back do not pull it all the way back to the 315 unit mark! Stop several times while in this process. Each time you stop, tap the cartridge to loosen bubbles as they form.

   Once the plunger is almost all of the way back; make sure you pull it back **past** the 315 unit mark. Prior to pulling the filler needle out of the vial, tap out as many bubbles as possible. Try to get all the bubbles up into one big bubble at the top of the cartridge, centred at the start of the filler nipple. Once you get the remaining bubbles formed into one big bubble, angle the cartridge back and forth while tapping it form 0 to about 45 deg in order to get the big bubble (or cluster of smaller bubbles right at the uppermost point in the cartridge at the start of the filler nipple. Push the plunger ahead enough (often 1/25 of the way up is necessary and there is enough lube on the O-rings to safely do this) to force the bubble(s) out into the vial. Then you can usually redraw the insulin with a minimum of bubbles until the plunger is **Past** the 315 unit mark.

3. Place the protector cap on the cartridge and proceed ot tap the heck out of the cartridge on a hard surface. This will force the remaining tiny bubbles up to the filler nipple. This is a key step.

4. Let the cartridge set vertical for 15 - 60 minutes (or all while you use up the remaining insulin in the old cartridge. When you return later, all remaining bubbles will be nicely *in* the filler nipple! This is also a key step.

5. Disetronic recommends tightening the lure lock onto the cartridge *after* the cartridge is in the pump. I find it better to do this:

   Attach the piston rod and with the large cog backed off. Attach the adaptor to the top of the cartridge. Remove the cap form the cartridge and **now** attach the lure lock. Use the piston rod ot push the plunger to the 315 unit mark (remember we had drawn it back past the 315 unit mark) and snug up the major cog to the back of the cartridge. This forces most of the remaining bubbles into the lure lock.

6. Drop the cartridge into place in the pump and proceed to prime. While priming tap the pump several times on a semi-hard surface like a pad of paper which is resting on a hard surface. You'll notice multitudes of small bubbles and foam going into the tubing. After the first 10 or so units of priming, hold the tubing vertically over your head while shaking the heck out of the pump. I shake it with arm swings from my knees to over my head. (This is somewhat of a cardio-workout as well). You will know when your cartridge is bubble-free when your vigorous shaking no longer produces bubbles to be pushed into the tubing.

The whole procedure above (excluding the time for the cartridge to set) takes about 10 minutes once you're used ot it (and my first cartridge change took me four hours)!

1. Don't shake insulin vial

2. Prime reservoir by moving plunger up and down while twisting back and forth, which insures lubrication is spread evenly.

3. Pre load reservoir with air at same number of units as insulin

4. Load vial with air and reservoir will fill with insulin and check for bubbles

5. Cycle plunger forward and backward a few times

6. Push plunger all the way up into reservoir under pressure and maintain its position there.

7. In this position tap the reservoir to knock out any remaining bubbles, if a few still remain start again with step five and do again.....

This input compliments of Charles S from California:

The only addition that I could suggest is to point out that when refilling a syringe I would disconnect the syringe from the tubing & refill the syringe. Then as I rejoined the tubing to the hub of tubing I would express some insulin on to the top of the hub and just over fill it. Then bring the male part of the tubing and join the small amount of extra insulin on top of the hub and not get any bubbles caught in the process. Thus no darn bubbles to flush out & no wasted insulin.