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[IP] Re:HELP air bubbles

I also had problems with air bubbles.  Did a search of the archives and came up with the following guidelines.  Thought I'd pass them along.  They helped tremendously and I don't have any problems with the darn things any more.  Good luck.  email @ redacted

[IP] How to Avoid Bubbles

     To: Insulin-Pumpers Mailing List <email @ redacted>
     Subject: [IP] How to Avoid Bubbles
     From: Andrew Aronoff <email @ redacted>
     Date: Fri, 25 Feb 2000 14:31:53 +0100
     Reply-To: email @ redacted

I haven't had any problems with bubbles in the infusion set tubing, but I
can certainly understand how they could happen. Here's what I do to avoid
them (using a Minimed 507C with a 3 ml reservoir). Of course, as in all
things diabetic, YMMV:

First of all, bubbles aren't magic. 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 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
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 some 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 more than 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.

Any suggestions for improving this procedure would be appreciated.
     From: "Mary Keller" <email @ redacted>

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     To: <email @ redacted>
     Subject: Re: [IP] How to Avoid Bubbles
     From: "Mary Keller" <email @ redacted>
     Date: Fri, 25 Feb 2000 09:06:19 -0500
     Reply-To: email @ redacted

Great tips, Andrew.  This is exactly what I do and have never had air
bubbles in 5 years of pumping.  Thanks for writing this up!

I also, with the insulin bottle still attached and the needle UP, flick the
reservoir several times with my index finger to dislodge any air.
Sometimes, even when it looks fine, there can be tiny bubbles still present.
This brings them into the neck of the needle and they can be pushed back
into the insulin bottle.  Then, slowly withdraw a bit more insulin to fill

Once the set is attached (reservoir still in the up position, I slowly push
the syringe to fill the tubing, and at times have had to flick the reservoir
to make sure no bubbles remain where the tubing and luer attach.  I too,
hold the tubing up to the light and check for ANY bubbles, then load the
reservoir into the pump.

I have found that if I take my time and do this the same way every time,
that sometimes, when priming, much less than 5 units are needed before
insulin starts to appear from the SoftSet needle.


ICQ#: 3822759

Bursting Bubbles

                   Did you know that when refrigerated insulin warms to room temperature, air bubbles come out of the solution? This can also happen when room temperature insulin is warmed to body temperature. If you  take these simple measures, you can minimize the amount of air that can accumulate in your infusion set and reservoir.

                   First, it is always best to let insulin warm to room temperature before you fill your reservoir, but if you must use insulin straight out of the fridge, or if the bottle feels cold, try this:

                   Create a vacuum in the air space at the top of the insulin vial. You can do this with the syringe/reservoir you are about to fill. Push the plunger all the way in, insert the filling needle into the air space in he insulin vial, then withdraw a full 3 ccís of air. Holding the plunger back, remove the needle from the vial. Now shake the vial vigorously for about five seconds and let it sit for 5 minutes. The vacuum will remove most of the air from the insulin. You can then proceed with filling your reservoir as usual.

                   If you notice bubbles in your reservoir, after youíve filled it, pull back the plunger and draw some additional air into the reservoir. Hold the reservoir by the base of the plunger, pointing up, and gently tap the reservoir until all of the little air bubbles have combined into one at the top of the reservoir,  then slowly and gently push the plunger until all of the air is out.

                   Finally, donít be overly concerned about tiny bubbles. One inch of air in the tubing equals one half of a unit of U-100 insulin, and it takes a lot of tiny bubbles to equal one inch.