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Re: [IP] double bubble (air in the infusion line)

On 28 Mar 2001, at 22:25, Jeff Yanof wrote:

> Any tips or tricks related to air bubbles in the influsion line?

are we talking about a small amount of champagne-sized bubbles? 
masses of champagne-sized bubbles, or big bubbles?

> - has there been a email posting/thread on this?

probably.  I have a bad memory.
> - how to proactively minimize bubbles when changing the
>   reservour and inf set(beyond the manuf. purge & prime specs).

Let the insulin warm up to room temperature.  I sometimes let it 
warm up to body temp by storing it my undies waistband or bra for 
a few hours--but that does tend to agitate the vial and allows air to 
dissolve into the insulin so I only do this when I'm feeling impatient 
with the wait. 

Then be careful when injecting air into the vial.  Do that with the 
syringe on *top* so that you don't inject air through the insulin in 
the vial.

When filling the reservoir, pull back on the plunger slowly to cause 
less agitation.  My trainer said to let the excess air in the vial (that 
you injected into the vial above) push the plunger, but when I do 
that I see it *creating* the champagne bubbles that quickly 
dissipate--which tells me that some of that air dissolved into the 
insulin and will re-form into champagne bubbles by the next day.

I've noticed that towards the end of the month, the insulin seems to 
develop **masses** of champagne bubbles more often.

Once you've filled the reservoir, hold it needle up and use a pen to 
knock the larger bubbles up towards the needle.  Slowly push 
those bubbles out.

Still holding the reservoir needle-up, remove the needle, make sure 
the insulin bulges out the top a bit, then attach the tubing.  

STILL needle-end-up, begin pushing the insulin through the tubing 
until you see it come out the other end.  

Then put it in your pump and prime until it drips more insulin out.

One fellow on this list actually places it pump down, tubing up for 
quite awhile (I forget how long) to let air float to end of the tubing, 
and then primes a bit more, I believe.  I'm usuallly too impatient for 
that much wait.  Also, I'm a needlephobe.  The quicker I get the 
infusion set inserted, the less anxious I become.  So instead I use 
that preparation time for removing bubbles later on.

Even with all these steps, I STILL occasionally get *masses* of 
champagne bubbles.  

Those masses of bubbles won't prime through the tubing the way a 
full bubble will, but they'll eventually collect up towards the infusion 
set.  I once left it alone to see what would happen, and sure 
enough, my BGs went up as those masses of bubbles went all the 
way through.  So in this situation--when there are *MASSES* of 
champagne bubbles-- I ignore what Minimed says about 
"champagne bubbles" causing no trouble....
Now, since those champagne bubbles won't prime through the 
tubing--unless I empty the reservoir in the process--I've come up 
with a way to remove those bubbles without wasting scads of 
insulin... But it's a bit laborious and time-consuming.

I do this when I'm quieting down in bed to prepare for sleep.  I have 
a hard time getting to sleep, so doing things that are quiet and 
tedious and boring actually helps me.

I disconnect.  Then starting at the pump end of the tubing and 
working towards the quick release point, I hold two or so inches of 
tubing vertical (pump end at the bottom) stretched between my left 
fingers.  Then I use my right middle finger to flick at the bubbles 
until they dislodge from the side of the tubing, break into smaller 
bubbles and begin to float up.  Sometimes it takes some 
considerable flicking-power!  

I just keep repeating this until I work *all* the bubbles up to the 
quick release point, then I prime and flick and prime and flick.

I only do this when I see *masses* of champagne bubbles, not just 
a few champagne bubbles, because those masses will eventually 
(in my experience) collect up towards the quick release as one 
large mass of tiny bubbles and they DO affect my bgs.  

If you don't see this happen with your champagne bubbles, then 
don't worry about them.

Incidently, when I see a large bubble in the tubing, I deal with the 
same way....  by flicking it to break it up into smaller bubbles that 
will float up easier.  I really hate wasting the insulin.  Cuz it usually 
means I'll need to refill the reservoir too soon to suit me.  I'd rather 
flick the bubbles than deal with refilling a reservoir.  But that's just 
me.  I'm a bit obsessive about odd things, I guess. :-)

> - how to periodically look for them in the infusion line.
>   (I presently hold the tube near --but not too close to-- a
>   lamp  w/o disconnecting.  

I disconnect and just hold the tubing up with a light source behind 
it -- even if the source is across the room.  Perhaps I just still have 
good upclose eyesight, I don't know.....

I check my tubing every night before bed.  I chose before bed 
simply because the timing works well for my brain.
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