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Re: [IP] Bubbles-Bubbles-Bubbles

Hi, Dave.

> I've been pumping since 10/1/01 and my biggest problem has been
> bubbles... Any suggestions?

I've used a Minimed 507C and now a 508 with 42" Sof-Set Ultimate QRs
for more than two years. I have zero problems with bubbles. After
emptying them from the reservoir during the fill, I *NEVER* see them.
Perhaps you'll find the following procedure (rev. 1) helpful. As in
all things diabetic, YMMV.

First of all, bubbles aren't magic. If the insulin used to fill the
reservoir is already at room temperature, then the bubbles are 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 5.

2. Before filling the reservoir, twist on the filling needle with the
   plastic cover so it's *tight*. This will minimize air leaks through
   the needle in step 5.

3. Let your insulin bottle reach room temperature before you use
   the insulin to fill the reservoir. Cold insulin releases air as it
   warms up. A 3 ml reservoir full of cold insulin could release
   enough air to displace 3 units of U-100 insulin.

4. 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.

5. 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 half-full, withdraw the needle 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. Then reinsert the needle
   in the insulin bottle and fill the reservoir the rest of the way.
   When the reservoir's full, tap it again and make sure no bubbles
   are present.

   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.

6. 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*.

7. 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.

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

9. 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.


regards, Andy
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