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[IP] Re: Magical Bubbles in tubing

Kathy Bruckmeyer wrote:
>... the bubble[s] appear!  Tiny little ones.  I always get the larger ones 
>out before I even connect, even from my tubing but when I look in my 
>reservoir, I see tiny little bubbles forming.

Hi, Kathy.

If you're talking about teensy-tiny "champagne" bubbles, they have hardly 
any volume and are unlikely to be the cause of high bg's.

I've used a Minimed 507C and now a 508 with 42" Sof-Set Ultimate QRs. 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 helpful. As in all things diabetic, YMMV.

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 reservoir 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.


regards, Andy
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