Accuchek air bubbles nightmare!!

[Marmite-lover]

Hi!

I have been connected to my insulin pump for 2 weeks now. The first week was pretty tiring as I was having so many hypos, but after some tweaks to my settings the last week has been a bit easier.

However, I have been struggling a bit with air bubbles in the infusion set. I have been having a look on the forum to see if there are any suggestions/techniques for an air bubble free life(!) and I did see that some people have found that having the new cartdidge of insulin at room temperature before connecting can help?

Basically, my DSN said it's probably easiest to draw up 3 cartdidges of insulin from the 10 ml vial at once, so then insert the first cartridge and then have the other two waiting in the fridge. When we had our pumps connected, I think the insulin vials waiting for us had been out of the fridge a little while. So we drew up three cartridges and I inserted the first one, primed etc. and I didn't seem to experience any problems with air bubbles in the set-clearly the insulin was being delivered as I was having so many hypos! :roll:

But it was when I changed the cartridge, so used one straight from the fridge, that although appeared air bubble free and before and after priming, somehow developed air bubble, as I ended up with very high sugars and on inspection of the tubing discovered there was air in it! I was freaked out by how quickly my sugars shot up, but luckily I did not develop ketones!

Then when I used the next cartdidge straight from the fridge the same thing happened again! I am SURE that the cartidges were air free before insertion and after priming, but somehow air seemed to have got into the set!!

Could it be something to do with using the insulin straight from the fridge? Or maybe I should draw up one cartridge at a time from the insulin vial?

I must admit I am feeling a bit demoralised, as my life feels consumed by my insulin pump at the moment! :roll:

After the first week of worrying about hypos, I am now worrying all the time about going high/air in the pump!

I know it is still early days, I just hope things will get a bit easier...

Any suggestions would be really helpful (sorry this post is a bit of a long garbled thing!)

 

[jopar]

The Pump nurse shouldn't have reccommended that you pre-fill your cartridges, as insulin can react with the plastic cartridge over time (most companies reccomend not leaving your insulin in the plastic cartridge for more than 6 days) so you should only fill one up for 6 days worth..

There are verious reasons for air bubbles, part is technique of filling you get better at knocking out air bubbles with time.. And don't inject the air into the vile through the insulin always ensure that the bottle is stood on the table when you inject the air into it..

Another reasons is when tend to inject more air into the vile than insulin you draw out, and this air is adsorbed by the insulin so when you fill up your cartridge with insulin, remove the cartridge from the blue collar, but leave the blue collar on the fill and leave this on until after you've replaced and sorted out your pump, this helps to degass the vile..

As insulin tempreture flutuates it adsorbs and releases air from it's solution... This is why you can find an air bubble in your cartridge after a day or so.. Impossible to avoid really as this is the nature of any solution... So it's important to regularly check for air bubble in your cartridge and prime is necessary..

I always wear my pump with the adaptor facing downwards, then if I get a air bubble develope it goes to the end of the cartridge away form the tubing.. And I always check before going to bed to ensure there's not one there..

Oh another tip here, as the nights are getting more chillier and we all like a warm bed..

Hot water bottles!

Be carefull if you use one of these that it doesn't get too near the tubing or pump as they can bake your insulin... With under electric blankets not a problem, but with electric over blankets could cause problems so need to be cautious with them..

 

[iHs]

Marmite

Although its ok to fill cartridges with insulin from fridge you do need to get them to room temp for about 24hrs before you put the cartridges in the pump. Insulin expands with warmth so that's why you are getting the air bubbles. Ideally get the cartridge up to body temp for a while especially if you put the pump in your bra like I do.

What may help you to fill the cartridges easier is to cut a small V nick either side of the blue vial adaptor as that helps to make remove the insulin vial ok and also using a 5p coin in the slot at the end of the plunger to help widen it so that when you screw the plunger in the cartridge, it doesn't wobble about.

 

[Cheryl]

I always remove a new vial from the fridge as soon as I draw up the last amount of insulin from the previous one (I only get through one cartidge every 7 to 9 days, so the insulin will be out of the fridge for up to 4 weeks until it's finally used; this has never caused me a problem).

I also spend quite a few minutes ficking & knocking the cartidge once I have drawn up the insulin to try & move all the bubbles to the top of the vial so that they're pushed through the tubing during priming. I then continue to knock the pump against the work surface quite hard while I prime the set until the bubbles stop coming out of the top of the vial. I use 80cm tubing & usually have to prime around 20-22 units to get rid of the bubbles. I rarely get bubbles following initial priming, though it's always a good idea to check a couple of times over the few hours following the insertion of a new vial, just to make sure.

It's always irritating to "waste" insulin priming, but necessary. Pumps can take quite a long time to get used to unless you're very lucky, but investing the time & effort now will pay off in the longer term. I know exactly how you feel being ruled by your pump, but things'll settle down eventually.

Good luck.

 

[jopar]

When you think about it you probably don't waste any more insulin than when injecting yourself after all when you'll using an insulin pen, you've got to dial up a unit or two to prime your pen with every injection..

So in my case quick acting used to last me about a week, and I could do between 3-5 injection a day, and levimer I spilt dose this, so I was losing between 7-14 units of insulin a day to priming my insulin pen.. so over a week I could lose 49-98 units of insulin, considering with a pump 1 cartridge lasts me about 3 weeks, and I generally prime once losing about 20 units of insulin quite a avoidence of insulin waste in my case

 

[iHs]

Have to admit that I never primed any insulin with a pen when I did my injections. I just primed when putting in a new cartridge and then that was it. I just left the pen needle on all the time until I felt it needed to be replaced. Can't say that it did me any harm as my bg levels were ok.

Regarding filling pump cartridges........

I now keep vial in fridge and just fill up when pump gets down to 20u. I don't use the vial adaptor anymore as I find it easier to use a disposable luer needle and inject air upwards into the insulin and then withdraw (like the old days). I use about 200u per week so any insulin that is left in vial after 30 days, I can then transfer by syringe into my insulin pen to use as backup. When using room temp insulin I found that I had about 100u left after 30 days in vial that using the vial adaptor to withdraw was a waste of time and because 30 days had elapsed, transferring it to an insulin pen was also a waste of time as the insulin had gone off.

So at the moment everything is in the fridge and every last drop of insulin is able to be used.

 

[jopar]

A couple of questions..

If you are leaving your insulin in the fridge between cartridge refills, why do you dump it after 30 days?

It's the warmth that could damage the insulin in the vail is airtight, it doesn't suffer airborn comtamination problems. So if it's kept in the fridge it will be fine until the expiry date..

The filling up of empty pen cartridges...

A very dodgy practice and slightly pointless to transfer insulin from a vial to refill an empty pen cartridge.. A practice I would totally not recommend anybody doing..

The insulin and the inside of the glass cartride is only sterile between the rubber bung and the end of rubber end seal.. it is impossible due to design to empty a cartridge completely so when you are injecting insulin back into the cartridge you are mixing old with fresh insulin, then because the inside of the cartridge as be exposed an no longer sterile you end up with a cartridge of insulin which could have comtaminates festering away in it..

A pointless activity because instead of putting your insulin at risk, you could have kept the vial which is sterile, and if needs be used the syringe to inject yourself with!


And I can't see the point of taking off the manufactuers collar, that's all ready to go to replace it with an item of similar to fill up the cartridge, which if we are all worried about insulin waste, doing this incurrs an extra unnecessary cost to everything!

Going back to insulin pens, I did use to keep my needles on my pen changing either as necessary or when I put a new cartridge in... I still found the need to prime, as air still got sucked back into the cartridge also it was a double check to ensure that the needle wasn't blocked which I found to have happened on occasions..

 

[iHs]

A couple of questions..

If you are leaving your insulin in the fridge between cartridge refills, why do you dump it after 30 days?

I don't. If you read msg again you'll see that I only dump room temp insulin after 30 days.

It's the warmth that could damage the insulin in the vail is airtight, it doesn't suffer airborn comtamination problems. So if it's kept in the fridge it will be fine until the expiry date..

The filling up of empty pen cartridges...

A very dodgy practice and slightly pointless to transfer insulin from a vial to refill an empty pen cartridge.. A practice I would totally not recommend anybody doing..

You've got a point.


My GP hasn't issued me with any pen cartridges and even if she did she would also need to give me a prescription for a new half unit pen. I just put about 20u per month in a pen from a vial and then start to use it as injections from pen before the 30 days is up. If I put a new 300u pen cartridge in every month loads of insulin would be wasted as I might only need to use the pen if I have an occlusion while I am out.

The insulin and the inside of the glass cartride is only sterile between the rubber bung and the end of rubber end seal.. it is impossible due to design to empty a cartridge completely so when you are injecting insulin back into the cartridge you are mixing old with fresh insulin, then because the inside of the cartridge as be exposed an no longer sterile you end up with a cartridge of insulin which could have comtaminates festering away in it..

|Point taken, but as I said, I am still all ok.

A pointless activity because instead of putting your insulin at risk, you could have kept the vial which is sterile, and if needs be used the syringe to inject yourself with!

I haven't used a syringe to inject myself with. I always use a pen.

And I can't see the point of taking off the manufactuers collar, that's all ready to go to replace it with an item of similar to fill up the cartridge, which if we are all worried about insulin waste, doing this incurrs an extra unnecessary cost to everything!

If Accu chek were to re design the vial collar so that it had a shorter needle then nearly all the insulin in the vial could be withdrawn but they haven't so there will always be some left that wont be able to be withdrawn if you use more than 100u per week and if 30 days has gone by.

Going back to insulin pens, I did use to keep my needles on my pen changing either as necessary or when I put a new cartridge in... I still found the need to prime, as air still got sucked back into the cartridge also it was a double check to ensure that the needle wasn't blocked which I found to have happened on occasions..

Can we get back to helping people fill cartridges ok as easily as poss

 

[Marmite-lover]

Hi again!

I would just like to say thank you so much for the useful advice!

I was considering contacting my DSN aboout the problems I have experienced, but actually I am really glad I made the forum my first port of call as your experience and help is invaluable!

I now feel a lot more hopeful that I will be able to get to grips with thing

Thanks again!

xxx

 

[iHs]

Another way to eliminate air bubbles is to attach the blue vial adaptor after you've got the cartridge up to body temp first for a while to allow the bubbles to form. Using your thumb flick it against the top of the cartridge where the neck is. This is easier to do if you tilt the cartridge slightly so that the bubble lines up in the centre of the cartridge before you start using your thumb nail to flick it up into the neck. Once you've done that take off the cartridge cap and attach the blue vial adaptor again and screw in the blue plunger. Very carefully push the plunger up just a tiny bit so that the bubbles come up to the surface of the needle and out of the top. Once you've done that twist off the vial adaptor and cap the cartridge again and then put it in the pump. Just chuck the vial adaptor away but make sure that you wipe around the filled cartridge with some tissue paper just incase there is some residue of insulin from using the vial adaptor.

This saves trying to prime bubbles into the tube as you've primed them out manually first. Touch wood,
this has worked out quite well for me.

 

[jopar]

You don't have to put the blue vial addaptor back on, to expell bubbles out of the cartridge, I do keep an spare plunger in case I need one..

What I actually find works well,

If I'm using a vial from the fridge I take this out 20 minutes before I attend to fill a cartridge, leave out on the side, then fill the cartridge as per normal tapping out any air bubble, then take off vial and put the cap on the cartridge (that comes with it) then take the plunger off, and as I stand the cartride up right I give it a couple of gentle taps on the table, then leave it for 30 mins or so... Then when I'm ready I give a couple more gentle taps to encourage any air bubbles to the top, rattach the plunger, take the cap off and level the insulin level off to the 3.15 mark.. Put into the pump..

Another thing to check is if you are experiencing a lot of bubble either while priming or building up when cartridge is in use.... Check the lunar lock is tight as air can seep back into tubing/cartridge.. The manual says hand tight, but my hand tight isn't tight enough and I use the knotch on the magifying glass to tighten, and also you should check every now and again durning the day to ensure that it remains tight, they can loosen slightly letting air back in...

A lot is to do with technique, and you soon learn not to shake your vial too much before or during the filling preceedure, due to making the insulin frothy as it forths up very easily indeed.. And this recreate a lot of bubbles.. Both for drawing up into the cartridge and when in the cartridge the bubbles spilt into much smaller ones which are a lot more diificult to get out...

And also when you fillin, let the air presure move the plunger only pull on the plunger when not enough pressure is available.. Then pull it back slowly and smoothly, don't move plunger side to side as this breaks the air seal on the bung letting air into the bottom of the cartride..

 

[sugar2]

Similar to iHs, I find that if I put the little blue adaptor on the cartridge, and connect the tubing, before loading the cartridge into teh pump, and pressing a small amount into the tube..kind of a small manual prime, I pretty much avoid most bubbles. I was finding that loading the cartridge into the pump, and then putting on the blue adaptor thingy on.

 

[iHs]

I think Jopar has raised a good point lol. You don't even need to put the blue vial adaptor on to expel the bubbles. As long as you get them up into the neck you can prime them out the top of the reservoir by just screwing in the plunger and pushing them out to the top of the neck. Just make sure that no insulin has dripped down the sides of the cartridge though. Wipe it with a piece of tissue.

I don't manually prime anymore Sugar2 by attaching the tube. I think getting the bubbles out manually from the reservoir is easier. )

 

[candi-girl]

I get my insulin out the fridge, fill up cartridge and then prime the tube and get rid of bubbles then stick it in the pump. Takes ages if the pump primes it, click click click... snore zzzZZZZ. My animas you could prime and the insulin would shoot out really quickly. That was MUCH better. Hey ho... anyway, no problems with bubbles that way.

 

[Marmite-lover]

I would just like to thank everyone again for all your very useful input and advice!

You are all very kind and supportive.

Some things like making sure the connections are really tight I did not realise and had actually been told not to tighten things too much in case I couldn't undo them later! :roll: I think getting advice from fellow pump users is invaluable as we are the ones who have to use our pump on a daily basis!

I have now compiled a list of all your useful tips to refer to, so here's hoping I have a bit more success from now on with pumping!

Someone likened my problems to how annoying it was when their i phone broke...yes, that must have been an inconvenience, but we need our pumps to work properly to keep us ALIVE!!

 

[iHs]

The thing to do Marmite is to have a go at trying out everyone's tips.

I tend to use 2 cartridges. One is in the pump and the other one is in the fridge with the vials. When the cartridge in the pump gets down to 20u, I then re fill the other one in the fridge.

Cartridges fill up easier with cold insulin than warm room temp stuff so that may help you for a while. The Combo pump is difficult to prime bubbles out through the tubing from the cartridge so manually priming them out is better. I once waisted about 30u of insulin trying to prime out a bubble which didn't go into the tubing, it just stayed in the cartridge and this was following the instructions in the manual (

 

[jopar]

If you fill up your cartridge with cold insulin from the fridge, then keep a very good eye on your cartridge as soon as the cold insulin starts to warm up to room tempreture it will start to release air from the insulin and you will get some nice large air bubbles in your cartridge..

At the end of the day, losing some insulin isn't the end of the world after all it isn't gold dust a vial costs about the same as one of the infusions sets... Strange that people get all worked up about losing some insulin priming their pumps,but don't bat a eye-lid about how many times they change their infusion sets...

 

[Herbie72]

Interesting discussion, this, thanks. But it has left me confused because everyone's been talking about needles, screwing in plungers and other technical stuff, and my Accu-Chek Spirit Combo has neither... unless I'm being completely thick. Are your Spirit pumps different to my Spirit Combo?

I have exactly the same bubble problems as the original poster, and it really affects my control - another annoying thing to throw in the mix when trying to get good control. I alway try to take the insulin vial out of the fridge with plenty of time to spare before changing cartridges, but sometimes this isn't always possible. I do find fewer bubbles when the insulin is warm, but I still do get them. It's the little blighters right at the top of the cartridge that really get me – it's almost impossible to tease them back into the vial.

When I do appear to have a bubble-free cartridge, ready for putting in the pump, as soon as I insert it, a giant bubble appears from out of nowhere. I often have to prime 50 units through the tubing to get rid of it / them.

One thing I don't do is prime mid-cartridge, so I'll try that once I get bubbles during the day.

I try to wear the pump during the day so that the tubing faces down and so any bubbles rise back to the top of the cartridge. But how do you do this at night?! You're horizontal and asleep, so how can you control the way the pump lies? :crazy:

One final thing, my insulin is stored in the fridge door - could the regular opening / closing of the door be frothing it up?

Thanks all :thumbup:

 

[phoenix]

Interesting to read, how different is the the accuchek to the Medtronic?
Unless the vial I'm using is almost empty, I've had no real bubble problems other than an occasional large one at the end of filling, very easily got rid of. I don't fill them straight from the fridge but no other 'special' treatment.
One difference is that my reservoir is smaller than the one used on the accuchek, (180u).if any big bubbles do enter, I've noticed that it's when the reservoir is almost full.

 

[Marmite-lover]

Hi phoenix! By the sounds of that I WANT A MEDTRONIC PUMP!!!!

I have heard that the accuchek pump can be more prone to bubbles and I have been struggling quite a bit...ended up with ketones and feeling very unwell because of these evil bubbles- frustrating because I know if I'd been on injection therapy this would not have happened, :roll: but equally when the pump does work it gives me much better control!

I feel like I'm stuck between a rock and a hard place...! :?

I haven't been wering my pump for almost 2 weeks because I have had to have operations on both of my eyes, so trying to get the courage back to reconnect when I am feeling a bit less battered!