bubbles in cartridge/infusion set

[sus matteos mum]

Can anyone give me any tips to avoid the fatal bubbles? There seam to be enough reasons to have unpredictable blood sugars without bubbles adding to the equation! My 10 year old son uses Humalog and I have heard that it can more problematic than Novo rapid........Any comments????????

 

[iHs]

Hi

Welcome to the forum.

Loads of questions and answers with advice regarding most problems have been left on the pump forum.

What pump do you have and do you get air bubbles in cartridge when filling up with insulin or do they appear after the cartridge has been put in the pump??

 

[Herbie72]

Bubbles are the bane of my life and affect my control MASSIVELY. Have got an appointment with my DSN next week (I think), so will raise the issue with her and report back.

 

[MushyPeaBrain]

I haven't had any issues with bubbles so here's what I do incase it's of any help

I store all vials of insulin (Novorapid) in the fridge EXCEPT the one I'm using to fill my cartridge. This is always kept at room temperature in a cupboard, upright and somewhere that doesn't get too much temperature variation.

I'm using the Animas 2020. When I need to fill my cartridge I put the cartridge syringe together. Next I move the plunger back and forth a few times as this helps coat the plunger and seal the cartridge from leaks. Next I draw up half the cartridge worth of air and inject it into the vial. I do this with the vial stood upright on the table, so that the air goes into the top and not through the insulin. Next I turn the vial upside down and draw up about half a cartridge and start flicking the cartridge with my finger. This sends the air bubbles to the top. I gently push the plunger up to release the air and then draw up the insulin again. I basically keep doing this until I have no bubbles. I'm always slow with moving the plunger as drawing up/putting back into the vial fast can create air bubble problems.

Finally I put the cartridge in my pump and when I prime I have the pump facing up so that any air bubbles left would be at the top and hopefully get primed out. I always fill my cartridge fully as my DSN told me not doing so can cause air bubbles but that might depend on pump type etc

Hope that helps

 

[iHs]

When I first started using the Accu Chek Spirit Combo, I always got bubbles in the cartridge but then I started thinking about going back to basics.

I didn't find the Accu Chek rep an awful lot of help as she demonstrated filling up cartridges by injecting air downwards and made it look really easy. What I didn't realise was that she demonstrated the technique of injecting 300u air downwards into a vial that had nothing in it :roll:
It was only when I left the hospital that I then became a bit angry with myself for not being able to pick up on what she was demonstrating.

The problem is I think in the design of the cartridges. The Animas cartridges are thin and only hold 200u insulin whereas the Accu Chek cartridges are wider and longer and can hold any amount upto 300u insulin. It’s therefore harder to fill the Accu Chek without any bubbles at all.

There are various ways to fill cartridges though and following the pump instruction manual doesn’t always help……

If people want to follow the technique that MPB has mentioned then they need to be a bit careful when injecting air downwards into a vial that is full up (new) with insulin when using Accu Chek cartridges. If 300u of air is injected downwards into a full vial, then because there is nowhere for the air to escape to, the plunger will rise before you can turn the insulin vial upside down to withdraw. I once lost nearly half a vial of insulin as the plunger in the cartridge came out of it and the seals blew off. I would recommend therefore that when injecting air downwards into a full vial for the first time that the first cartridge contains no more than 200u insulin then they wont have the problem I had. The next fill up will be ok though as the insulin in the vial will be reduced so there’s more room for the air and you can fill up with 300u ……..

I still get my cartridges upto body temperature (boob temp) for about 10hrs regardless of whether I use room temp vial or one that has been in the fridge, as I keep my pump inside my bra. By doing so it makes air bubbles easily rise and then I just sharp flick with my thumb nail against the side of the cartridge to make the bubbles join up to being just one and then tilt cartridge slightly to get the bubble in the centre of cartridge at the bottom of the neck and then sharp flick a couple of times and then screw in plunger and push the bubble out. This works fairly well for me. I then put push on the black adaptor with a new tube already screwed in and put the cartridge in the pump and then let the pump go through the prime etc……….

Hope that helps some of you using Accu Chek

 

[sus matteos mum]

Thank you all for your comments, our problems are mainly after the cartridge and set have been changed and the pump on for a while. Could the fact of my son being very active (he likes throwing himself about and standing on his head!!) have anything to do with it?? Clearly thriough this activity his pump get turned upsidedown regularly. What do you think?
We have a spirit combo pump and use the accu check spirit cartridges.

 

[carolync]

Hi, hope you have got sorted out and are having fewer bubbles. I have been on a pump for 12 years and have had a lot of problems with them on and off and they have caused a lot of headaches. I would echo what others have said about temperatures of the insulin, techniques for filling the cartridges,tubing being kept out of snaggable reach etc. However, things have improved for me considerably since moving onto Apidra/Glulisine insulin instead of Humalog at my DSNs suggestions - far fewer incidences. It may be worth the ask if all else fails. Just for info I have an Animas Vibe. Good luck, it is a frustrating problem

 

[Scoop4]

I have been on the pump for 5 years and have problems with bubble in the cartridge. I am not overly active like your son but I have temperature problems which seem to have an adverse effect on the insulin. Basically I get sweats and when this happens I getting bubbles. Have been told to keep pump and cartridge away from my skin and try to keep it outside my clothing this seems to help some. I do tend to check cartridge and tubing a lot at meal times or watching telly and get rid of them when they appear.

 

[dowuchyalike]

I'm always happy that there are no visible bubbles in my new cartridge, however, I often find that a day or two later that a huge one can just appear seemingly from nowhere. DSN reckons that thousands of minute bubbles can be present when you fill a new cartridge and eventually they all just come together to create one big one. I use Novorapid and have tried all the obvious solutions recommended by others but to no avail. Now I just make sure that the pump is always upside down when in use so any air bubbles I'm unaware of float to the opposite end of the cartridge away from the entrance to the tubing. With this technique, I can get down to the last 20 units in the cartridge without bubbles ever entering the tubing, and at that point I just dispense with the remaining insulin and change the cartridge. Obviously, if see a bubble I'll prime it out, but this technique seems to provide something of a solution, although I would prefer not to get them in the first place.

 

[CarbsRok]

I'm always happy that there are no visible bubbles in my new cartridge, however, I often find that a day or two later that a huge one can just appear seemingly from nowhere. DSN reckons that thousands of minute bubbles can be present when you fill a new cartridge and eventually they all just come together to create one big one. I use Novorapid and have tried all the obvious solutions recommended by others but to no avail. Now I just make sure that the pump is always upside down when in use so any air bubbles I'm unaware of float to the opposite end of the cartridge away from the entrance to the tubing. With this technique, I can get down to the last 20 units in the cartridge without bubbles ever entering the tubing, and at that point I just dispense with the remaining insulin and change the cartridge. Obviously, if see a bubble I'll prime it out, but this technique seems to provide something of a solution, although I would prefer not to get them in the first place.

If you have a bubble appear from nowhere! then the simple explanation is you have air getting in.
So make sure you have the tubing connected tight enough to the cartridge.
To chuck out 20 units of insulin is a dreadful waste of NHS money. To me that would equal a days worth of insulin or one years worth. :shock:

If you do for any reason get a bubble in your tubing just watch it progress down the tubing and then prime it out once it has reached the end.

 

[dowuchyalike]

I'm always happy that there are no visible bubbles in my new cartridge, however, I often find that a day or two later that a huge one can just appear seemingly from nowhere. DSN reckons that thousands of minute bubbles can be present when you fill a new cartridge and eventually they all just come together to create one big one. I use Novorapid and have tried all the obvious solutions recommended by others but to no avail. Now I just make sure that the pump is always upside down when in use so any air bubbles I'm unaware of float to the opposite end of the cartridge away from the entrance to the tubing. With this technique, I can get down to the last 20 units in the cartridge without bubbles ever entering the tubing, and at that point I just dispense with the remaining insulin and change the cartridge. Obviously, if see a bubble I'll prime it out, but this technique seems to provide something of a solution, although I would prefer not to get them in the first place.

If you have a bubble appear from nowhere! then the simple explanation is you have air getting in.
So make sure you have the tubing connected tight enough to the cartridge.
To chuck out 20 units of insulin is a dreadful waste of NHS money. To me that would equal a days worth of insulin or one years worth. :shock:

If you do for any reason get a bubble in your tubing just watch it progress down the tubing and then prime it out once it has reached the end.

I think you're over reacting to the loss of few units of insulin. You waste 25 every time you prime and then when you come to a bottle that doesn't contain 300 and you're refilling a new cartridge, you can't really make use of it in any way unless you save all those bottles with less than 300 and attempt to move insulin from one to another - hardly a workable solution. I don't throw 20 away every time but if I do get down to the end and there's a bubble there and it takes 25 units to dispel it, then what can you do?

 

[CarbsRok]

If you have a bubble in your tubing and you let it go down to the end of your tubing thats pos 1 or 2 units, not 25 But if you have a bubble the length of your tubing then you have air leaking into it.
If a vial doesn't have enough to fill your cartridge then use another vial. It's a very simple operation to do.

What it boils down to though if you are getting huge bubbles then you have air leaking into the cartridge so you need to make sure that all connections are tight

 

[dowuchyalike]

If you have a bubble in your tubing and you let it go down to the end of your tubing thats pos 1 or 2 units, not 25 But if you have a bubble the length of your tubing then you have air leaking into it.
If a vial doesn't have enough to fill your cartridge then use another vial. It's a very simple operation to do.

What it boils down to though if you are getting huge bubbles then you have air leaking into the cartridge so you need to make sure that all connections are tight

I'm talking about bubbles in the cartridge not in the tubing. To get rid of it is going to waste a fair few units for sure.

If an insulin vial has say 50 units left in it, there's no easy way to get that 50 units into a cartridge and then withdraw 250 from a new cartridge; ergo, those 50 units are wasted. That was my point. If you know of a solution to that or I'm being dim and missing something (which wouldn't be beyond the realms of possibility! :crazy do please tell.

I''ll look into the tightness of the tubing where it connects with the cartridge. Cheers for that. :thumbup:

 

[CarbsRok]

If you have a bubble in your tubing and you let it go down to the end of your tubing thats pos 1 or 2 units, not 25 But if you have a bubble the length of your tubing then you have air leaking into it.
If a vial doesn't have enough to fill your cartridge then use another vial. It's a very simple operation to do.

What it boils down to though if you are getting huge bubbles then you have air leaking into the cartridge so you need to make sure that all connections are tight

I'm talking about bubbles in the cartridge not in the tubing. To get rid of it is going to waste a fair few units for sure.

If an insulin vial has say 50 units left in it, there's no easy way to get that 50 units into a cartridge and then withdraw 250 from a new cartridge; ergo, those 50 units are wasted. That was my point. If you know of a solution to that or I'm being dim and missing something (which wouldn't be beyond the realms of possibility! :crazy, do please tell.

I''ll look into the tightness of the tubing where it connects with the cartridge. Cheers for that. :thumbup:

Again if the bubble is in the cartridge wait until it gets to the end of the tubing then prime it out.
Another tip is to also fill your cartridge and let it stand for 20 mins before poping into your pump. This allows any stray bubbles to surface. You are using room temp insulin to fill the cartridge aren't you?
It is quite simple to take 50 units from one vial and 250 from another All you do is push some air into the new vial 1st and then just draw up the 50 units first then poke needle into new vial with air already pushed in and withdraw the insulin. No waste and no problem

 

[dowuchyalike]

If you have a bubble in your tubing and you let it go down to the end of your tubing thats pos 1 or 2 units, not 25 But if you have a bubble the length of your tubing then you have air leaking into it.
If a vial doesn't have enough to fill your cartridge then use another vial. It's a very simple operation to do.

What it boils down to though if you are getting huge bubbles then you have air leaking into the cartridge so you need to make sure that all connections are tight

I'm talking about bubbles in the cartridge not in the tubing. To get rid of it is going to waste a fair few units for sure.

If an insulin vial has say 50 units left in it, there's no easy way to get that 50 units into a cartridge and then withdraw 250 from a new cartridge; ergo, those 50 units are wasted. That was my point. If you know of a solution to that or I'm being dim and missing something (which wouldn't be beyond the realms of possibility! :crazy, do please tell.

I''ll look into the tightness of the tubing where it connects with the cartridge. Cheers for that. :thumbup:

Again if the bubble is in the cartridge wait until it gets to the end of the tubing then prime it out.
Another tip is to also fill your cartridge and let it stand for 20 mins before poping into your pump. This allows any stray bubbles to surface. You are using room temp insulin to fill the cartridge aren't you?
It is quite simple to take 50 units from one vial and 250 from another All you do is push some air into the new vial 1st and then just draw up the 50 units first then poke needle into new vial with air already pushed in and withdraw the insulin. No waste and no problem

I don't like the idea of waiting until the bubble reaches the end of the tubing. That could take a while and I'm a tad forgetful and could see it meaning missed insulin.

The vial solution seems like a good one. Obliged for that. Previously, I''d kept several part-used vials and moved insulin from one to another with a syringe until I had 300 units in one. It never really worked though because of the whole air/pressure issue. Clinic just told me to use a new vial outright and dispense with the part-filled one and never suggested any other solution. I've learnt more on this forum about my pump than from any professional source. I'm extremely thankful for that.