Accuchek airbubbles

[donnellysdogs]

Hi Everyone

How on earth can I stop getting the airbubbles 5 hours after I do my cartridge changes on my accu combo pump. I think I have done a great cartridge change, and for the past 3 weeks, since starting my levels rise 5 hours later and I can see an airbubble in tube. Or the next day there is a bubble.

Does everybody have this, has anybody found a way around it. I'm having 5 good days with levels but the day of change and the next day I have problems. Even the rep sent me away with an airbubble in it when I first went live with it.

It is my only frustration with my new best friend....tried everything,,first 2 changes were from bottle that was at room temeprature for 2 weeks. Changeover Sat due to a hiccup was with cold from fridge warmed up in hands first as it was needed quick......

Has anybody found perfection yet?

 

[jopar]

Err nope and I've been trying for almost 3 years..

But I decreased the amount of times this happans..

Give plenty of time between filling the cartridge and replacing it in the pump..

I take my insulin out the fridge the night before..

When I go to fill the cartridge, I will pull the plunger back and forth several times to ensure that it it the inside of the cartridge is well lubicated (helps to stop air bubbles sticking to the side)

Inject the air into the vial as the vial is stood on the table, so you'll not pushing the air through the insulin

Allow the insulin transfering across to fill the cartridge rather than pulling on the plunger..

Once full I tap it against the table, and then put the top on, leave to stand for a while before changing the cartridge..

When you ready to change, tap the end of the cartridge on the table again, then adjust for correct reading of amount.. (you need to remember to keep the plunging rod)

Sometimes you still get bubbles even with doing this little lot, but cuts them back..

Also ensure that that the lunar lock is tight, use the nogging thing on the magifying glass to tighten a bit.. As sometimes if this isn't tight enough then air can seep back into the cartridge over a couple of days..

Another tip

I always ensure that the pump is point downwards, so if any bubble present or form in the cartridge, this keeps it well away from getting into the tubing and causing highs..

 

[johnny37]

I noticed this too. Tapping it does not seem to work. When filling the cartridge I push/pull the plunger several timers (as Jopar does) until fairly confident Im not sucking in any air. Another trick Ive found is to prime the cartridge without the tube attached. Keep going until all air is expelled (you can see it bubble-up as it clears). Then stop and prime again with the tube attached. All this should be done with the cartridge upright and the pump standing a a level surface. If it happens between cartidge changes prime again with/without tube as before.

 

[jopar]

The problem with priming the cartridge in the pump without the tubing you have the possibility of the insulin runing back down into the cartridge space inside the pump, which can gum up the piston rod...

I know that it's supposed to be a water-tight seal, but alas human error either by not replacing the collor often enough or securing the collar probably who can effect waterproofness, hence even though spirit pumps carry an IP rating of x8 (IPX8) upto 60 minutes under 8ft of water, Rouche do not gurantte due to human error, cracked casing etc that it's waterproof, only splash proof..

 

[donnellysdogs]

Well Tuesday night I took my cartridge out to room temp and left until yesterday afternoon until after I had my bath. No airbubbles. Connected. Primed. All ok....no air bubbles. I even changed the cartridge connector too.

Went to bed at 9.30....and an air bubble, I always tap quite hard the bottom before and during priming. So I reprimed again. Air bubble came out ok.

This morning went for massage and accidentally half ripped out the cannula and set. So when come home I took it out and put another in. Looked at my cartrdige and chanmpagne bubbles. So, banged bottom, reprimed and staggered at the quantity of airbubbles that went along the tubing.

I also push/pull the plunger to 'prime' the cartridge.

The thing the air bubbles in the tubing even the little ones do let me down and push my levels up. I guarantee now the day of cartridge change and the day after my levels will go up due to them. THe other 5 days my levels stay pretty much level between 5-8 ( 9 sometimes after eating).

Even when I connect the pump after my bath on changing just the set over, there is a suction back in the tube and I always leave it on with the connector and tube going downward.

My pump always faces downward when awake, although it is less downward when I sleep, but saying that I just finding it so frustrating that 2 days out of 7 my levels go up, and it's airbubbles that are doing it.

If it was something else I could blame I would, but it isn't. I never prime without tube and when doing the priming and changeover the pump is always sat on it's bottom facing up.

I know that now the 2nd day is over since changeover, my levels will be good for the next 5 days. Even the trainer on the pump, sent me away with a big bubble in it when I was first connected, and said it wouldn't affect me as it would stay in the top, but it didn't as when I was first connected when I laid down to sleep the pump was horizontal so it ended up travelling down the line-and she was the trainer...so now the pump at night is defintely as much as I can (I move alot) facing down.

I just find it frustrating that the manufacturers make something that isn't quite 100%. We didn't get airbubbles in our insulin with MDI so just what is the cause of them in pumps, and what are they doing to improve the situation?

 

[jopar]

If you move around in bed a lot, I would in the morning just ensure that the lunar lock is tight.. I use the maginfying glass duffer knotch to check that the lock is tight after hand tightening it..

Difference between pre-filled and our cartridge..

Pre-filled you prime the air out every time you do an injection, then the need to dump 1 or 2 units of insulin.. The insulin pen is kept at room tempreture so the adsorbed air in the insulin isn't released so easily..

When we fill our cartridges, we pump air into the vial to get insulin out so part of this air will be adsorbed by the insulin.. Once the insulin cartridge is in the pump, it very near the body so in the main is at body tempreture this release more air from the insulin, and because we aren't priming it out with every bolus we notice it a lot more...

I actually keep my pump with the lunar lock pointind downwards, so that air stays at the other end of the cartridge out the way, not had a problem over night and I'm another one that moves around in a lot when sleeping, but I leave my pump to roam though...

 

[donnellysdogs]

my lunar lock always down day time, night time i try to makesure it is, but can't be sure. good idea with checking it is secure tho' will keep 'key' by bed....

 

[donnellysdogs]

Also read this on a website, but can't remember which one, but copied it over to remind me to speak to my DSN about it:

"Suck back" after disconnecting then reconnecting.Although they say that newer pumps don't "suck back" air into the tubing when disconnected, I personally have found that they do. For some folks, they see no issues with disconnecting, showering, reconnecting. However, some people do get a high glucose reading afterwards on an irregular basis. Why not try doing an external prime, where you are not connected to the pump, until you see the insulin come out the end of the set before reconnecting (stop the prime before reconnecting). If you do this on 3-4 occasions you may notice that sometimes the insulin comes out immediately, but other times, it may take a fraction of a unit or more before you see insulin come out due to "air suck back". The most I've seen my old Disetronic H-Tron suck back air was 5 units. Yes, egad! My Medtronic Paradigm, which I love, I've seen suck back almost a full unit. But not with every disconnect. Sometimes there is no suck back

I've tried this after my bath's and I do get 'suck back'.....

 

[josie38]

I had a lot of problems with bubbles and my pump which is a accuchek combo. My dsn changed my insulin from humalog to apidra and now i have no more problems with bubbles.

josie

 

[iHs]

I've been able to compare the Animas 200u reservoir with the Accu Chek Spirit 300u and can now see why we nearly all are experiencing air bubbles with the Spirit.

It's all to do with the way the reservoirs have been designed. The Animas is thinner and has an internal plunger within the reservoir; the Accu Chek has a plunger that needs to be screwed in and has only 2 o ring seals, the Animas has 3. The Spirit has not got a stop mechanism at the bottom whereas the Animas has. Another thing in favour of the Animas is that it fills up using a small luer disposable needle which is easy to detach by twist and lock. The Spirit uses a push on insulin vial adaptor which is difficult to remove with insulin in the reservoir.

What is happening I suspect is that by filling the Spirit with room temperature insulin, the reservoir fills extremely quickly and because there is no stop at the bottom of the reservoir, people have to try to keep their thumb firmly pressed under the cartridge plunger to stop insulin shooting out the bottom (there is no stop) and at the same time, try to remove the vial of insulin from the adaptor. This probably results in the plunger moving very slightly and air is sucked in as the insulin vial is removed from the adaptor. :cry: :evil:

This is something that Accu Chek should address. I don't worry too much myself about the bubble as I keep the pump inside my bra with tube going downwards but loads of others like to put pump on their waistband or inside a pocket and I imagine that at times, the pump if pointing downwards will dig in the top of their leg when sitting down.

 

[donnellysdogs]

Have contacted Accuchek via their website as to what they think is the best way to get rid of bubbles, other than what they say in the books......will let you know if I get a response....

Interesting to know Josie's answer of Apidra instead of humalog.......have asked my DSN via email to see if this can help me.

Had raised levels again today this afternoon, took off pump, banged and primed it, and lo and behold more airbubbles coming down the tube. This is depsite pointing downwards and being 3 days since cartridge change. I know that as soon as my levels reach 9 then I have to bang and prime.....but boy, am I finding this a tiresome routine....everything else about the pump is brilliant.....

 

[donnellysdogs]

Accucheks response:

When using the pump it is part of the procedure to check the pump every few hours for air bubbles and to see if the infusion set tubing is on correctly. The only advice I can suggest is to prime the bubbles out when you see them, which is what you have done

I have written back a response.....will let you know if any better response is received!!!!

 

[sugar2]

Hi,

I have exactly the same probem. Change cartridge,,, get rid of bubbles.....prime infusion set...no bubbles...and then, a few hours later...a massive bubble! Thank youfor teh expalnation though..it is good to know. DonnelsDogs. I have contacted Accuchek about this too... and they said basicaly that it was me. Quite prepared to believe that sometimes this is right...but not everytime. Will meail them again..maybe if we all complain, tehy might re engineers something. It is so annoying to get rubbish control for a couple of hours every week. I know bolus to avoid it...so not an issue, but not the best approach I am sure!

 

[donnellysdogs]

I have now reported my airbubble / reservation situation with my pump on the MHRA yellow card for mechanical failures on medical equipment, as to me Accuchek seem to be in denial about the impact that bubbles can have. I have also had very badly dented tubes straight out of the packets and boxes recently as well.

Telling us to check the tubes on a 2-3 hourly basis isn't real living is it? Do they expect us to do that during the night too or working in out jobs?

According to MHRA letter I have received I am the first and only person to report this.....to me if we accept that our pumps and sets are perfect we are never going to get them to improve the problems that some of us are experiencing with failed sets, reservoirs etc......

 

[jopar]

Air bubbles aren't a mechanical failure etc, it's a problem with all pump manufacturers the pumpers list did a survery, and it seems that all pumpers to verying degree's faced bubbles in their cartridges/tubings they even looked at what insulin we everbody used...


It's best to to plan infusion set changes for before a meal, and also avoid changing before bedtime, by doing this you are then bolusing, if any problems with infusion set etc will be picked up quicker, as well as checking a hour after changing sets..

Every manufacturer also advises regular inspection of tubing for bubbles during the day and before retiring for the night, priming if necessary...

If you feel this little safety measure isn't practicle for you, then perhaps the pump isn't for you

 

[sugar2]

Hi Jopat,

I really do agree with what you have written, and that we do have to check the pump regularly...but if we are getting air bubbles, after following all the advice etc, and doing the checks, then something is not right, I completely accept that sometimes that something may be me...but not always...and I too got bubbles in the cartrdige when t was filled vy the trainer....about 2 hours later..it was fine at first. If the equipment experts can not fill them correctly, then I think there is a problem.

IHS explanation rang true with me. Will try suggesting this to them.

I have not heard of the yellow card thing before though.

Don't get me wrong, I love my pump, and wouldn't ever want to give it back...but Like DD says, when they try to brush you off, like you are the only one experiencing this, it is a little irritating. There are at least 2 of us! I am sure it does happen with all pumps too, to a hreater ir lesser extent.

 

[donnellysdogs]

Jopars suggestion that perhaps pump therapy isn't for me, just because I asked a question about getting rid of bubbles, is far from actually what I feel about my pump. I actually have had really good levels between 5-8 for ages now since going on the pump.

This weekend, my piston rod got stuck. For almost 7 hours my levels had gone up to above 11. I did everything, first off thinking I had made a mistake with my carbs that evening, nope. Gave extra bolus, didn't lower levels. Then I thought airbubbles, reprimed, and thought I had given another extra bolus. Didn't work, levels still going up. Looked at tubing and cartridge couldn't see anything wrong. No alarms sounding. Phoned accuchek. They told me to change set. Did that and yet another bolus. Nothing, levels still going up. I decided just to check one more time and do a reprime....then I looked at the piston when doing it....due to long tube, my reprimes are 30 units and the piston rod did not move, despite the machine counting up 30 units. So, I thought I'll do a cartridge change and check that the piston moves up and down then. Did cartridge change, everything seemed ok so by this time it was 1am so I thought I would get an hours sleep. Checked at 2am, and levels down good. I was not going to go to sleep the rest of the night without knowing that the pump was working, so I did not want to have to give myself an injection bolus, as if the pump or something wasn't working then it would just be delaying me realising.
Phoned accuchek at 8.30 Monday morning and told them what had happened. They then went through process of telling me to change the battery as well. Do another, take out cartridge, but re-use it. Did this and piston rod did not go fully up to meet the bottom of the cartridge, although it was whizzing through the numbers as if it was. They told me to do another full cartrridge change. Yep, the piston went up to 0 and back down properly. Cartridge loaded properly with another full cartridge. Accuchek did not want to send out another pump until something happened again.
Today, I was going to fast and not have any breakfast, and my levels normally stay well below 8, so this was really unusual. Today they went up to 15 so I did another reprime, and another bolus and yes, they came down. Tonight, I have had my usual salad and quiche that I have 3 times a week, and I know my levels again normally stay nicely below 8. Tonight they have gone back up to 11.7, and I am waiting now to see if an extra bolus has worked.......

All this is in addition to having to get a new remote control as the one I was given 3 months ago, just used to go blank without any warning.

It's just at times like this, that I realise it is just a mechanical piece of equipment that is not 100% all the time, and it is this that bugs me, as I really do try hard to keep my levels even, and the problems I have with levels going up, really. Saying that, I do like the fact that when things run smoothly my levels are probably more level than a non diabetic now, and I love it. It is not a case as Jopar states that Pump Therapy does not suit me, it is just frustration at things that are out of my control on occasions.

I certainly wouldn't buy anything for myself spending £3000 on something that was not going to perform 100% all the time as it should. When we report malfunctions directly to the Manufacturers, just what do they do with the information? When the NHS is paying for say me changing my set, when it was not necessary-do they get re-imbursed by Roche for the wasted insulin and sets?

I do honestly think that pumps are great, but I also wonder about the NHS paying for all any extra insulin reprimes and set changes etc that may additionally be done because they are not guaranteed foolproof......

 

[jopar]

What do I know, I've only been pumping for 3 years :lol:

Air bubbles are in the main chemistry/physics and how molecules asorb in liquid against temperture it actually happens with all insulins, but we take little notice due to the method used to inject, ever wondered where that little bit of air comes from in an insulin pen cartridge? In the old days, we pumped our into the vial so that we could draw out the insulin with a syringe but we don't notice the air as well we inject straight away....

Did you know that if the lunar lock isn't probably tightened this will cause air to seep back in.. Hand tight isn't always enough I have to use the lunar knotch on the magifying glass to tighten mine, checked on a daily base as they can losen...

As for sticking pistion, yep I've had this happen a couple of times but not a mechanical fault, but insulin on the pistion rod or I've been low on battery power...

Now I didn't actually say donnellydogs shouldn't personal shouldn't be pumping...

I actually said that if somebody didn't want to do the necessary checks or found that taking BG to insure that everything was ok after changing infusion set etc, then perhaps pumping isn't for them...

As yet my dealings with rouche over the years pumping, I've had nothing but excellent customer service, even when it was deemed my pump did need replacing this was arranged as quickly as possible and all went smoothly..

But has I said, what do I know about pumps

 

[SophiaW]

I came accross a youtube video a few weeks ago that gave a solution to bubbles in an insulin pump. Take a look and see if it helps at all.

http://www.youtube.com/watch?v=OwbelFCNGz4

If links aren't allowed then go to youtube and type in the search box "no more bubbles!!" and it should be the first video link that comes up in the list.

 

[donnellysdogs]

Couldn't do lunar lock any tighter if I tried....still I am actually not moaning about the airbubbles, or whether the piston rod gets insulin on it, or if anything untoward happens, I just find it frustrating that we only know the effects of them due to our levels rising, and then I feel as if I am wasting good NHS money on the set changes, or cartridge changes etc. The NHS is cash strapped and yet they are having to supply and pay for us to have enough sets/.cartridges etc for problems. I wish they could get money refunded to them if we are having to do 'extra's' to sort out the problems.

If I paid for £3000 for a new engine for my car, I wouldn't expect to have to keep paying for a top up of oil every week because the garage knew there was a small problem with the engine. When Vax knew my floor scrubber (£80) was faulty 3 times with the actual scrubbers going faulty, they actually contacted me to try and to correct the design faults on their machines with the scrubbers.

So, basically, if say Roche know that for example insulin can get back on to the piston rod and cause it to stop, I would just like to know that the problem is being addressed.

I have come to accept airbubbles, and I do a reprime every time I do a cartridge change 4 hours afterwards and this has resolved the problems for me, but still not the frustration that for every reprime I have to do the NHS is effectively paying for that wasted air going through my tubes.