Insulin Pump

[SophieOrman]

Hello, we got the insulin pump for my daughter on Tuesday and we are using it as we would normally however it is filled with saline so if mistakes are made it doesn't matter. I keep getting bubbles in the tubing though and I really don't understand why!! I phoned the team and they said I had to reset the revisor and do a new cannula which I did, but here I am again with bubbles! Any tips? I'll phone again just wondered if you guys could help me out as well.

Thank you

 

[noblehead]

Tagging some pump users who may be able to assist @azure @CarbsRok @iHs @Juicyj

 

[dancer]

I once had to fill a reservoir with water from a vial, instead of insulin. My DSN wanted to see my technique, as I was getting large bubbles in the tubing. There were lots of tiny bubbles I couldn't get rid of and my DSN said that this was because it was water and not insulin. It is possible that the same thing is happening with you.

 

[azure]

Assuming it's possible to get rid of the bubbles, this is what I do with insulin @SophieOrman

Make sure it's at room temp.
Push the plunger on the reservoir up and down gently once or twice to lubricate it
Then inject the same amount of air into my vial of insulin as I want units (approx)
Then, keeping reservoir needle in the vial, turn the vial upside down carefully
Withdraw the plunger a little so that you get maybe a third full of insulin/water, then push approx half of that back into the vial which should get rid of any air or bubbles on top
Then carefully and slowly draw back the plunger to just past the amount of units you want
Finally push back those few extra units into the vial

You should now have a lovely bubble-free reservoir

If you're using pre-filled reservoirs, then make sure they're at room temp and screw/fix tubing on tightly.

 

[Juicyj]

Hi there, could you post some pictures of the bubbles ?

I sometimes get cannulas that look like bubbles but aren't really, as long as your filling the set properly there shouldn't be an issue but would help to see what's going on

 

[rockape37]

As Azure said. I do the exact same thing though sometimes i use a pen to tap the side of the reservoir to dislodge air bubbles.

When i was using saline as a trial i was getting quite a lot of bubbles though these days now on insulin its quite rare but i was told not to worry about them unless they are bigger than 3mm. I have to say that i have had bigger and still had good insulin delivery ie. no high BG's.

You could prime the tubing again to get rid of them. With my pump (Medtronic 640g) it wold be going through the process of set change without actually changing the set. So what you would di is disconnect from her body, remove the reservoir and rewnd the pump. Then refit and load the reservoir, fill the tubing. Then reconnect to her body, no need to fill the canular as it was removed and will already be filled.

Regards

Martin

 

[SophieOrman]

I once had to fill a reservoir with water from a vial, instead of insulin. My DSN wanted to see my technique, as I was getting large bubbles in the tubing. There were lots of tiny bubbles I couldn't get rid of and my DSN said that this was because it was water and not insulin. It is possible that the same thing is happening with you.

They are lots of little bubble so hopefully it's that although I did see other people have mentioned about turning it slowly are carefully, I can safely say iv just been turning it normally not worrying about it so I will give that ago!

Thank you

 

[SophieOrman]

Tagging some pump users who may be able to assist @azure @CarbsRok @iHs @Juicyj

Thank you

 

[SophieOrman]

Assuming it's possible to get rid of the bubbles, this is what I do with insulin @SophieOrman

Make sure it's at room temp.
Push the plunger on the reservoir up and down gently once or twice to lubricate it
Then inject the same amount of air into my vial of insulin as I want units (approx)
Then, keeping reservoir needle in the vial, turn the vial upside down carefully
Withdraw the plunger a little so that you get maybe a third full of insulin/water, then push approx half of that back into the vial which should get rid of any air or bubbles on top
Then carefully and slowly draw back the plunger to just past the amount of units you want
Finally push back those few extra units into the vial

You should now have a lovely bubble-free reservoir

If you're using pre-filled reservoirs, then make sure they're at room temp and screw/fix tubing on tightly.

Thank you for the reply. I think I'm going wrong because I just turn it can't say I'm overly cautious about it! So I will try that thank you!

 

[SophieOrman]

They look like this, sorry for the late reply!

 

[SophieOrman]

As Azure said. I do the exact same thing though sometimes i use a pen to tap the side of the reservoir to dislodge air bubbles.

When i was using saline as a trial i was getting quite a lot of bubbles though these days now on insulin its quite rare but i was told not to worry about them unless they are bigger than 3mm. I have to say that i have had bigger and still had good insulin delivery ie. no high BG's.

You could prime the tubing again to get rid of them. With my pump (Medtronic 640g) it wold be going through the process of set change without actually changing the set. So what you would di is disconnect from her body, remove the reservoir and rewnd the pump. Then refit and load the reservoir, fill the tubing. Then reconnect to her body, no need to fill the canular as it was removed and will already be filled.

Regards

Martin

Hello! Thank you for the tip of just priming the tube again I didn't know I have been doing a whole new cannula and resivor (please forgive me if this is the wrong wording). I will go that now as she is only 3 and is puting up a fight as it is!

Thank you

 

[rockape37]

Hello! Thank you for the tip of just priming the tube again I didn't know I have been doing a whole new cannula and resivor (please forgive me if this is the wrong wording). I will go that now as she is only 3 and is puting up a fight as it is!

Thank you

Sorted then, try not to worry too much as if her BG is ok then it isn't a problem.
Also air bubbles will Not do her any harm at all as they are Not going into the blood stream but just into the fatty layer just under the skin.

Regards

Martin

 

[azure]

What pump is it @SophieOrman ?

 

[iHs]

This is what I do.....

1) Inject about about 20u of air from the csrtridge plunger UPWARDS into the vial which will make the 20u of air go to the other end of vial as bubbles.
2) pull back the plunger slowly to get about 10u of insulin with a bubble in the csrtridge.
3) push the plunger up into the vial quickly so that the insulin and bubble go back into the vial
4) pull back the plunger slowly again to withdraw the insulin which should then be free of any bubbles but if not, repeat step 3 and 4 again.

This was the way many nurses withdrew liquid from vials in the 60's, 70s and 80's

IMPORTANT bit......

when changing technique, always use a fresh vial as problems will arise from injecting air downwards and then changing to injecting air upwards. There will be a large air lock forming in the vial.

 

[rockape37]

This is what I do.....

1) Inject about about 20u of air from the csrtridge plunger UPWARDS into the vial which will make the 20u of air go to the other end of vial as bubbles.
2) pull back the plunger slowly to get about 10u of insulin with a bubble in the csrtridge.
3) push the plunger up into the vial quickly so that the insulin and bubble go back into the vial
4) pull back the plunger slowly again to withdraw the insulin which should then be free of any bubbles but if not, repeat step 3 and 4 again.

This was the way many nurses withdrew liquid from vials in the 60's, 70s and 80's

IMPORTANT bit......

when changing technique, always use a fresh vial as problems will arise from injecting air downwards and then changing to injecting air upwards. There will be a large air lock forming in the vial.

If you remove the filled reservoir from the transfer guard (the fitting between the insulin vial and insulin reservoir) this will release the vacuum from the vial of insulin. If you do it the other way round the air/vacuum will remain in the insulin vial.

Regards

Martin

Sorry i think i may have miss read your post, i thought you said that there will be vacum left in the vial after filling the reservoir.

 

[azure]

I forgot to say that when the reservoir needle is still in the upside down vial, I use my middle finger and thumb to gently flick the top of the reservoir cartridge as this gets any bubbles to the top so they can be pushed back into the vial.

 

[iHs]

@rockape37

yes I know that...OH saw the rise up in the rubber membrane so I stuck a pen needle in with the needle guard removed to release the air lol......This was back in 2010 and being new to the Combo

sorry......didn't use a pen needle......used a disposable luer needle instead but e blue vial adaptor would also work to release the air

 

[donnellysdogs]

What pump are you using?

Are you noticing bubbles when priming etc or say 24 hours after sets have been in?

Please use room temp insulin when you start... water/saline may not work the same way..

Make sure you tap the bottom lightly of the pump on your knee/ hand/work top whilst it is priming initially. If you do it the whole time you will jyst get more bubbles.....

Personally, for me I always wore the pump so bubbles would go to the opposite end not the tube end...

 

[azure]

Any improvement @SophieOrman ?

 

[endocrinegremlin]

It seems I'm a little different so I'll just jot my process down for you. I have an animas and my sets are insert 30s which come in two parts so there are three parts overall. The vial I fill ip, the tubing, and the set itself. I started my diabetes on syringes and bottles of insulin so a lot of my process is muscle memory.

Ok so first I change the set on my body. This gives a few seconds for stinging to stop before I fiddle with it more and makes sure its ok, or looks ok, before I insert tubing. This means if the set inserts wrong and blood comes back through it won't contaminate my tubing and mean I have to start that again too. But then...

But form the plunger and vile ect, Slowly pull the plunger down and push it back up three or four times ...until it stops feeling stiff to do so is how I judge it.

Make sure the plunger is pressed as far up as it can go and then press into the bottle of insulin. Give it a moment to settle.

Slowly start pulling the plunger down. Going too fast will nearly always result in bubbles. If small bubbles appear you can flick your finger against it, as if pinging a fly away and it usually dislodges them. Pull down until you have the insulin you want. (Not everyone will use a full vial in the days between set changes).

Pull your vial free. Turn it upside down to see if any bubbles float to the top. So called champagne bubbles that are really tiny won't really have an impact but ones you can see through need rid of.

Try pinging your vial again. If the bubbles don't go then you can try sending insulin back into the bottle until the bubble goes with it and then trying to withdraw more bubble free. Or you may decide to send it all back in and start again. If a large bubble appears at the top of the vial then I'd keep it out of the bottle and push the plunger up until it 'disappears' and you see insulin appear at the top of the needle, then you can just insert and draw more but be careful as once the vial as insulin in it the bottle will try suck it all back if poked again!

The key is getting the vial perfect when you connect it to the tubing and do not let it sit before connecting the tubing and the vial as this allows oxygen to get in and disrupt things. They come with little toppers to stop that if you are still wanting to take more time about things at the moment. Then make sure your pump is primed until insulin is coming out the other side ok. Lastly it may be that the site is still working though it looks as though it has air. Sometimes insulin just sort of hangs around in the tube. So if you're unsure disconnect the tube and set it to several units and ask it to go and see if it comes out. It may be that there isn't an issue.

Practice your finger pinging though. It is a very useful skill.