Ah bubbles, the things you love to hate. I have lost count of how many times I have beaten a syringe to death, let it sit out on the counter at room temperature, and made sure all the attachments were tightened BUT the bubbles still showed up! So, I definitely do not profess to have the magic answer for this one, but I do have a lot of ideas that people share with me while trying to help me out. Perhaps they might help you?
For those of you not yet pumping, or lucky enough to not have been attacked by bubbles <g>, I will explain. When bubbles get into the syringe that you fill and put into your pump, they make their way into the tubing and take the place of insulin. With a child who has a low basal rate, missing tenths of a unit makes her sugars rise. Little bubbles are not so bad, but those big ones can play havoc with those lovely sugars.
Again, this is something very individual. Some people don't even notice the little suckers are there. We wish we could bust all of them!! Bubbles or no bubbles, we would not do without pumping. Here are some ideas I would like to share with you.
1. Leave your insulin out until it reaches room temperature. (We use a mixture of insulins so we have to leave them both out until they warm up a bit)
2. Tighten all the spots where there is an attachment. That will help prevent bubbles from getting in.
3. After your syringe has been filled, allow it to sit for awhile so bubbles will rise to the top. Then you can push the darn things out.
4. Wear the pump upside down, then the bubbles rise away from the tubing. Love this one, wish Erica wore a belt!
5. Create a large bubble in the syringe by taking in some air then use that to 'suck' up all of the little bubbles. It is then easy to remove the large bubble (and all of the small ones along with it).
6. Make sure you get most of the air out of the neck of the syringe before flicking it, which breaks up the bubbles and spreads them around.
7. Don't shake your insulin vial.
8. Insert a second open needle (regular insulin syringe) into the vial/cartridge of insulin before you start to draw the insulin into the pump syringe. Air is then drawn into the bottle at the same time as the insulin is drawn into the syringe.
9. Using a cartridge for filling the syringe, rather than a vial, helps keep those bubbles away.
10. If you are using a pen cartridge to draw insulin from, I find that actually PUSHING the insulin into the reservoir by depressing the cartridge plunger helps to alleviate the bubbles.
11. Do you have any ideas to share? Please e-mail me so I can post them or use them myself <g>!
Here is a complete procedure for filling a Minimed reservoir which is used by Andy Aronoff, e-mail address: firstname.lastname@example.org
Thanks Andy for sharing this with us :)
If you have a procedure that works for you that you would like to share, please pass it along.
Consider the following:
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 plunger 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.