# Air bubbles in tubing



## ch1ps (Sep 14, 2013)

I keep getting air bubbles in my tubing, except, when I fill the reservoir I don't see any bubbles in it. 

I straighten the tube when filling.  It is very frustrating.  Any tips on how to over come this?

*edit* My insulin is room temperature too!


Thanks
Pauline


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## everydayupsanddowns (Sep 14, 2013)

Not sure what others do. One of the main problems seems to be how warm the insulin gets in use (as you've mentioned, needs to be room temp minimum). You could try holding the vial for a short while before filling?

The other thing that seems to help me is to only half-fill the reservoir with air before filling, then fill very slowly. Creates a very slight vacuum that seems to make the insulin in the vial less aerated (or it could be my imagination!). And also along the same lines when you inject the air into the vial, are you doing it with the vial downwards, to avoid blowing the initial splurge of bubbles through the insulin?

Hope you manage to find a technique that helps


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## ch1ps (Sep 14, 2013)

Thanks for the tips.  I will try the slower fill next time to see if that helps.


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## trophywench (Sep 14, 2013)

The other thing I do when the res is half full-ish (if it's fuller, shoot some of it back into the vial) should I see or just suspect a tiny bubble (or more) is re-invert the whole caboodle (ie vial down, reservoir up, so the air in the vial surrounds the needle) and suck up some more air into the res, so you now have shedloads of air in the res and only a bit of insulin.

It's easy then to re-invert it again - needle in insulin - and thoroughly amalgamate all air into one huge air bubble, which is easy to push back into the vial with the plunger, followed by some of the bubble-less insulin.  Wait patiently or about 10 secs.  Do not agitate the vial or the res.

Then withdraw the rest of the insulin you want.

On my pump, before inserting the res, you have to put the plunger where you want it to be.  eg they are 315ml reservoirs, so you set the pump at say 305 or anyway a bit less than it actually is, so if you half filled it, you'd set it at 145 or something - and then insert the res.  As you screw it in a bubble of insulin appears on the top of the res pointy bit.  Then screw the tube onto it and prime the tube obviously look at the top for when the insulin starts coming out of the other end, but then visually check the tubing all the way back to the res to make sure, before stopping the prime.  Then attach the - wet! - tube to the cannula and prime the cann.

Sounds terribly time consuming, but it's worth spending an extra minute on this - if it even takes that long - once you've done it a couple of times.


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## ch1ps (Sep 14, 2013)

Thanks for the extra information and advice.


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## Redkite (Sep 15, 2013)

Another tip which helps some people is to degas the vial, as shown in this clip:

http://youtu.be/OwbelFCNGz4

I find this a bit tricky, as there is a strong vacuum left in the vial after removing the air, but if you are patient then it does eliminate bubbles.  However, bubbles can and do form over time in the reservoir, even if it starts off bubble-free.  It's a good idea to visually inspect the tubing from time to time to make sure there aren't any, and if there are, disconnect and prime insulin through to clear the bubble out.


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## m1dnc (Sep 15, 2013)

I've also found that it helps to gently warm the insulin vial closer to bady heat before filing the reservoir by putting the vial in the breast pocket of my shirt for twenty minutes or so. This seems to reduce the number of little bubbles that form in the reservoir after a couple of days.


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## ch1ps (Sep 15, 2013)

Thanks Redkite & m1dnc


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## Pumper_Sue (Sep 15, 2013)

One of the things to double check is that you have the connection tight enough ie no air can get in.
Some people find filling the cartridge then standing it for a while helps as well. If you have small pesky bubbles right at the bottom nr the plunger then use a pen to tap a few times this dislodges then so they rise to the top and you can then get rid of them.


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## everydayupsanddowns (Sep 15, 2013)

Redkite said:


> Another tip which helps some people is to degas the vial, as shown in this clip:
> 
> http://youtu.be/OwbelFCNGz4
> 
> I find this a bit tricky, as there is a strong vacuum left in the vial after removing the air, but if you are patient then it does eliminate bubbles.  However, bubbles can and do form over time in the reservoir, even if it starts off bubble-free.  It's a good idea to visually inspect the tubing from time to time to make sure there aren't any, and if there are, disconnect and prime insulin through to clear the bubble out.



I would strongly advise against this technique, based in my own (admittedly limited) experience. I found the vacuum this created was too strong and caused the 'o ring' seals to fail on Medtronic reservoirs, insulin began to leak behind them instead of being properly delivered. I used the technique perhaps 3 times and had o ring failures on 2 of those!

I found it much better to introduce only a very slight vacuum, by only half-filling the revervoir with air before drawing up the insulin.


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## Redkite (Sep 15, 2013)

That's interesting - lots of people swear by this method, but I too gave it up because I found it too fiddly trying to fill the reservoir against the pull of the vacuum.  I almost needed a third hand.  Set changes are an against-the-clock time challenge in our house, so this method didn't suit us!  Medtronic shouldn't be recommending this if it causes leakages.


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## everydayupsanddowns (Sep 15, 2013)

Well all I know is that I had a 66% failure rate. First time BGs seemed fine for a few hours, then BGs would creep up, set change would make no difference and eventually when I investigated the reservoir there was clearly insulin leaking backwards behind the plunger  Second time I went straight for a full set change and the same thing had happened again.

I would advise against the method as I think the pressures involved are just too great for the o ring seals to cope with. If people are happy to use the method then fair enough, but it's worth bearing in mind and checking the o-ring seals if BGs are playing up (which of course would wreck your pump's idea of when the set was changed as you'd have to rewind to check)


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## Atanaa (Sep 23, 2013)

I can only speak from personal experience, but having used both the Accu-check Spirit pump and the Medtronic Veo I found the Veo absolutely terrible for this. Despite warming to the insulin to body temp. before the change and following all the other standard advice I continually found bubbles - sometimes several cm long - in the tubing. In the end I reverted to using the Spirit pump which although not perfect does seam to be much better in this regard. 

My point being, if you have this problem repeatedly despite following the advise, you might want to think about changing to a different pump.


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## HOBIE (Sep 23, 2013)

Have had pump for more than 6 yrs & never got any bubles. You can get bubbles in a syringe. If you hold the thing upside down. ITS NOT the pump. Its not pumping backwards


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## Pumper_Sue (Sep 23, 2013)

Atanaa said:


> My point being, if you have this problem repeatedly despite following the advise, you might want to think about changing to a different pump.



Who would be paying for this pump?


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## Atanaa (Sep 23, 2013)

I've no idea what the arrangement are in ch1ps's area, but surely if they feel she needs a pump then they should provide her with one that actually works!


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## Pumper_Sue (Sep 23, 2013)

Atanaa said:


> I've no idea what the arrangement are in ch1ps's area, but surely if they feel she needs a pump then they should provide her with one that actually works!



The pumps do work, it's user error 99.9% of the time.
Main problem being new pumpers don't get things right to start with, who does anyway?
Secondly many people have never used a syringe before and the amount of problems this causes makes me  at times.
Example on another forum one pumper could not grasp how to remove insulin from 2 different vials into one pump cartridge 
Other instances it boils down to not attaching the tubing correctly. Another is just filling the cartridge to quickly.

I've never ever used a pen for injecting, always syringes and had 2 different pumps have never ever had a problem with bubbles.
Bottom line is these pumps are medical devices so can not be allowed to have faults which stop the delivery of insulin.


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## Cumbrianlass (Sep 23, 2013)

I struggled with large air bubbles in my pump (Veo)- regardless of how carefully I drew up my insulin etc etc - then my Rep gave me some sound advice - as I wear my pump attached to the front of my bra and next to my body - she advised after I fill my reservoir I pop it in my bra for an hour -to bring it up to temperature then push out any bubbles by reconnecting the plunger and needle part. Works a treat.


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## everydayupsanddowns (Sep 23, 2013)

Cumbrianlass said:


> I struggled with large air bubbles in my pump (Veo)- regardless of how carefully I drew up my insulin etc etc - then my Rep gave me some sound advice - as I wear my pump attached to the front of my bra and next to my body - she advised after I fill my reservoir I pop it in my bra for an hour -to bring it up to temperature then push out any bubbles by reconnecting the plunger and needle part. Works a treat.



I can believe that Cumbrianlass, oxygen is more soluble in liquids at lower temps, so as you warm a liquid it bubbles out


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