Occlusion Troubleshooting

Note that Tandem pumps and cartridges have only been tested with NovoLog (Novo Nordisk Insulin Aspart) or Humalog (Eli Lilly Insulin Lispro),  U-100 insulin and are contraindicated for use with anything other than these two insulins (and their generic forms), including Apidra. If your doctor has prescribed Apidra, it is important to note that Apidra labeling indicates that, “the reservoir should be changed at least every 48 hours.”

Most occlusions occur at the infusion site, but it is possible to have an occlusion in either the infusion set tubing or the cartridge. The pump is designed to alert you of those occlusions to minimize the impact they have on insulin delivery. The following troubleshooting steps can be used in response to either an Alarm 2 or an Alarm 26 Occlusion on the t:slim X2 pump, and will help determine whether the occlusion is at the infusion set cannula, infusion set tubing, or in the pump cartridge.

If you are also experiencing high BGs related to an occlusion, please consult the Glucose Troubleshooting guide.

  1. VERY IMPORTANT: Before starting, first disconnect your tubing from your infusion site.
  2. Tighten the t:lock connection between your infusion set tubing and your cartridge tubing by twisting it clockwise

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  1. If there are any air bubbles visible in the tubing, remove them by going to Options -> Load -> Fill Tubing, and Tapping “Fill” not “New” when prompted. Be sure you are still disconnected from your infusion site before starting the tubing fill to prevent the unintended delivery of insulin.
  2. When there are no visible air bubbles in your tubing, hold your tubing so that the connector needle is pointed down, and deliver a 5-unit bolus . Note that this will affect the IOB displayed on your pump. If you are using Control-IQ technology, please note that it is unlikely that your pump will increase your basal rate or deliver an automatic correction bolus for up to 5 hours due to this increase in displayed IOB. Please take this into account when making management decisions.
    • If the Occlusion Alarm did not recur during this bolus, the occlusion is likely at the infusion site. Remove the infusion set and inspect the cannula for any kinks or bends by gently wiggling the tip of the cannula. Any visible damage to the cannula is most likely the cause of the occlusion. Insert a new infusion site and resume normal delivery.

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  1. If the occlusion alarm did recur, the occlusion is likely in either the tubing or the cartridge itself. To determine which, disconnect tubing from the t:lock connection to the cartridge, hold the connection so it’s pointing down, and deliver another 5-unit bolus. Note that this will affect the IOB displayed on your pump. If you are using Control-IQ technology, please note that it is unlikely that your pump will increase your basal rate or deliver an automatic correction bolus for up to 5 hours due to this increase in displayed IOB. Please take this into account when making management decisions.
    • If the Occlusion Alarm did not recur during this bolus, the occlusion is likely in the tubing. Change your infusion set and tubing and resume normal delivery.
  2. If the Occlusion Alarm did recur during the second bolus, the occlusion is likely in the cartridge. Install a new cartridge and resume normal delivery.
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