Getting that big drop

[Protimenow]

On this forum, we've discussed this before, but it may be useful to bring it back up.

The issue is this: different meters (and even different strips) take different amounts of blood. The Protime 5 channel strip takes the most, with the 3 channel strips not too far behind. InRatio and CoaguChek take considerably less. The question is -- how do you get ENOUGH blood for a test and how do you get it onto the strip.

I may not be writing anything that others haven't, but I still wouldn't be surprised if some here offer other suggestions.

The ProTime meters make it fairly easy to get the blood onto the strip (they call it a cuvette). These come with a combination lancing and collection device (called a tenderlette). What worked best for me was letting my hand hang below heart level, so the blood would pool slightly in my fingers. When I incised my finger, I tried to still keep it below my heart. The ProTime is different from the others -- they want you to wipe away the first drop, and then to put the blood into a small collection cup on the tenderlette. Most of the time, I had to 'milk' the finger. I'm not sure if this 'milking' effected the accuracy of the test or not -- it diluted the thrombin with plasma -- but I was usually not able to get enough blood into the cup without a bit of squeezing of the finger.

Recently, I learned that running warm water on the fingers for a minute or two actually DOES increase the blood flow in the finger. I'll probably try again with this semi-retired meter and see if the warm water does the trick.

InRatio and CoaguChek do things a bit differently. The tests they run are based no the FIRST drop of blood -- thrombin, platelets and certain clotting factors near the skin effect the INR -- if you don't use the first drop, you'll get an inaccurate result. The blood should also be deposited onto the strip within fifteen seconds of the incision.

For myself, I run my hand under warm water before making the incision. I use a 21 gauge lancet in a lancing device set for the deepest incision. The incision is made at the side of the fingertip (there's a good sketch of the spot on the finger with the most blood, on the InRatio website). You may have to press the lancet to make good contact with the fingertip. A 21 gauge lancet against a warmed finger should provide enough blood.

Once the finger is incised, a second challenge should be addressed (for all but the CoaguChek XS) --- you should get enough blood onto a small dot on the strip within 15 seconds. I've sometimes had to put glasses on so I can see that the drop is precisely positioned over the dot. You really only have one chance. If your drop doesn't look large enough, press just above the knuckle, and more blood should go through the incision -- don't milk the finger.

The CoaguChek XS makes it easier -- just touch the drop to the side of the strip and capillary action will bring the blood into the strip. I haven't had the pleasure of trying an XS but look forward to doing it some time in the future.

A few other things -- capillary tubes or other tube collection devices are available from a variety of manufacturers. These can suck the blood out of the finger, into a small 'tube.' Place the tube over the collection spot and squeeze gently to transfer the blood to the strip. I've tried this but without good results -- I wound up getting air bubbles into the blood when I transferred it onto the strip.

In this longish item, I hope I may have answered some of the questions that testers encounter. The warm water on the finger may be the best tip I've encountered -- I used to waste enough CoaguChek strips that I gave up on the meter -- the warmed finger seems to help get enough blood flow into the finger so I was able to run a test without problems.

I'm looking forward to any other tips you can provide -- or even criticism about some of the 'tips' I'm giving here.

 

[Eva]

I too keep my finger umder hot running water for a whiiiiiiiiiiiiiiile! Then I prick my finger three times, as I use the softest prickers. So, I do three pricks next to each other and then try to get the blood out from the three spots. Sometimes, I wipe off the first drop and measure the second one if I have enough blood. Otherwise, I use the first blood. There should be no difference, but the nurse encouraged me if I could to use the second drop in case there was still some alcohol or water on the finger.

I love my machine. At the start, I wasted quite a few. But not I am becoming more professional

 

[Protimenow]

Eva:

I'm not sure about the reason for three finger sticks. This doesn't make much sense to me. If you're using a 21 gauge lancet and incising deeply enough, you should be able to get a good, healthy drop that is large enough for most meters.

Depending on your meter (unless it's a ProTime), they want the blood within 15 seconds of incising the finger, and ONLY want the first drop because that drop contains some clotting factors that aren't in second or later drops.
If you double or triple these factors by taking two or three drops, wouldn't you be throwing the actual test results off? Taking more than one drop, to me, sounds like bad advice - and the manufacturers of the meters don't give this recommendation. I'm guessing that whoever trained you probably gave you bad advice.

I personally don't use the alcohol before making the incision - and after two years of testing, I've had no problems with infection. Rinsing the hand in warm water probably helps assure that the area being incised is pretty clean.

I've read about some testers who swing their arms around to dry off the alcohol - this should certainly increase the blood in the finger and make it easy to get a good drop.

And I, too, love my machine. I loved my ProTime Classic, I loved my ProTime 3 even more, and I have even stronger feelings for my InRatio.

I'm looking forward to reading comments from others, too.

 

[Bina]

I too keep my finger umder hot running water for a whiiiiiiiiiiiiiiile! Then I prick my finger three times, as I use the softest prickers. So, I do three pricks next to each other and then try to get the blood out from the three spots. Sometimes, I wipe off the first drop and measure the second one if I have enough blood. Otherwise, I use the first blood. There should be no difference, but the nurse encouraged me if I could to use the second drop in case there was still some alcohol or water on the finger.

I love my machine. At the start, I wasted quite a few. But not I am becoming more professional

Eva, I don't know where you have gotten your training from, but what you are doing is not the standard procedure
for the Coaguchek XS model of monitor.
We don't use any alcohol wipes.
We don't use the second drop of blood.
We don't need to prick our finger 3 times.

Simply wash the hands with plain soap and very warm water, rinse well and dry well with a clean towel,
then one swift click with the lancet pen, and hold the drop of blood beside the strip. That's it.
Don't be shy with the lance, "just do it".
Eva, let me know if I can be of any help to you.
((hugs))

 

[Eva]

Thanks Protime and Baina.

Normally, I do not use alcohol. That was the comment of the Nurse at my cardio's office. I do keep my hand under hot water for a while after being well washed with soap. Sometimes, I get enough blood with one prick, some other times, I do not. This is when I prick again and again next to each other to form one big drop of blood.

May be I should use the stronger, deeper, lancets. I am now using the colored (not sure what gauge), but they are soft and cause NO PAIN!!

 

[CATDOG]

Just curious, since I'm not there yet, do you use the needle lancets, or the tiny blade lancet?
Lancet pen? Is it reuseable? I'm only familiar with the single-use spring-loaded lancets with a case about 1" long.
I guess I'll have to talk to nurse google.

 

[Protimenow]

It seems as if your automatic, one use lancets are designed for taking blood for blood glucose testing. Blood glucose testing uses a 30 or 33 gauge lancet and doesn't penetrate very deep. These are NOT what you need for testing your INR.

I've used one use lancing devices that were designed to get a 'large' drop of blood, but lately I've been using a lancet that ships with some of the cheap glucose monitors, and 22 gauge lancets that should be available at a local pharmacy or online.

(I have extra lancing devices - just PM me and I'll send one).

The small, colored lancets that come with blood glucose meters won't make a big enough incision for testing INRs. Making three small holes to get a bigger drop is NOT the way to do your test.

What you'll probably need is 21 gauge lancets, and the deepest setting on your lancing device. The incision hurts more if you think about it -- but it's not really pain, it lasts for less time than sitting with your arm on a lab table while an inept lab tech pokes your arm looking for blood.

 

[catwoman]

Thanks Protime and Baina.

Normally, I do not use alcohol. That was the comment of the Nurse at my cardio's office. I do keep my hand under hot water for a while after being well washed with soap. Sometimes, I get enough blood with one prick, some other times, I do not. This is when I prick again and again next to each other to form one big drop of blood.

May be I should use the stronger, deeper, lancets. I am now using the colored (not sure what gauge), but they are soft and cause NO PAIN!!

I sometimes use the "shotgun approach," too. My lancet is set on 5.
I like Texas-sized drops of blood.

 

[CATDOG]

Oh my goodness, now you're giving me the willies. I guess this might take more courage at first than I thought. I suppose it gets to be old hat soon--hopefully. But still maybe better than 4 jabs: a can't find it so grind it senior phlebotomist--after 2 misses and a collapsed vein by the newbie. Does it have to be from your fingers? Seems like they are advertising blood glucose meter strips now that can use blood from anywhere.

 

[Eva]

Thanks Protimenow for your offer and explanation. I have a collection of devices including the original device that came with my INR machine which I will restart using. I switched a few months ago trying to avoid the pain...just tooooooo sensitive these months.

I will follow your approach, Marcia! Ouch!!:wink2:

 

[Protimenow]

Really, even with the 21 gauge lancets and the depth set to maximum, there isn't much discomfort -- and if there is any, it's usually gone in seconds. Through just the normal daily activities, I sometimes find that I may have cut myself and didn't even know it -- and get more blood than a stupid little lancet does. Even if you have to apply a little pressure to the lancing device in order to get a big enough drop, it's really not that big a deal.

The only time it REALLY hurt was when I got a new meter that I wasn't certain about and I tested my wife -- the incision didn't hurt her, but I sure didn't like it.

ANTICIPATING the pain of the incision can make it much worse -- just do it, get it over with, and be done with it. ONE stick, a big drop of blood, and you're done.

(As far as alternate sites - the new blood glucose meters use SO LITTLE BLOOD that you can get it from almost anywhere. The base of the thumb, wrist, etc. work for these test strips. Unfortunately, it's not enough to actually get some coagulation started. Although the amount of blood required may eventually drop when the meters improve, I don't think we'll ever get to the low amounts that blood glucose meters use. A big or a small drop - or even the somewhat larger amounts that ProTime meters require is still nothing compared to the lab blood draws.)

 

[Bina]

Thanks Protime and Bina.

Normally, I do not use alcohol. That was the comment of the Nurse at my cardio's office. I do keep my hand under hot water for a while after being well washed with soap. Sometimes, I get enough blood with one prick, some other times, I do not. This is when I prick again and again next to each other to form one big drop of blood.

May be I should use the stronger, deeper, lancets. I am now using the colored (not sure what gauge), but they are soft and cause NO PAIN!!

Eva, I understand that you are going through a very sensitive time right now as I was the same a couple of years ago. But, if you go back to the lancing pen that came with your monitor, and use the yellow 21 gauge little lancers, the job will be done in a split second.
I think my pen is set on 4.5 for the sticking depth and I use my little finger.
Best wishes with this and sending more hugs while I am here. :thumbup:

 

[catwoman]

Eva, I understand that you are going through a very sensitive time right now as I was the same a couple of years ago. But, if you go back to the lancing pen that came with your monitor, and use the yellow 21 gauge little lancers, the job will be done in a split second.
I think my pen is set on 4.5 for the sticking depth and I use my little finger.
Best wishes with this and sending more hugs while I am here. :thumbup:

Eva:

Bina's right.
When I started home-testing, I was using a ProTime 3. The incision gadget made a slice and I did feel a sting. I like the lancing devices used with INRatio (same as for CoaguChek). I use 21 gauge needles and set the device @ 5. It does NOT hurt. Anticipation makes things seem to hurt.
Just jab, get the drop of blood out and do your test. The first couple of tests are the most time-consuming. I have run tests while seated at my desk @ work. And no one knew what I was doing.
In a few months, it'll be old hat.

 

[Protimenow]

Another nice thing about tne InRatio is the very quiet beep. The ProTime is much louder and actually annoys one of my dogs. The ProTime 3 lets you turn the beep completely off.

One thing that I encountered with the InRatio (and it would be the same with CoaguChek) is a strange one that happened to me. I incised my finger and wasn't careful to position it above the dot on the strip - instead, the blood dripped down the side of my finger and under my fingernail. I had to use a different finger. This was no big deal - but something I'm fairly careful not to repeat.

I never thought of using my pinky - or any fingers other than the two that I always use (second and third from the thumb), but may some day give it a try.

Eva -- as Marsha said, anticipation makes you focus on feeling whatever happens to your finger -- after a while, when the testing stuff becomes practically second nature, it won't seem like a big deal at all. You'll also probably get the same feeling of empowerment that many of us get because we're able to control when a test is run and, in many ways, to take control of our own well being.

 

[Country]

I have an Inratio 2. and i usually have a pretty tough time getting a good amount of blood for a sample.

I have taken some good advice from someone on here and started running my tests directly after I take a shower.(it warms up my hands and also softens up the skin.)

I currently use a varity of lancets. i have one use Unistik 21ga, some lil blue one use lancets from my docs office(23ga possibly?) and then i have my lancet pen that was sent with my meter with 23 ga needles.

I have also learned that as i lance my finger i get better results if i "pinch" my finger with the others around it (supposedly it allows the needle to penetrate deeper)

as of lately i have found a never ending supply of blood in the middle finger on my right hand. i lance the thumb side of the finger and it will produce multiple huge drops of blood.
(although i still have to squeeze the finger to get the blood to "come out and play")

as time goes on i hope to iron out the problems i do have. more info and expieriences are always great to hear!

having a meter is the only way, that being on warfarin, could ever work for me!

 

[Freddie]

Country, have you ever tried using your baby finger? The skin may not be as tough as the thumb. Just a thought.

 

[Protimenow]

Country: They advise AGAINST 'milking' the finger -- the serum dilutes the blood and can possibly impact your results (at least, this is what others here have said).
I run warm water over my fingers for a few minutes before I lance my finger. Typically, it's the meaty part of the fingertip on the second or third finger of my left hand-I'm right handed, and it's easiest to lance with a lancet in my right hand.
I use 21 (or 22) gauge lancets and a lancing device set on maximum depth. I try to put some pressure on the lancing device before firing it, and it usually does the job for me.
You might try swinging your arm around for a while (some have reported that this causes blood to rush to the hands). If you don't get a big enough drop, InRatio (I think I read it at their site) suggests that instead of milking the fingertip, you put some pressure on the knuckle -- this keeps the blood from returning to the heart, and causes it to pool at the incision site, resulting in higher blood flow.
I seldom have trouble getting a good drop of blood - but if I fail with one finger, the InRatio gives you a couple minutes to try with another finger.
Just remember three things: the test is set to use blood taken within fifteen seconds of making the incision; the test uses the first drop so don't wipe any off your finger; if you put an inadequate amount of blood on the strip and it starts drawing it into the strip, don't add more.

Practice some more (even if you practice getting blood, without actually testing or wasting strips), and I'm sure you'll get a good drop nine times (or more) out of ten.

 

[Country]

Country, have you ever tried using your baby finger? The skin may not be as tough as the thumb. Just a thought.

Freddie,
i was talking about lancing the middle finger on the right hand. the side of that middle finger that is closest to my thumb. i think that i would bend the needle if i tried to lance my thumb!! haha jk.

Protime,
I dont think that i can warm up my hands anymore then when i first get out of a hot shower.... I literally test as soon as i leave my bathroom.

but im telling you.... even with those 21 ga Unistik one time use lancets, I really dont bleed all over the place. it really just barley leaves a speck of blood on my finger after i lance. but with a little presure i can get the drops flowing.

 

[Protimenow]

Make sure your lancing device is set to go to the maximum depth, and press the lancing device slightly into your finger. You don't need a lot of blood -- just a big enough drop.
Holding your arm (and hand) BELOW your heart helps to increase the amount of blood in your hand. And, as mentioned before, squeezing the knuckle below the incision stops the flow of blood back into the finger and should help get that extra amount of blood you need.

You can download most of this information from the InRatio site. If you call and ask tech support about getting an adequate drop, they may even send you some strips.

 

[Country]

, they may even send you some strips.

now that would be awesome! i might just have to try that out! thanks.

and lately i have been using lancets that are at a preset depth.... they cant be changed. but with my stick pen lancet i always have that sucker maxed out!