First At Home Test-Very Low INR

[MandyMV]

Hi Gang,
Well we just got our hemosense INRatio machine from Raytel thanks to the lovely folks at our Coumadin clinic. We watched the video and tried to get in touch with our Raytel trainer but something with the phone number is wacky. Anyway we couldn't help ourselves and we tried out a test...it doesn't seem that difficult for savvy computer users. We did everything with the video...made sure the test strip matched the screen, wiped with alcohol, dried with gauze, made the stick dropped the blood and waited for the result....YIKES it says 1.7!! What? So in the name of science we tried again an hour later....1.4!!! I know we should have waited for training but isn't it supposed to be simple. Could we have screwed something up so bad his numbers would come back so low. Ryan is supposed to be 2.5 to 3.0 for his mechanical MV. So do I freak out or is it ok to wait until Monday to call the coumadin clinic and the testing trainer to make sure we didn't screw up. I wish we left it alone because now I am going to be making sure every ten minutes he doesn't have any signs of clots.
Any advice is appreciated.

Cheers,
Theresa

 

[Bina]

Theresa, can you run a test right now on someone who is NOT on coumadin and see if they have an INR of around 1.0 ?
Then at least you will know that your machine and what you are doing is correct.

 

[MandyMV]

Hi Bina,
I did try on me and it ended up wasted for not enough blood. maybe I will try again. The only thing keeping me sane is that when you see his blood come from the prick versus mine there is definitely a difference in clotting times as mine clotted before I could get the drop off and his we had to apply pressure for a bit. Maybe I will try again. We are so going to have to pay for these extra strips not sure insurance will cover our mistakes!!
Cheers,
Theresa

 

[Bina]

Hi, first of all.....skip the alcohol wipe, just wash with soap and water.
Then make sure you have a good drop of blood, hang your hand down and you can even soak the fingers in very warm water, dry with a clean towel and test.
I would not worry about wasting another strip, an INR of under 2.0 is not a good place to be.

 

[Bina]

I've got to sign off, but please do NOT let this go until Monday.
When I was 3 weeks post op my INR dropped to 1.9 and I went to the ER right away for a heparin drip. They sent me home with a Lovenox shot 2 days later.
Even if he takes more coumadin tonight it will have no effect for another 3 days.
I woud re-test or go to the hospital. Good Luck.

 

[Blanche]

Another perspective

Another perspective

Theresa:

My husband had been testing on the ProTime monitor since 2001 with great success. In the fall of 2007, we decided to up grade to the INRatio monitor.

We read the materials for the INRatio several times and watched the video twice. When we went to test (we both need to test..Al for Valvereplacement, me for a-fib) we messed up the first three tests.

Since those first steps with the INRatio, we have had no problems and really like the new monitor. I think the reason that there were problems with the first tests is that there is always stress when we begin new processes.

Stick with it and have faith. THis is going to be a good thing for you. We love our new monitor and would not trade it for the world. Relax a bit, and it will get better.

Regards,
Blanche

 

[Magic8Ball]

I think i messed up the first 4 out of 5 tests with my coagucheck xs.

Stressing plays a part.

Now only mess up every now and then when too little blood drops on the strip.

 

[Bina]

My pharmacist was a great teacher.....no messed up strips.
He said to me, "You must have a really good drop of blood on your finger to drop onto the strip."
If you don't have that good drop of blood, don't bother.
When you tilt your finger the drop of blood should be large enough that it is ready to fall.

 

[catwoman]

Theresa:

When I got my ProTime 3, it came with alcohol wipes. I remembered having seen something here about alcohol affecting your INR results. So, I've never used the wipes (which have never been sent with cuvettes since my first order). I just wash my hand with antibacterial soap & rinse and dry very thoroughly.Right now, you're nervous because this is a new procedure. Been there, done that. I was all thumbs when I had to demonstrate a test at my PCP's office.

I have paperwork ready to send to QAS this week for an INRatio and will have to go back through a demonstration at my PCP's office, I suppose.

On the testing supplies: I have paid out of pocket for the last 2-3 years. Much easier for me, albeit more expensive. However, I can call the shots on how many to purchase and how often.

Does your boyfriend have an FSA for medical expenses? If not, best to set one up for the next available year. You save on your taxes because the money that goes into a flex account is not taxed and you get reimbursed for your medical expenses, even for OTC things like first-aid supplies, aspirin, eyedrops, etc.

 

[MandyMV]

Thanks for all your comments it does calm my nerves a bit. I finally retested myself (non-coumadin user) last night and got .9 so it seems the machine is about on par (I do have amazing clotting powers). We retested Ryan today and still got 1.8. Of course it is the weekend so everyone we would call is not around. He took his normal dose of 7.5mg tonight and I guess we will call the coumadin clinic first thing. Oh and the training nurse got in touch with us today and it seems we are doing everything right. I am sure they will also want a lab test tomorrow as this is pretty low and our first time using the machine. Again any advice is always welcome as it helps calm the nerves to hear from others.

 

[Bina]

Most MVR ranges are 2.5-3.5 so if Ryan has tested at 1.8 he is well out of his range.
Maybe his doc has given him a lower range of 2.0-3.0 but if I was at 1.8 my doc would have had me in the hospital yesterday for heparin.

 

[Ross]

Don't make the mistake of expecting your machine to equal a lab draw. It doesn't work like that.

 

[MandyMV]

Hi Ross,
Thanks for the tip. I did read that on some other threads, though I thought they would be within .5 or so of each other. Of course the reason we got the home test monitor is that it takes three days for the lab to come back so even if they test today he could be in range by the time they get that result...

 

[Ross]

I just don't want you freaking out because the numbers aren't the same. Yes, there can be up to a .5 difference, but always trust YOUR MACHINE unless you have good reason not too. When making dose adjustments, do it from your machine readings, not the labs or else remember what the other said all the time.

 

[Karlynn]

Since you tested at .9 don't second guess your machine, or let your doctor or nurse try to get you to test him at the lab for a while along with the machine. Don't let them wait until they get a lab result to adjust his dose. Hopefully your doctor is fine with home testing and won't be concerned, but many doctors still look on home testing as voodoo medicine. (Because they haven't bothered to read current information on ACT management.)