Soreness after finger stick

[chaconne]

I'm new to the home testing world and have been doing a few practice finger sticks with Unistik Normal and Extra. One thing I notice is soreness around the stick area that lasts up to a few days. This could become a problem for me if I'm testing weekly, since I'm a guitar player.

I'm interested in know other's experiences with this.

 

[Protimenow]

It sounds like you may be using the wrong lancets, and squeezing the finger to get the blood out.

What you should be using is 21 gauge (or, if you can't find 21s, 26 gauge) lancets, set to the deepest setting. I think that you're using the lancets designed for blood glucose testing. These are 31 or 33 gauge - very fine - and don't make a deep or large enough incision to gt the necessary drop of blood. (If you need 21 gauge lancets - I have a lifetime supply - send me an IM and I'll send you a box).

You've probably seen lots of threads about finger preparation -- but I'll repeat here. Wash your hand(s) in warm water, dry thoroughly. A lot of people use the alcohol wipes that you can get at a pharmacy -- I haven't had problems with infection so I don't use them. Some people swing their hands over their heads to dry them - it also draws the blood into the fingers. You can gently squeeze below your knuckle, and this will help make the blood pool in the fingertip. Finally, don't be afraid to apply a bit of pressure to the lancing device -- if you don't push it against the fingertip, you may not get an adequate incision or large enough drop of blood.

It's really not a painful process. Get the blood - if you've prepped well, you probably won't have to coax the drop out. I use a piece of paper towel to apply pressure to the incision and it stops in just a few seconds. I VERY RARELY have any bruising or tenderness in the fingertip. I've found, too, that using the 'fleshier' part of the fingertip usually produces a larger drop.

Try this -- with the proper prep and the right sized lancets, you should be able to get a good drop and have little or no discomfort in your fingertip.

 

[chaconne]

I'm using Unistik 2 Extra - 21G, 3.0mm depth. I've washed in warm water and squeezed below the knuckle, but maybe not good enough. To get a drop out I have to press hard. It's also possible that I have extra thick skin (as a steel-string guitar player) and need even deeper ones.

 

[pellicle]

I'm new to the home testing world and have been doing a few practice finger sticks with Unistik Normal and Extra. One thing I notice is soreness around the stick area that lasts up to a few days.

I've noticed something similar myself. I had put it down to the possibility of a very minor infection of the wound. Sometimes it persists as sore for a few days. Nothing dreadful, just a slight ouch.

I have been experimenting with a quick spray of alcohol onto the finger first to ensure its clean. Too early for results yet.

Where do you stab? The pad or slightly to the side? I understood that long term towards the side caused less nerve damage (resulting in a loss of feeling in the pad)

 

[Protimenow]

21 gauge is the way to go -- and you're already doing it. It could be that your skin has thickened/toughened. Have you tried a different finger? Perhaps the hand that you use for strumming and picking would be better than your 'string' fingers. I'm just thinking that those fingers may be less thickened -- especially the pinkie and the one next to it. From what I recall, those fingers aren't of much use in guitar playing.

Although it may take a bit of practice to incise a finger on your non-dominant hand, and to get the drop from there onto the strip (one of the capillary tubes that are available for this purpose may help), this may be a better approach to this issue.

In theory, too (though I haven't read about anyone actually doing it), you might be able to get a drop from your finger in the area BETWEEN the knuckles - not the fingertip itself. I haven''t tried this, but this area may be easier to incise than a fingertip and there may even be fewer nerves there. Again - I haven't seen or heard of it being done there, but suspect that it COULD be done there, if the fingertips won't work. (OTOH -- with the CoaguChek XS and InRatio, it may be possible that they rely on clotting factors in the skin of the fingertip and an INR from anywhere else on the finger may not be the same).

So -- try the other hand, if you can, and be sure to push that lancing device against the finger when you make the cut.

 

[Jkm7]

Does the blood necessarily have to be from a finger? Why not a toe?

 

[Freddie]

For soft fingers:
wash your hands in warm water, dry off with a paper towel and hold that damp paper towel until your fingers begin to look like prunes and "poke" on the side of your finger. I find the baby finger works best.

Good Luck

 

[chaconne]

OK, better success tonight. I washed in warm for a longer period of time and pricked on my right hand (picking and strumming hand), near the middle of the finger, instead of the left hand and to the side. I tried it twice and measured the INR with the meter, about 3 hours apart. The first time I had to squeeze to get the blood out, but the second time it came out fast and kept forming drops of blood. The prick that bled the most is the least sore! I'm sure I'll get the hang of it all soon.

The meter read 3.2 and 3.1. My lab results have hovered around 3 for the last 5 months. Not bad for my first two tries at a home meter! Thanks for all your help and advice, I'm very grateful to have so many on this forum to consult with.

 

[pellicle]

Why not a toe?

Often thought the same. Pad of my second toe seems a candidate to me

Will likely experiment with this at home and see if:
* its easy or hard to then get the droplet on the strip
* any difference in INR is found

 

[pellicle]

. The first time I had to squeeze to get the blood out, but the second time it came out fast and kept forming drops of blood. The prick that bled the most is the least sore! I'm sure I'll get the hang of it all soon.

The meter read 3.2 and 3.1. My lab results have hovered around 3 for the last 5 months.

Interesting results. Make sure that:
* you don't squeeze
* follow the 15 second rule (http://www.valvereplacement.org/forums/showthread.php?41136-the-15-second-rule)

If you are having issues getting the required blood in the short time, try using a bit of thread to lightly tourniquet your finger back near the hand. A short time (15 or 20 seconds) gets my finger nicely flush with blood and a good sized sample in seconds of lancing.

My understanding is that a light tourniquet will not trigger the subcutaneous thrombin events (which Roche say squeezing does) leading to slightly elevated INR values over veinus results in your samples.

 

[Protimenow]

Why not a toe?

I suspect that there may be a few reasons. First -- the meters (CoaguChek and InRatio) were developed, taking into account some of the clotting factors (in addition to thrombin) that are activated when you make the incision. These factors may exist in different concentrations in the toes, so the result of a 'toe stick' may not match those for a 'finger stick.' Second -- the skin on a toe may be thicker than the skin on the fingers, so it may actually be harder to make an adequate incision than it is on the finger. Third -- the toe is extremely sensitive (think about it when you have a grain of sand in your shoe or a small hair stuck in the skin of the toe). A toe incision might actually be pretty painful. Fourth -- you WALK on those toes, don't you? I'm not sure that it's a good idea to intentionally make an incision in a surface that gets that much pressure, so often. Sure - wounds on the toe heal - they usually close up pretty quickly - but I don't know if it's that good an idea to intentionally cut into the toe. Finally - unless someone was helping you to get that drop, wouldn't incising the toe and coaxing a drop out onto a strip be kind of awkward?


(FWIW - the ProTime meter, and possibly the Coag-Sense, want you to discard the first drop of blood so that the other clotting factors aren't involved in the test. An incision anywhere on the body that gets veinous blood will probably work with this/these meters. I'll know more about whether or not Coag-Sense wants that first drop or not in a few days)

 

[gerrychuck]

I'm a guitar player too; I have been pricking myself on the side of the fingertip on the right hand, and switch fingers week to week. I have also been using the Unistik Extras, and have also had some soreness. Reading this thread makes me realize I probably haven't been prepping thoroughly enough. I have new lancets which I haven't tried yet; definitely will have to check the gauge first!

 

[pellicle]

Hi

There is enough uncertainty in your reply (may be, may exist, might...) to suggest actual testing is the only real way to resolve it.

Why not a toe?

I suspect that there may be a few reasons.
First -- the meters (CoaguChek and InRatio) were developed, taking into account some of the clotting factors (

Second -- the skin on a toe may be thicker

Third -- the toe is extremely sensitive .

Fourth -- you WALK on those toes, don't you? I'

Finally - unless someone was helping you to get that drop,

)

I see the validity of the points you raise, particularly the final point, as the mechanical difficulty (flexibility) will make it nearly impossible for some people. However I reckon that fingers are no less sensitive than toes, the reverse in fact.

Humans once spent most of their lives with no shoes and sox, so feet were always going to be subject to cuts and nicks and splinters. Far more so than finger tips. Modern people who wear shoes and live protected lives (compared to hunter gatherers) put less stress on the skin of their toes than you suggest.

As to using the digits, playing the guitar will put stresses directly on the location of incision, while the toe will probably be nicely tucked away and protected in a foot glove (shoe).

I also feel that there is likely to be far less difference metabolically between the subcutaneous clotting agents in finger tips vs toe tips than you suggest. They are after all extremely similar.

So ultimately this question can only really be answered by experiment. I think its an interesting experiment and will be doing it (as I implied above) when I get home from hospital.

I'll publish my results

 

[Protimenow]

I am interested in seeing your results.

One thing that I keep thinking about is how the FOOT used to be a site of torture -- that its rich supply of nerve endings makes it a very sensitive target.

In any case -- I am certainly interested in what your testing shows -- especially if you can compare it to finger stick and lab results.

 

[pellicle]

One thing that I keep thinking about is how the FOOT used to be a site of torture -- that its rich supply of nerve endings makes it a very sensitive target.

well thanks for the encouragement ;-)

my early thoughts (still awaiting release from hospital) are:
* difficulty of application of toe drop to strip
* easier to wash hands than feet

will do two INR tests asap (finger then toe) and post results.

No lab INR in this set. I have signed out of the lab here (there is an upfront fee of $300 for membership and they bill the national healthcare for tests after that.

 

[Protimenow]

Of course, you could try to learn to strum the guitar with your feet....

 

[pellicle]

Can imagine chords will require training

 

[Protimenow]

Yeah, and some fancy toe picking

 

[chaconne]

Of course, you could try to learn to strum the guitar with your feet....

I saw a guy who was born with no arms sing and play guitar for the Pope on TV a few years ago. He seemed very skilled at using his feet to strum a steel-string acoustic guitar. I suppose he might have more trouble playing classical.

 

[Protimenow]

I guess you can probably play piano with your feet, too. It may not sound all that great, but, boy, wouldn't that make an interesting picture?

Sorry that this digressed as far as it has.
I saw an instructional video at a medical supply company that cautioned against using fingers that had callouses, scars, or other areas of skin thickness for blood testing. I'm guessing that, as a guitar player, you've probably got the kind of surface on your fingers that would make getting a good incision (and a good drop of blood), somewhat difficult. You may want to try the least used fingers (pinky?) -- and, perhaps, the heel or side of the hand - you probably have plenty of capillary resources there, it may not be too hard to get a drop of blood from there, the wound may close fairly quickly, it may give you an accurate reading with your meter. Of course, these systems are designed for fingers - if you can find a good, usable one, this would be the best option.