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Home testing - getting a good sample

Much to my amazement, the anti-coagulation clinic have agreed for me to do home testing. My INR has only been in range twice, but they say I am stable enough even though I have had some very low numbers, and was on clexane two weeks ago.

I didn't argue, but went home, set up my machine (well dh did) and put in one of my test strips. When the countdown started I pricked my finger, and no blood appeared. I tried massaging my finger, and when blood did appear, it was more than 15 seconds after I had pricked my finger, so was no good. I repeated this with a deeper lancet setting, and only managed to get a tiny smear of blood, which was not enough to get a reading. Eventually the timer countdown finished, and I had failed to get a reading.

After multiple finger pricking and three failed test strips I have booked an appointment with my practice nurse to see if she can help me. I really don't want to fail as a home tester. My anti-coagulation clinic is at a hospital where parking is very difficult and I am normally there an hour.

Also, my clinic have told me to test fortnightly, but I would prefer to test weekly. If I do test weekly and get out of range readings, would it be unreasonable to call them in anyway?

Did anyone else find getting a good sample of blood hard when they began home testing? A friend has suggested rubbing my hands warm before pricking my fingers. Any other tips?

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Permalink Reply by John French on February 9, 2012 at 20:33
Madeleine - when I first tried taking a sample I followed the advice in the Coaguchek manual/ DVD and pricked my finger in the side as suggested.I wasted two or more strips as I never got enough blood to satisfy the test. I tried deeper and deeper settings on the lancet but that didn't help.

I then changed to doing the test as the clinic did - I.e pricking the end of the finger tip. Ever since I have done that I have had no problems getting enough blood. It is supposed to be more painful according to Coaguchek manual but I don't find it any worse to be honest.

Not sure if that matches your experience or not.

My clinic told me that I could check myself more regularly if I wanted but if the results are in the therapeutic range then not to call it in until the designated time. They said if I got a test out of range I should call it in as they need to be able to assess and dosing changes. If you know you are out of range you don't to wait for the next planned time to call in the results.
Permalink Reply by Madeleine M on February 10, 2012 at 9:39
I have been pricking the side of my finger, so perhaps that is where I have been going wrong too.

My clinic also like to prick the finger tip, but I do find it more painful, so tend to ask them to do the side. However, if pricking the end of the finger is what is needed to avoid the clinic, then I will go for it. I know everyone is different, bit what setting do you have your lancet device at?
Permalink Reply by John French on February 10, 2012 at 10:03
Madeleine - I have my lancet set to 2 but probably could get away with less to be honest.

I found that using the finger tip rather than the side was better in two ways - it seems to be more reliable in getting the right amount of blood and it is much easier to get what blood you do have onto the strip when doing it yourself.

Hope that helps
Permalink Reply by Madeleine M on February 10, 2012 at 11:28
Thanks. I had my setting at 4 for the side of my finger, so I will reduce it when I try again on Monday.
Permalink Reply by John French on February 10, 2012 at 11:35

I did the same when I tried the side of the finger - I kept increasing the lancet setting and still didn't get enough blood onto the strip.

Permalink Reply by olly sagar on February 12, 2012 at 12:20

The advice is not to massage the finger as this can affect the sample. Try putting finger tips in a bowl of warm water for a few minutes then making sure you keep your arm (and them!) pointing downwards until you've got the sample.  Don't give up, it's so much more convenient than having to go the surgery.

As for how often to test. Warfarin levels are renowned in having a mind of their own. Nobody really knows why you can get different results even day to day sometimes. 2 weekly at the moment sounds very sensible. The trick is not to get anxious about it all which will come more naturally to you over time when you get a few more good INR recordings in the book. Then it'll get to a monthly test, life normalising as well as the ratio!

 

Permalink Reply by Elaine Howlin on February 12, 2012 at 15:18

Hi Madeleine

I have found that washing my hands in warm water helps to produce a better flow of blood and also makes the skin a bit softer therefore enabling the lancet to penetrate easily. Also try letting your arm hang down for a little while as gravity helps.

Keep trying and don't get disheartened.

Regards

Elaine

Permalink Reply by Madeleine M on February 16, 2012 at 16:32
My practice nurse was not much help when I went to see her. She tried twice to prick my finger, and both times got an error 5 message. She said that she thought I would struggle to use the machine because my fingers are so thin, and my hands are usually cold. She had not been trained on coaguchek, and suggested that I call the clinic and ask for their help. I did that a few days ago, and am still waiting for them to call back.

After trying a few more strips, and getting more errors, today I have finally got a result. I immersed my hands in a bowl of quite warm water, until they were red/pink and tingling for nearly 5 minutes. When I lanced my finger, I got a really good amount of blood. Unfortunately my INR came back as 2.0, so I called my result on to the answer phone that ignored my last message. Let's hope that they actually check the answer phone. I'm going for my discharge appointment with my surgeon on Monday, and my yellow book shows my warfarin control has not been great.
Permalink Reply by John French on February 16, 2012 at 19:08
Madeleine - once you find what works for you in getting the blood onto the strips it should be more straightforward - hopefully. My anti Coag clinic returns calls when I leave messages on their answerphone.

The INR levels are a bit of a mystery some times - I have been on Warfarin for nearly 5 months now and my dose is going up steadily all the time to stay in range. So many people are in the same boat before it stabilises according to many of the posts on this site.

My increase in dose can't be diet related as if that were the case it would go up and down when I ate the wrongs things. Plus my diet is pretty consistent anyway. Mine appears more like I am getting used to the Warfarin and I need higher and higher doses to keep me at the right INR level.

So don't despair
Permalink Reply by Madeleine M on February 16, 2012 at 19:24
My warfarin dose keeps rising too. I would not be surprised if it goes above 10 mg a day, I'm on 8.5 mg a day at the moment. A dose which works one week is insufficient the next. I'm really looking forward to when I have stabilised, and I don't need to think about INR too much.

Hopefully the clinic will call back tomorrow. If they don't I shall contact my GP for advice.
Permalink Reply by John French on February 16, 2012 at 20:10
I have steadily increased does to 9.5 mg now. Every time I increase the does INR stays stable for a couple of weeks and then falls. Does is increased and the cycle repeats. It really does seems that my body gets used to the warfarin so metabolises it more quickly and therefore affecting the INR.
Permalink Reply by olly sagar on February 16, 2012 at 20:55

I agree, don't despair! As have said before, the way Warfarin levels vary in all who take it is still a medical mystery! Everyone's different. The joy of the Coagucheck is that you are more in control and it's so much easier to keep an eye on things. Over time you'll find it gets less of an anxiety - honest!

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