A DIFFERENT Incision Site

[Protimenow]

I went to my Anticoagulation Clinic and this time they wanted to test using their meter (vs a blood draw). I held my hand, palm up, and was told to turn my hand over - palm down.

The nurse who took my blood told me that the fingertips were too painful. Instead, she made her incision on the SIDE of my finger, at the side of my fingernail. This was surprising. She was able to get enough blood for the test strip. It probably was a bit less uncomfortable.

However, I wonder if blood taken from this spot, versus the fingertip, may not produce accurate results. The testers are designed to use blood from the fingertip -- this includes clotting factors that are located in, and just below, the skin. I wonder if the same concentration of these factors are in this new incision site.

I am going to repeat my tests with the Coag-Sense (and maybe the CoaguChek XS) using this new location and see if I get results that are similar to the ones that I took a few hours ago.

Have any of you heard of, or had tests, using the top side of the finger, at the side of the nail?

 

[pellicle]

I always take from the side of my finger. I was advised to not use the centers as over time this will result in loss of feeling due to damaged nerves.
From the manual

Pardon the red square, this image was one I made for a discussion on the 15 second rule. Anyway it says sides too. At the first time I had a an INR sample done the nurse said to use the side and explained the nerve ending damage to the pads.

Depending if I'm doing the day on keyboard (work) or the day doing house reno I choose the side. When my fingers are resting on the keyboard one side is up and gets less keyboard strike. Keeping the "wound" away from physical damage I find helps the incision to heal better

 

[Protimenow]

My test was taken further to the side than in the manual. My palm was actually on the table when the incision was made. I guess that I didn't make it clear that the incision was perhaps 1/4 - 1/2 inch away from the site shown in the manual - it was REALLY the SIDE of the finger.

 

[pellicle]

Seems to me that on the manual picture to go more up the side you'd be in the nail

 

[Protimenow]

I'll try both sites - with one or more meters - and see if there's any difference.

 

[pellicle]

I'll put my money on the only difference found being due to other factors. But this is the spirit of investigation: try the obvious and see if its different or not.

(I hope you weren't thinking I was suggesting the incision location made a difference to INR)

 

[pellicle]

Hi

This is my incision site (on keyboard days)

Its the other side on manual labor days.

This is where I understood the manual was suggesting to stick (based on the diagram). Do you (protimenow) consider this the side?

 

[Protimenow]

To me, the manual suggested a spot a bit more towards the center of the fingertip. The incision that I got on Wednesday was just a bit further from center than the one you illustrate -- but pretty darned close.

 

[Protimenow]

I have a lot of InRatio strips, and I'm not using that meter as much as I am using my CoaguChek XS and Coag-Sense, so I'll test at both sites -- closer to the center of the fingertip, and at the side of the finger. There may not be enough difference in clotting factors at the two sites -- but I'll see what the meter says.

 

[Protimenow]

It didn't seem important enough to me to accelerate testing just so that I can see if that 1/4 - 1/2 inch from my usual incision location made a difference. Because my anticoagulation clinic did a test on its meter last Wednesday, I've changed my test day to Wednesday. I tested with my Coag-Sense on the fleshy part of my fingertip and on the side of the fingertip. Both tests were done within a minute or two of each other. The Coag-Sense gave me the same INR with both locations, and the prothrombin times were .4 seconds apart. Based on this single pair of tests, the location really doesn't make much, if any, difference.

I'm not sure that the side of the finger hurts much less than it does a bit further in, but it probably won't bleed if I go back to my keyboard right after making the incision.

(FWIW -- the CoaguChek XS is STILL giving higher values than the Coag-Sense. The Coag-Sense gave me two 3.2s, the XS was 3.8, still within accepted variance, but seemingly always a bit higher than the Coag-Sense)

(Also -- even if my INR is closer to 3.8 than it is to 3.2 - and I have no idea whether it is or not - I am not changing dose, diet or activity because of it)