INR level via lab draw vs. fingerstick test

[Warrick]

Here in NZ Roche are the importer of St Jude valves , they sent me a meter for free as long as I want it, the catch is they are the only ones in NZ that sell the strips so they have a customer for life, do they not suppy meters in other countries?

 

[pellicle]

Warwick, I seem to recall seeing ads for online medical supply shops and pharmacies (drug stores as they call them) selling them, so I think the biggest issue is most are just feeling locked in by their insurance companies and don't want to pony up their own $500

Isn't there any joint in NZ supplying strips?
Have you thought about buying across the ditch?

Or are you just meaning that by supplying you the thing you will buy their products?

Anyways

https://www.capesmedical.co.nz/medic...trip/24-packet

PS that perhaps explains why ATS gave me my free one too, maybe they import those valves?

 

[Agian]

Lancing the same point is a great idea. Logical.
Pel, how long should the rubber band be on? Is there a range outside of which you get inaccurate results?

 

[pellicle]

Lancing the same point is a great idea. Logical.

yeah ... a diabetic I know pointed it out to me early on ...

how long should the rubber band be on? Is there a range outside of which you get inaccurate results?

dunno ... but to me, whatever you do make it consistent ... There could well be a case the the torniquet can influence things, so I 1) keep it to a shor time 2) keep it consistent.

I reckon that if the entire process from wrap - prick - drip is close to 15 seconds (which it is for me) that it shouldn't upset the results.

I've tried it with and without and found exactly the same number (and I've done this more than a few times). I know that in the interests of science I could perhaps try intervals of differing length (say 30 seconds wrap or more) but I just haven't been motivated to. Also (for myself) if the finger doesn't turn pink in the first 5 seconds I've found (from trying this without using a strip) that I won't get blood even after 30 seconds. So I use another finger and start my wrap up further and work down further ... that always gets it.

Being a ****** I also test the first of a new batch of strips with testing done with the last strip of the old batch (yes I know that wastes one) to check that there is no interbatch variance. So far its been 0.1 between batches (where not exact). Always make the subsequent test on a different finger (which is how I know that I can't feel anything on my main testing finger ...).

 

[Freddie]

Kolyur, I've read this thread and the results you got from the Coaguchek monitor and the results from the lab.
Two questions: 1) are you keeping the strips in the fridge? if you are don't. 2) Do you have the monitor 'set' on INR?
The Coaguchek monitor has 3 settings; %Q , Sec , and INR.
BTW, you can actually scrape your finger on the edge of the test strip, no need to wait for a 'drop'.

 

[pellicle]

Hi Freddie

...1) are you keeping the strips in the fridge? if you are don't.

this is a good point ... I'd say "if you are then make sure you allow the bottle to come to room temp before you open it." Otherwise humidity will condense on the strips on a hot humid day.

Roche actually recommend storage in the fridge for hot locations (like where I lived in Australia) where room temperature (often assumed to be 20C) is over 35C for extended times (like months)

http://www.apsfa.org/docs/XS%20Strip...e%20Insert.pdf

Storing the Test Strips
Store the test strips in their container, with the cap closed. You can store the test strips at room temperature or in the refrigerator (2 to 30°C or 36 to 86°F). When stored properly, the test strips can be used up until the expiration date printed on the test strip container.

 

[Paleowoman]

Lancing the same point is a great idea. Logical.

yeah ... a diabetic I know pointed it out to me early on ....

Mega apologies if I have misunderstood here, but being diabetic I do regular blood glucose tests on my fingers and I wouldn't dream of lancing the same point each time, soon end up with bruised fingers. I use different fingers each time, and different sides of the fingers. When I was in hospital having AVR the nurses obviously had no idea where to place the lancet and how to do it, I ended up with bruises on every finger !

 

[kolyur]

I'm about ready to throw this thing out the window. To be fair, though, the problem is probably with me. My wife and I went through about 8 strips this morning and we were only able to get one good sample from me and none from her. In one case I was able to get a good hanging drop without the rubber band (I wanted to see if that was somehow the source of the problem) but I still got a high INR reading of 4.3. I was careful about following the 15 second rule (between finger prick and machine acceptance beep). In all other cases we just couldn't get enough blood from a prick. I have a good lancing tool with adjustable depth. Usually what happens is that an initial small bead of blood will form at the prick, but no amount of squeezing or massaging will cause any more to come out. I didn't try max depth on the tool so perhaps that should be my next step.

One other thing I noticed, maybe it's nothing, is that usually the initial bead of blood is very light red in color. I don't get any dark red blood (like I saw in pellicle's video) until I start squeezing the finger. Could I be misapplying the lancing tool?

 

[pellicle]

Hi

I'm about ready to throw this thing out the window.

that's perfectly understandable and I reckon that you should give it a bit of a break for a while. I was also at first quite pissed off with mine and as I was already signed with a lab I put it to one side for a few months, till the lab started shitting me to tears and I just picked it up and had another go. I do believe that cognitive functions are impaired a little bit after surgery, so it could be you're just not "in the right frame of mind"

To be fair, though, the problem is probably with me. My wife and I went through about 8 strips this morning and we were only able to get one good sample from me and none from her.

you don't need the drop to be "hanging" , just get a decent amount ... meaning not just a wet stain. The term is meant to be a descriptor. You will know when you've blown enough strips.

also, why not just practice without placing it on any strip ... just see how much of a "click" is needed ...

In one case I was able to get a good hanging drop without the rubber band (I wanted to see if that was somehow the source of the problem) but I still got a high INR reading of 4.3. I was careful about following the 15 second rule (between finger prick and machine acceptance beep).

it could actually be that your INR is high ... did the lance bleed for a while afterwards?

In all other cases we just couldn't get enough blood from a prick. I have a good lancing tool with adjustable depth. Usually what happens is that an initial small bead of blood will form at the prick, but no amount of squeezing or massaging will cause any more to come out. I didn't try max depth on the tool so perhaps that should be my next step.

are your hands "cold" or looking pale? Are you getting "performance" stage fright or feeling rushed? That will cause the external blood vessels to constrict.

One other thing I noticed, maybe it's nothing, is that usually the initial bead of blood is very light red in color. I don't get any dark red blood (like I saw in pellicle's video) until I start squeezing the finger. Could I be misapplying the lancing tool?

its possible ... its the one it came with right?

I reckon do a few "no strip" dry runs and just see ... it could be as simple as your hands are cold because your house is cold? In Australia (where we don't heat our houses in winter cos we're stupid) I often do the washing up first and then do it after my hands have been in the warm water. Dry with a towel and go to it.

 

[pellicle]

...I do regular blood glucose tests on my fingers and I wouldn't dream of lancing the same point each time,

why not?

I only test once a week ... and I've never had a bruise from a lance yet ... nerve damage however is a real issue, so whatever you do, don't be lancing the tips or pads of your fingers..

 

[Paleowoman]

I do regular blood glucose tests on my fingers and I wouldn't dream of lancing the same point each time

why not?

I only test once a week ... and I've never had a bruise from a lance yet ... nerve damage however is a real issue, so whatever you do, don't be lancing the tips or pads of your fingers..

Ah, right, if you only test once a week it certainly wouldn't be a problem to use the same place always. I test several times a week, occasionally several times a day - and yes, never on tips or pads of the fingers, always on the sides with the lancet device at the minimum strength needed. I was unaware that you didn't have to test very often - apologies.

 

[pellicle]

Ah, right, if you only test once a week it certainly wouldn't be a problem to use the same place always.

yeah ... when I do daily testing I usually rotate through my hand ... for a diabetic when testing a couple of times daily its really different.

for instance in this post these are blind diabetics ... needing finger tips for reading:

https://nfb.org/finger-sticking

[FONT=&quot]Finger Sticking Locations[/FONT]
[FONT=&quot]You should generally use the sides of your fingers for sticking sites. More nerves are present in the center of fingers, so lancing in this location may bring more pain. Note several glucose monitors now allow "alternative site" testing - but their instructions specify that critical readings should be taken from the fingers.[/FONT]

must be super frustrating...

I test several times a week, occasionally several times a day - and yes, never on tips or pads of the fingers, always on the sides with the lancet device at the minimum strength needed.

yeah, its a point I often make to people bitching about self testing for INR ... compared to diabetics we have it real easy ... we test weekly (some even stretch longer, but I don't reckon its worth saving $5 a week to just know)

... and we need to make less adjustments to diet and does than diabetics too ...

I was unaware that you didn't have to test very often - apologies.

none needed ... that's what discussion is for .. clear up misconceptions / misunderstandings

 

[Agian]

Mega apologies if I have misunderstood here, but being diabetic I do regular blood glucose tests on my fingers and I wouldn't dream of lancing the same point each time, soon end up with bruised fingers. I use different fingers each time, and different sides of the fingers. When I was in hospital having AVR the nurses obviously had no idea where to place the lancet and how to do it, I ended up with bruises on every finger !

Curiosity killed the cat, so I'm glad I'm not a cat. Carbs increase your BSL, but you don't consume any. So... Shouldn't you BSL be 'normal' all the time?

 

[dick0236]

............. In all other cases we just couldn't get enough blood from a prick. I have a good lancing tool with adjustable depth. Usually what happens is that an initial small bead of blood will form at the prick, but no amount of squeezing or massaging will cause any more to come out. I didn't try max depth on the tool so perhaps that should be my next step.

One other thing I noticed, maybe it's nothing, is that usually the initial bead of blood is very light red in color. I don't get any dark red blood (like I saw in pellicle's video) until I start squeezing the finger. Could I be misapplying the lancing tool?

I would think your meter would give you an "error message" if the sample was too small.....but maybe not? I had a similar problem when I first used my meter because I could not get a good sample. I called Coaguchek and they sent me a box of their lancets that had a depth of 1.8 mm and width of 23 gauge/0.63 mm. They are single use lancets in the shape of a "T"....REF 04348150001, NDC No. 50924-043-01. They do not produce a "prick", but rather a "tiny slice", like a razor blade cut.........without pain LOL and it solved my droplet probllem and it seems to stop bleeding much faster after the test.

 

[Agian]

Forum members will have to forgive me for my tardiness. I intended to do this yesterday, but completely forgot.
It has come to my attention that many may not be familiar with the term '******'. I have decided to upload a picture of such a specimen, for educational purposes.
******s come in many varieties and are not therefore defined by their attire. Rather, it is the urge to exclaim 'What a ******!', which identifies them as such.
The term is quite common in Oceania and the British Isles (where it is often interchangeable with '****').

 

[catwoman]

I'm about ready to throw this thing out the window. To be fair, though, the problem is probably with me. My wife and I went through about 8 strips this morning and we were only able to get one good sample from me and none from her. In one case I was able to get a good hanging drop without the rubber band (I wanted to see if that was somehow the source of the problem) but I still got a high INR reading of 4.3. I was careful about following the 15 second rule (between finger prick and machine acceptance beep). In all other cases we just couldn't get enough blood from a prick. I have a good lancing tool with adjustable depth. Usually what happens is that an initial small bead of blood will form at the prick, but no amount of squeezing or massaging will cause any more to come out. I didn't try max depth on the tool so perhaps that should be my next step.

One other thing I noticed, maybe it's nothing, is that usually the initial bead of blood is very light red in color. I don't get any dark red blood (like I saw in pellicle's video) until I start squeezing the finger. Could I be misapplying the lancing tool?

One thought -- have you had any POC tests elsewhere, other than on your own CoaguChek XS? I have checked my XS against my PCP's monitor and it was identical. I had cataract surgery in May 2016 and had to get my INR down pre-op. I tested at home before going to the surgery center, where they rechecked my INR -- 1st day it was identical, it was 0.1 off the 2nd day. I've only had lab draws done at hospitals (ER visits relating to appendicitis and complications that required rehospitalization to stop an abdominal hematoma).
There is at least one condition that rules out using a POC monitor for INR testing -- Antiphospholipid (ASP) Antibody Syndrome, an immune disorder. I know several valvers who have this and must have lab draws.

Here is something about POC problems with ASP:
http://www.apsfa.org/fingerstick.htm

 

[Warrick]

Warwick, I seem to recall seeing ads for online medical supply shops and pharmacies (drug stores as they call them) selling them, so I think the biggest issue is most are just feeling locked in by their insurance companies and don't want to pony up their own $500

Isn't there any joint in NZ supplying strips?
Have you thought about buying across the ditch?

Or are you just meaning that by supplying you the thing you will buy their products?

Anyways

https://www.capesmedical.co.nz/medic...trip/24-packet

PS that perhaps explains why ATS gave me my free one too, maybe they import those valves?

Hi , the capes medical price for 24 strips is actually $35 more than buying from Roche, I think Roche has sole distribution and everyone including hospitals and pharmacies in NZ buy from them . Some aussie ebay sales look cheaper but then theres GST to pay when you import so your no better off, $332 NZD for 48 strips from Roche here.

 

[Warrick]

Thanks... I will try calling the 800 number. I bought mine on Amazon from [what appeared to be] a reputable seller. When I received it, it looked to be in "new" condition as advertised. I could be mistaken but I don't think any ol' joe can buy these directly from Roche in the USA; you have to be either a doctor or part of their monthly-fee program which I wasn't interested in. Mine says something like "for sale to physicians only" on the front of the box.

I bought the strips from the same seller and they were in sealed containers, expiration 10/2017. I was careful to use the code chip as directed. I'd be surprised if they manufacture enough of these that there would be counterfeits floating around. Other than the INR result, absolutely nothing in the device or packaging suggests that I don't have the "real deal."

I can probably return it but that puts me back at square one with home testing.

Don't give up on it, I got inconsistant readings with the lab when starting out, the cardiac nurse got me in to see the haemostasis unit at the main hospital which helped. I kept at it and tested every time i went to the hospital lab (they use a coaguchek for INR testing also rather than a blood draw) until I was getting consistantly the same readings and I had the confidence in the machine and myself that it was right, and I go to the lab once in a blue moon now.

When I had my wires out last month I took the meter into hospital with me and the doctor took my readings as right rather than doing a blood draw and waiting 6 hours.
Pellicles info is great, I still get the odd error 5 but it's generally when I'm rushing it it turns to custard, I know they say don't milk the finger but at the lab they give one good squeeze so so do I, I find cold hands are no good and I find rubbing the blood down into the finger I'm going to prick beforehand makes for a good drop,

can't say I've ever had a bruise either but if the lance pen is set for too deep it hurts and the drops not as big, all of what pellicle said cold, rushed etc causes problems, 180 seconds is a long time but not when you are panicky, if you are not getting a good drop near the end of the countdown then just turn the machine off rather than waste the strip, I know they say they have a "warm up" time but thats what the haemostasis unit told me and it's saved me a few strips, they still work the same

 

[pellicle]

... if you are not getting a good drop near the end of the countdown then just turn the machine off rather than waste the strip, I know they say they have a "warm up" time but thats what the haemostasis unit told me and it's saved me a few strips, they still work the same

That's a very good idea!!
I'll try that for sure and report back

 

[pellicle]

...
can't say I've ever had a bruise either but if the lance pen is set for too deep it hurts and the drops not as big, all of what pellicle said cold, rushed etc causes problems, 180 seconds is a long time but not when you are panicky, if you are not getting a good drop near the end of the countdown then just turn the machine off rather than waste the strip...

well I tried this this morning and got an Error 6 but I did take the strip out of the machine. So next time I'll try just turning it off and on again.

If that works then perhaps its only good for a "retry" when close to the time limit.