Lancets for INR testing

[pellicle]

Hi

For whatever reason people seem to find themselves asking for advice about getting enough blood, one of the problems is often as simple as not using the right lance. The right lances are supplied with the Roche CoaguChek system.
Coagucheck

Blood glucose testing

I've added more details in the blog post.
http://cjeastwd.blogspot.com/2023/06/inr-lance-sizes.html
Hopefully someone finds this useful

 

[ATHENS1964]

orange 21G 2.2 mm
blue 21G 1.8 mm
yellow softclix

 

[pellicle]

orange 21G 2.2 mm
blue 21G 1.8 mm
yellow softclix

But are all three shown suitable for getting sufficient blood sample for Coaguchek?

 

[Emmapenny]

Oddly my son has been really struggling lately with the yellow coaguchek lancets - they just don’t seem to be penetrating his skin like they used to and he often has to try 3 or 4 times to get even a sight of blood. His hands are warm and he’s using enough pressure so I wonder if we need to change the device - maybe it’s not forceful enough anymore. We’ve been using it less than 1 year and im not sure of their shelf life.

He didn’t use to have any problem with the lancets.

 

[ATHENS1964]

But are all three shown suitable for getting sufficient blood sample for Coaguchek?

I have tried all 3 and I had a good drop size, if you see the orange in the photo they recommend it for the coagulation test.

 

[ATHENS1964]

Oddly my son has been really struggling lately with the yellow coaguchek lancets - they just don’t seem to be penetrating his skin like they used to and he often has to try 3 or 4 times to get even a sight of blood. His hands are warm and he’s using enough pressure so I wonder if we need to change the device - maybe it’s not forceful enough anymore. We’ve been using it less than 1 year and im not sure of their shelf life.

He didn’t use to have any problem with the lancets.

Buy 21G 2.2mm is suitable for a good drop of blood , I think amazon has also ask at a pharmacy, it will be easy to find you.
The cost in Greece is 20 euros for a box of 100 pieces

 

[pellicle]

Hi

Oddly my son has been really struggling lately with the yellow coaguchek lancets - they just don’t seem to be penetrating his skin like they used to and he often has to try 3 or 4 times to get even a sight of blood.

so, a few thoughts

• are you lancing the same spot? If so this will cause a callus to form and it will porgressively take more and more to penetrate that (gardeners and outdoor workers will attest to this)
• are you lancing the side or the "pad" ... you should lance around the side about where the fingerprint stops
• have you changed lance? I get a few months from once lance but I also need to gradually adjust the depth (which is what the adjustment adjusts.
• the power of the impact will have little to zero effect as long as its sharp.

His hands are warm and he’s using enough pressure so

his pressure is not really important, its not like a staple gun (where pressure is more important on harder materials)

Does it bleed later (after lancing)? Is he using the rubber band?

I wonder if we need to change the device - maybe it’s not forceful enough anymore. We’ve been using it less than 1 year and im not sure of their shelf life.

they don't have a shelf life that I know of. I'm still on the first packet of (50) lances that came with my coaguchek some 12 years ago. They are afterall stainless steel and capped in plastic to protect the tip from oxidation.

PS: The Roche training manual shows side (and depending on the publications says side.

Hope that helps

 

[pellicle]

I have tried all 3 and I had a good drop size, if you see the orange in the photo they recommend it for the coagulation test.

personally (based on experience here) every time someone says "I'm not getting enough blood" it turns out they are using a smaller gauge lance. So if smaller gauges are working on your skin then good, but don't be afraid to step up the diameter.

Its basic wound principles, the bigger the hole the more blood; depth is not as much a factor.

 

[Emmapenny]

Hi

so, a few thoughts

• are you lancing the same spot? If so this will cause a callus to form and it will porgressively take more and more to penetrate that (gardeners and outdoor workers will attest to this)
• are you lancing the side or the "pad" ... you should lance around the side about where the fingerprint stops
• have you changed lance? I get a few months from once lance but I also need to gradually adjust the depth (which is what the adjustment adjusts.
• the power of the impact will have little to zero effect as long as its sharp.

his pressure is not really important, its not like a staple gun (where pressure is more important on harder materials)

Does it bleed later (after lancing)? Is he using the rubber band?


they don't have a shelf life that I know of. I'm still on the first packet of (50) lances that came with my coaguchek some 12 years ago. They are afterall stainless steel and capped in plastic to protect the tip from oxidation.

PS: The Roche training manual shows side (and depending on the publications says side.
View attachment 889272
Hope that helps

Thanks for your response.

He varies each time which finger he uses and he goes on the side of the finger as per advice.

He was using the rubber band method but it doesn’t help with the problem.

The finger looks ready (nice & pink) but he draws no blood. it’s more that the needle is not penetrating enough.

I’ve ordered some different lancets to try.

We did order a new batch of the softclix and I think that’s maybe when the issue started . It’s exactly the same brand as he had before but it did seem to coincide.

It wasn’t the shell life of the lancet I was querying - it’s the actual device he uses to put the lancet in (like a pen) I wonder if changing that may help. I’ll try that if the new lancets don’t help!

 

[ATHENS1964]

Thanks for your response.

He varies each time which finger he uses and he goes on the side of the finger as per advice.

He was using the rubber band method but it doesn’t help with the problem.

The finger looks ready (nice & pink) but he draws no blood. it’s more that the needle is not penetrating enough.

I’ve ordered some different lancets to try.

We did order a new batch of the softclix and I think that’s maybe when the issue started . It’s exactly the same brand as he had before but it did seem to coincide.

It wasn’t the shell life of the lancet I was querying - it’s the actual device he uses to put the lancet in (like a pen) I wonder if changing that may help. I’ll try that if the new lancets don’t help!

Every time I pierce another finger besides the thumb, I have 8 fingers with 2 sides each, that is to say, I have 16 tests in about 6 months to pierce the same finger.
I use softclix or one of the things I have seen, my knowledge is that all 3 are 21 G for that and I have a good drop, I have not lost a film due to insufficient drop here and 2 years or so, I follow what he mentioned above and the pellicle as well as the roche manual

 

[pellicle]

Hi

t’s the actual device he uses to put the lancet in (like a pen) I wonder if changing that may help. I’ll try that if the new lancets don’t help!

as mentioned, mine is 12 years old and has done a lot of lancing (way more than one per week).

Without being there I can't say, there are too many variables, but as I'm not clear when the last time you changed lance, put in a new one and set depth to something like 4

hope that helps

Best Wishes

 

[Mister_James]

If you test weekly, same finger,same spot if you are that accurate. That's 52 lancings.
520 lancings in 10 years.
It is more painful to lance the same area before it heals but calluses will not be the issue.
I practice guitar, hours a day, every day and I have calluses on one hand and I use mostly my ring finger on one hand and no issues

 

[Protimenow]

Pellicle: you've been reusing your lancets for YEARS? You have probably put your lancets into their protective plastic piece between uses?

That's mind boggling to me.

I have hundreds of 21 gauge lancets, and I can't seem to give them away.

Maybe I've been overpaying (about 25 cents per use) by using single use lancets.

Info about 'gauge': although it may be somewhat counterintuitive, but the needle gets bigger as the gauge gets smaller -- 31 gauge (blood glucose) is much finer than 21 gauge (INR testing).

 

[pellicle]

Pellicle: you've been reusing your lancets for YEARS? You have probably put your lancets into their protective plastic piece between uses?

Not the same actual lancet, but the packet I got hasn't run out yet. Often months on a Lancet though.

Frankly I just forget about it. It works, I get blood, I stop the bleeding with a piece of tissue paper, I write up my result up, then put it away for next week.

 

[Timmay]

I have tried all 3 and I had a good drop size, if you see the orange in the photo they recommend it for the coagulation test.

I don’t know where this picture came from but the yellow indicated in this picture does not match what the actual yellow CoaguChek lancets of old truly are. The old Roche Coagucheck yellow lancets are definitely 21G and puncture plenty deep. I use setting 3 on the Softclix.

I struggled with getting enough blood for a bit and then finally fell into a routine that worked for me (like most of us do). Then, one day, I swapped to the yellow 21G lancets (significantly tapered if you were to magnify the tip). Wow. What a difference. I was already using thick lances … but these yellow ones with the tapered tip actually made a difference when using different settings on the softclix.

Working with pellicle made me realize a couple other things too …

1) Use the right lancet
2) There’s a difference between a plump finger and a warm finger. I fell into a routine of warm water and heating my hand over the stove to warm it up. But, that is WAY different than a pump finger (working out, walk outside in hot weather, hot shower, etc). Plump fingers make all the difference in the world and a simple warm-up procedure using hot water and/or the stove did not “plump” my fingers correctly.
3) Wrapping the finger with a thick rubber band is a process. It is not just a quick wrap. You want to start wrapping below the knuckle and end up at above the knuckle. This will cause blood to be forced upwards … make a plump finger because you forced the blood toward the tip with your wrapping technique.

Watch pellicle’s video and you’ll see this. Thanks pellicle!!!

Tim

 

[pellicle]

Thanks pellicle!!!

You're welcome mate, it's what places like this are for.

 

[tom in MO]

I don’t know where this picture came from but the yellow indicated in this picture does not match what the actual yellow CoaguChek lancets of old truly are. The old Roche Coagucheck yellow lancets are definitely 21G and puncture plenty deep. I use setting 3 on the Softclix.

I struggled with getting enough blood for a bit and then finally fell into a routine that worked for me (like most of us do). Then, one day, I swapped to the yellow 21G lancets (significantly tapered if you were to magnify the tip). Wow. What a difference. I was already using thick lances … but these yellow ones with the tapered tip actually made a difference when using different settings on the softclix.

Working with pellicle made me realize a couple other things too …

1) Use the right lancet
2) There’s a difference between a plump finger and a warm finger. I fell into a routine of warm water and heating my hand over the stove to warm it up. But, that is WAY different than a pump finger (working out, walk outside in hot weather, hot shower, etc). Plump fingers make all the difference in the world and a simple warm-up procedure using hot water and/or the stove did not “plump” my fingers correctly.
3) Wrapping the finger with a thick rubber band is a process. It is not just a quick wrap. You want to start wrapping below the knuckle and end up at above the knuckle. This will cause blood to be forced upwards … make a plump finger because you forced the blood toward the tip with your wrapping technique.

Watch pellicle’s video and you’ll see this. Thanks pellicle!!!

Tim

Per the meter's, Coagcheck XS, instructions:

• Warm your hand by holding it under your arm, use a hand warmer, and/or wash your hand with warm water. (Putting my hand in a bowl of hot water works for me. )
• Hold your arm down by your side, so that your hand is below your waist.
• Massage your finger from its base.
• Massage your finger until you see increased color in your fingertip. Keeping your hand down,
  press the tip of the lancet firmly against the side of your fingertip. Press the release button. Gently massage your finger from its base until a drop of blood is formed. Do not press or squeeze the finger.
  

 

[Timmay]

Per the meter's, Coagcheck XS, instructions:

• Warm your hand by holding it under your arm, use a hand warmer, and/or wash your hand with warm water. (Putting my hand in a bowl of hot water works for me. )
• Hold your arm down by your side, so that your hand is below your waist.
• Massage your finger from its base.
• Massage your finger until you see increased color in your fingertip. Keeping your hand down,
  press the tip of the lancet firmly against the side of your fingertip. Press the release button. Gently massage your finger from its base until a drop of blood is formed. Do not press or squeeze the finger.

Been there, done that. But hey, thanks for the noob instructions.

 

[acki46]

@pellicle - I had always assume the lancets were single use and I threw them in the bin. You haven't run into infection issues or similar reusing the same lancets (assume not, otherwise you would've stopped reuse)?

Not the same actual lancet, but the packet I got hasn't run out yet. Often months on a Lancet though.

Frankly I just forget about it. It works, I get blood, I stop the bleeding with a piece of tissue paper, I write up my result up, then put it away for next week.

Been there, done that. But hey, thanks for the noob instructions.

I too used to have issues getting a large enough sample, so I've been spinning my arm around a couple of times (like a windmill) to force blood into my hand and then using a rubber band before testing - seems to work for me.

 

[Timmay]

I too use the same lancet many many times. If I had to guess I’d say 10 - 24 times. I test twice a week. Probably change the lancet every couple months? I don’t even know. I’ll set a google reminder to make sure that I change it every 2 months.

Never had a problem with infection. And using the large tapered yellow lancets always gets enough blood.