Rachel’s adventures with a sharp pointy object and lots of plasters
…Hmmm…well a slight problem. Slight hiccup in the plans though, as I was unable to get a blood sample – or at least a valid blood sample. How hard can it be stabbing your finger with a sharp object and then putting the resulting blood that collects on a strip of plastic?! Harder than it looks!
The testing procedure’s very strict, as once the machine’s warmed up and done it’s quality control checks, and checked the test strip to make sure it’s okay to use, within it’s expiry date, and functioning properly, you have to apply the blood sample to the test strip within 120 seconds (2 minutes). You also have to apply the blood within 15 seconds of lancing your finger to get the blood sample, and though you can massage your finger to stimulate the blood flow before you lance it, and you can gently massage it after you’ve lanced it, you can’t put any pressure on it or squeeze it, otherwise you get fluid from the surrounding tissue mixing with the blood and it invalidates the reading. If you use the blood sample more than 15 seconds after you’ve lanced your finger the coagulation process will have already begun, and again would give you an invalid result.
The lancing device has various settings, from 1 to 5.5 for the depth it fires the lancet. For normal skin they recommend starting at 2, and if the blood drop isn’t large enough increasing the depth by a notch. So, I started at 2, and absolutely nothing happened – no blood at all! Went up to 3, and again, nothing happened! Went up to 4, and got a tiny drop of blood. Of course all the time the countdown timer on the machine’s going, and the small drop of blood I got from setting the lancet to 4 wasn’t enough to get a reading, which meant starting all over again with a new test strip (I got 6 in the starter pack, and the things are damned expensive – £61 for a pack of 24!). I’ve already used two of the testing strips and not managed to actually get a proper test done, and until we get approval from the PCT to get the strips on prescription I’ll have to buy my own strips. This is going to work out very pricey based on current attempts!
Now by this time because I’d been moving my hands about trying to get a new lancet out of the packet and get the top off the pack of testing strips (they have to be kept in the container with the top on to the very last minute otherwise they react with the air and it makes them unusable) I had blood – infact I had more blood than I knew what to do with! All three fingers that I’d tried lancing were by this time bleeding freely, and of course being on warfarin, it just doesn’t stop! So there I was, sitting there with tissue wrapped around my fingers, trying to wipe blood off the lancing device and the screen of the machine, but one of them I couldn’t get to stop bleeding at all! (that was the one I tried on the ‘4′ setting)
Fortunately my travel first aid kit I’d never got round to putting away after my travels this summer, so it was still on top of the pile of books at the side of the bed. In it amongst the assorted plasters and bandages and such like is some spray for stopping bleeding – very useful stuff to have around when you’re on warfarin! It took a hefty squirt of that to stop it, and that one’s got a plaster on it. Meanwhile the rest of my fingers look like pin cushions with various puncture marks and bruising from where it’s carried on bleeding under the skin.
Lessons learnt:
- DON’T use the number ‘4′ setting!
- keep a first aid kit and some ’stop bleeding fast’ spray handy
- put machine etc. on a wipeable surface as it’s a lot easier to clean the blood up afterwards!
I’m going to ring the surgery and make an appointment to go and see the nurse practitioner for a lesson in how to lance fingers and get a valid sample without a) bleeding to death, and b) ending up looking like a pin-cushion!
Update:
By Friday I’d figured out that maybe the problem was that my hands were too cold to get the blood flowing properly the first time I’d done it. I figured out the warm hands bit on Thursday night when I realised that after a day of typing my hands were a lot warmer than when I tried yesterday morning. Whenever docs need veins in my hands for anything it always involves a lot of wiggling fingers around, clenching fingers, and flapping around like a demented penguin, so on Friday morning, having already got fairly warm hands as I’d not long been out of the shower and been doing bits and pieces so I’d been using my hands, I figured it was worth another shot. I must have looked as though I was doing some weird version of the hokey-cokey with all the “shaking it all about” stuff! Friday’s attempt went a lot better in that I managed to get a fairly decent drop on the 2.5 setting, but then got a “6″ error (I think that’s another variation on the “You did it wrong you muppet!” code ). Next attempt with another finger seemed to be going well, but then I made the mistake of trying to use the side of the strip, wondering if that’d work any better, and learnt the hard way that it doesn’t! Unfortunately that meant that I was out of time again.
On Friday morning after I’d cleaned up I was searching online for any handy hints on using the lancets, and of course found loads of info on glucose monitoring, which is a lot more straightforward because you only need a very small amount of blood, and you can put pressure on the finger to get a larger drop – with the INR testing it’s that you can’t put any pressure on it that makes it more difficult. Obviously that’s why they give you 6 strips in the starter pack to get to started because you need them to figure out how to do it right – it’s a lot trickier than it looks on the training DVD!
My new plan (which maybe I should have tried from the start) is that as I’ve been at work at the beginning of the week anyway, and didn’t have time to take my time over it, which is what it needs, is that I’m going to leave further testing attempts until later in the week (partly as I’ve only got a very limited supply of test strips left). In the meantime though what I may do, as I have a fair few lancets, is to practice just the lancing bit. If I can get the hang of that, hopefully it should be easier to put the two steps, getting the blood, and then testing it, easier to do. I did feel better about it after a friend who’s a practice nurse at a GP surgery and runs their INR clinic, using the “pro” version of the machine I’ve got, said when she first started doing it, it took her a while to get the hang of getting a decent sample out of some patients, and like me, she “wasted” no end of those very expensive testing strips. At least I’m not on my own in finding it tricky.
Hopefully it won’t be long before I get the hang of it, but in the meantime I think I’ll stock up on some more plasters just in case. 
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