DIY INR

Well, today I did my very first own pin-prick blood test for my very first own DIY INR on my squeaky new CoaguChek machine...

I discover that using the machine is a piece of cake, as the instructions are really clear and they include a DVD as well as a user manual, plus an A4 format instruction booklet with pictures. Got it all set up pretty easily...

And then discovered that I am rubbish at doing my own pin-prick tests. Oh yes. I managed to get the little needle thing into the pricking pen they provide, gold star for that because the surgery phlebotomist couldn't figure it out. People don't seem to like pulling the heads off stuff, but it comes naturally to me. I suspect I was an executioner in a previous life.

So, I tried to get the blood flowing as they suggest, by massaging the finger and even putting it on the radiator (ow). Then did the pin prick. Despite the darn thing feeling like it just excavated its way to Australia, there was a pitiful amount of blood. I tried putting it on the strip and got an error which (on leafing through the manual) turns out to be a 'blood test error', which (of course) means I didn't put enough on. Swearing ensues.

Start again... Different finger (nurse says you can't use the same finger twice). Same result. By now I am starting to feel pained, so I spend a goodly amount of time getting a finger with so much blood in it that it is purple and pulsing (okay, maybe I exaggerate slightly...) I set the machine up, I take the blood - success! Hooray! I get a beep rather than a sulky 'error 5'.

And an INR! Oh, the feeling of achievement! And it's in range... By now, I am spouting blood out of three fingers, which have ungratefully decided to provide blood now it's not needed, and the room looks like I decided to film a slasher movie here. Every darn thing has little smears of blood on it.

I sit here now typing with three cotton wool balls taped to my fingers, and you'd be surprised how easy that isn't. But hey, I did it, in the end! Now all I need is a really large supply of strips and Bob, as they say, is your favourite uncle!

Plus, of course, I didn't have to trail into the surgery, which (however much I love my chats with Jo the blood nurse) is a pain in the posterior. I'm sure it will be worth the angst, and the blood smears everywhere, and I hope that eventually I will get better at the pin pricking!

[Hidden]

Hiya Eatsalottie,

Well done, welcome to the DIY INR Club.It gets easier and easier. I find it best to wash hands in warm to hot water and thoroughly dry. Wait 10 mins or so to make sure skin is dry, turn the tip of the needle pen up to say 4 and press hard on your finger and.... bingo!

Keep giving us reports as to your progress.

John

[Hidden in reply to Hidden]

Thanks John! That sounds like a good plan and I had worked out that 5 is definitely too deep!

Lis

[rosyG]

I loved it when I got mine-(now on Apixaban) but had the same issues at first- I found running hand under hot water first did the trick !!

[Hidden in reply to rosyG]

Hi Rosy, I'd love to be on Apixaban but our surgery doesn't do it... Will try hot water next time because the radiator definitely wasn't a good idea!

Lis

[10gingercats in reply to Hidden]

I feel sure Bob will come in with a definitive reply but as I understand it your practice cannot refuse to supply you with Apixaban if you request it unless there a medical reason why you cannot be prescribed it.

[Hidden in reply to 10gingercats]

Yes, in England that's true - I'm in Wales, whole other ball game unfortunately! The whole of our health area is wedded to warfarin...

[10gingercats in reply to Hidden]

Oh, b....r!!

[Mrspat in reply to Hidden]

I know that Wales and Scotland run their health services separately from England but I think I would write to my MP and ask him/her to raise why health decisions are taken on medical grounds in England but on cost grounds in Wales. And yes - I do know there are swings and roundabouts.

[Hidden in reply to Mrspat]

Our surgery receptionist had conniptions this morning about the cost of the test strips, I was thinking, hmm good job the doctor didn't! Yes, it's all on costs here. Not a bad idea to contact our MP, make him work for his money!

[Hidden in reply to Hidden]

I was told they are £3.85 per strip.

[Hidden in reply to Hidden]

Yes, cheap they are not. I am going to have to get good at bleeding, very fast...

[Wrighty39 in reply to Hidden]

Very odd. Having never been on any anti-coagulant in 12 years of 'care' I was asked to choose one so I chose Apixaban simply because it wasn't rat poison. However, Apixaban doesn't get very good write-ups from some users!

[Hidden in reply to Wrighty39]

Does it not? I didn't know that, what don't people like about it? I think warfarin is the drug of choice here because it's cheap as chips. Plus the doctors know it, which is always a factor. New is scary.

[AnneTS in reply to Hidden]

If you do a Freedom of Information enquiry regarding the cost of a patient attending their local anticoagulation clinic and the cost of the self-testing there is no contest. The local health service saves buckets of money on we self-testers. In addition the NOACS cost much more (some cost £78 per month) and work out much more expensive than Warfarin even factoring in the cost of the strips and the lancets. Also, under NICE guidelines a year or so ago NICE recommended that patients be encouraged to self-test on grounds of cost, staff resourcing and self-management outcomes.

[Hidden in reply to AnneTS]

Is that so? Wow... Yes, I hadn't thought of it that way but of course you're right. Our doctor was perfectly happy for me to self-test, it was the receptionist who was quoting the cost of the strips at me in disapproving tones lol.

[dedeottie in reply to Hidden]

In South Wales things are changing.I am now on apixaban and numerous other people that I know across the region have have been offered the choice of warfarin or one of the new anticoagulants. X

[Hidden in reply to dedeottie]

Interesting news! Thanks dedeottie!

[Hidden in reply to Hidden]

I'd like to too, but our surgery will not provide at the present time. Are you in U.K.?

[Hidden in reply to Hidden]

Yes, we're in North Wales...

[10gingercats]

Anyone who makes me laugh in the morning.esp. a dark grey morning as it is today, gets my vote!I love your sense of humour.We allhave to frequently remind ourselves of this in this 'game' of AF.of ...it gets us 'through' where,sometimes all else fails!

[Hidden in reply to 10gingercats]

Thanks 10gingercats (wondering if you really do have 10 ginger cats! Sounds like fun!). It made me laugh too after I stopped bleeding all over the place

[jeanjeannie50]

Hmm, when and 'if' I get my own INR machine I'll be on to you for advice! Thing is my surgery is on the way to the supermarket I go to, so always pop there when I have my INR done. I keep thinking, do I want to spend £300 on my own machine or pop to my lovely surgery (which is a large house in the countryside with lots of parking). I always have a laugh with my nurse Sarah and we talk about which perfume I'm wearing, her latest one comes out of her bag for me to try and she pays me so many compliments and lets face it no one else does! Oooh I'd miss it!

Jean

[Hidden in reply to jeanjeannie50]

If your surgery's really convenient and you enjoy the visit, maybe the machine isn't for you - I love our nurse Jo, we have great chats, but I have to drag myself down the hill with the dog in tow (she's blind and diabetic, I can't leave her to her own devices), so it's a bit of a faff. Plus it takes a chunk out of my working day that I need... So for me it makes sense

[Hidden]

That's very interesting, thank you - looks like you need a very convincing excuse and a good EP!

[souljacs4 in reply to Hidden]

It might be worth asking your EP. My mum had AF which lead to CHF she had an awful time on warfarin and after seeing her like that I really didn't want to take it. I know a lot of people who have been on it for years without a problem. But I am really glad I didn't have to take it.

[Hidden in reply to souljacs4]

EP, what EP lol. I will have to find one

[souljacs4 in reply to Hidden]

I have a seen a few in the south wales area but I went privately to the spire in Bristol very pleased with the EP there.

[Hidden in reply to souljacs4]

I guess our nearest would be the Liverpool Chest n Heart, I will have to investigate...

[Wrighty39 in reply to Hidden]

Is this a blog about warfarin and such? If so they (LHCH) told me to get my GP to prescribe and she asked me to choose!

[Hidden in reply to Wrighty39]

Really? I asked our GP about NOACs and he said flatly that the health authority only used warfarin. I'm guessing you have to be a problem to get anything else.

[Hidden in reply to Hidden]

Please tell me a GP is only one seen with AF

[Hidden in reply to Hidden]

I read all the pros and cons and was a very informed patient and convinced my GP it was the way forward been on pradaxa a few years now

[Hidden in reply to Hidden]

Any side effects?

[Hidden in reply to Hidden]

None that I'm aware of been on them about 18 months now. Yearly bloods main side effect no more weekly or more INR hurrah

[jennydog in reply to Hidden]

My EP in Liverpool prescribed Pradaxa for me due to my unstable INR. I'm liberated!

When you write to your MP it would be a good idea to copy to your AM.

Best wishes.

[Hidden in reply to jennydog]

I will have a go - it's worth a try! Thanks!

[CDreamer]

LOL. xxxx

[CaroleF]

Your post is a ray of sunshine on an otherwise grey and bitterly cold day, Hidden and you've cheered me up no end with your amusing description. I laughed out loud - really! It looks as if you have received good advice about how to achieve a less blood be-smattered test next time. Good Luck!

[Hidden in reply to CaroleF]

Thanks Carol! Yes, hopefully next time more blood on the strip and less on the house!

[StuJ019]

Well done practice makes perfect . I am lucky I have had no problems taking warfarin the last to years and my inr has been so constant I only have to get it checked every twelve weeks now, my inr nurse says Im just a show off regarding my steady reading.

[Hidden in reply to StuJ019]

Mine was really steady, then I went on a diet - it's all the veggies that seem to make it a bit more up and down! Weird, eh. Great that yours is so steady though - I'm going to work on getting mine back to nice and constant.

[StuJ019 in reply to Hidden]

My diet does not change very much I tend to stick with plain and simple foods so I think that helps keep my readings steady. Good luck getting back to constant.

[Hidden]

Radiator ow indeed try putting your finger in warm water and dry it. Worked a treat with my insulin patients

[Hidden in reply to Hidden]

Thanks, frills! Yes, I'm going to try hot water next time, radiators are not a good idea!

[Hidden in reply to Hidden]

Warm water ha ha not hot

[Hidden in reply to Hidden]

Okay I will try

[Hidden]

Odd the way if consultant writes then whey hey you can have it

[Hidden in reply to Hidden]

Yes, it is, isn't it? I guess consultants rule!

[Hidden in reply to Hidden]

Some may think so to me they are just a man or woman good in their field. Got to warm my respect as my own has

[Hidden in reply to Hidden]

Oh very true...

[Hidden in reply to Hidden]

Earn not warm lol

[Hidden in reply to Hidden]

haha I figured, got to love predictive text!

[RexH]

Hi , had the same problem when first diagnosed. Don't worry it will get easier. Have found the fouth and little finger the better ones to get blood at first.

Have never used thumb nor second finger, as you use these for turning switches knobs etc.. So don't want them less senitive or sore.

Sorry to here you have joined the Diabetes club. Also if finger pricked has different settings, set on 1 of 2 not as deep, little less painful, and warm fingers under warm tap, to help blood flow.

[Hidden in reply to RexH]

Oh, it's for the INR not diabetes Rex, I already have a diabetic dog, I know all about that! In fact it was the fourth finger that worked in the end - I'll remember that... And I will set it less deep next time - I didn't know whether 1 or 5 was deep, but I do now!

[dedeottie]

Ha! You will become an expert I assure you. I had to set the dial at 4 to get results. Try putting the machine on a surface with the strip hanging over the edge at an angle pointing away from you. I found that helped when getting blood onto the strip. Good luck! X

[Hidden in reply to dedeottie]

Thanks dedeottie! Those sound like very good ideas, I will try all of them and hopefully get a better result!

[ILowe]

I hate to discourage you. It took me over 18 months to get the knack. My average strips was 3.3 per attempt, and that gets expensive. Frustrating because I was always good at dissection and my university class would choose me to do the difficult bits. I also dare to work with live mains electricity sometimes, so, manual dexterity is not the problem. In the end I ate humble pie, and asked my wife to help. We quickly discovered that putting the blood at the side of the strip did not work. The blood, even copious blood, just flooded over to the other side, and never up the center. So my wife held my finger, and put the drop in the center. That nearly always worked. We also positioned it so she could get a clear view.

After several months of this, I tried on my own. It almost always works. A few more tips. I always swing my hand for 30 seconds, hanging downwards. I do NOT prick the side of the finger (ouch) and avoid the tip. I go for the white bit where it gets fleshy instead of muscles. I then go to the base of the finger and move the blood towards the tip. Bingo, out pops a ball of blood. Nothing came out until pushed. Then I use my other hand to hold the finger above the center, and dab a good load on. ie use the steady hand to manipulate the bloody finger, and keep your elbows close to your body so reducing the tendency to tremble.

I started at depth 4, and can now get a good ball at depth 3. I even once, borrowed a glucose meter, and put a second drop on that. Thanks for your humour!

[Hidden in reply to ILowe]

Oh goodness - it sounds like you've had a real trial, and lots of sore fingers! I have mine crossed that it will be better next time. Thank you (and everyone) for all the great tips. Hopefully next time will be better!

[irene75359]

Eatsalottie, your description is hilarious! This was me a year ago when I first got my CoaguChek, and I went through countless strips. Now I never get an error message, simple rules, warm hands and DON'T move your finger from the strip until you get the positive bleep - I have been known to squeeze whilst my finger is glued to the side as there obviously wasn't enough blood for an immediate bleep. The machine seems to have a sensor that sends an error message the minute you remove your finger when not enough blood has percolated back.

I wouldn't be without mine now. Good luck!

[Hidden in reply to irene75359]

Thanks Irene, that sounds encouraging - I am going to write a list of all the good advice and hopefully next time will be better!

[Tut7iFru7i]

so glad you didnt let it beat you .where did you get your machine because i would like to buy one.like you so rightly going to get it checked so frequently is a right pain best regards xx

[Hidden in reply to Tut7iFru7i]

I got it from the manufacturer, Roche - they do a 24 month interest free thing which is pretty good, because it's not a cheap bit of kit. But not having to drag down to the surgery every week will be worth it!

[Hidden]

Just seen your post as I haven't been receiving emails for a few days.

I dont think that anyone has mentioned a very good tip ......ensure thst your finger tip is slightly over the test strip - not just to the side - so that the blood falls on to the strip rather than relying on it being drawn in at the side .

I have to ensure that quite a lot of blood is drawn and hsve the Lancet device set at 5. I had great fun to begin with including having a faulty meter ( which was replaced ) and Lancet without a spring. Perseverance was needed. I would have thrown the whole lot out if it hadn't cost £300 but I'm so glad I didn't .

[Hidden in reply to Hidden]

Oh my goodness, I am so glad the meter and lancet worked, or I'd have been tearing my hair out! Poor you! Thank you for that tip, that sounds like very sensible advice - I think part of the problem I had was that I wasn't getting a lot of blood out and by putting it on the side of the strip, by the time it had finished travelling there wasn't enough. I am sure that I'll get the hang of it in time

[Hidden]

Yes, I think not having sufficient blood drawn is the primary stumbling block ! I still make that mistake of I'm in too much of a hurry.

[Hidden in reply to Hidden]

I'm going to take a deep breath and try to get it right next time lol.

[AnneTS]

You are not alone Eatsallottie. After10 years I still cannot get the hang of that pen which comes with the Coaguchek machine. You described beautifully what happens sometimes when a finger refuses to give up any blood and then when you have tried two or more others there is a sudden gush! My anticoag nurse advised me to use Unistik instead of the pen. I ordered a box of 100 Unistik 3 extra from Amazon at a cost of about £6. They work wonderfully and now that I have a hit rate of 99.9% I will ask my gp for a prescription when I eventually run out. You twist the grey end of the Unistik and remove it. You then put the Unistik up against your chosen finger and press the raised lever (on the main body of the Unistik). No pain and a good flow. I believe diabetics use these or similar and I figured that they can't afford to mess up each time they self-test - especially if they have to test several times a day. Why don't you ask your anticoag nurse or the surgery nurse at your gp for a few samples to try?Anne

[Hidden in reply to AnneTS]

Thanks very much Anne, that sounds like a very good alternative... I'll see how I go in the next few weeks and if I'm still struggling I'll order some of these. Good to know there's something else out there!

[Hidden in reply to AnneTS]

I use these, they are excellent.

[Hidden]

Well done, I've been self testing for 3 years now, and I still very occasionally get an error5. I can't get on with the pen provided so I went to Boots and bought (yes, I can get them in the NHS but try to be economical), a box of Unistick3 Normal depth lancettes. They are very good, I prick the side of the right ring finger, and give it a good squeeze, and normally get a nice big drip onto the stick. I do mine once a month and if worried I ring to speak to the INR nurse, but generally I self medicate. It's great to be able to do this. Once a year I take the machine in to have it calibrated against the clinics. It's always ok.

[Hidden in reply to Hidden]

The Unisticks sound really good - I think I will invest next time I'm near a Boots! Thanks for the feedback

[dgex2010]

Well done you! Also for brightening up my Sunday morning! You did make me laugh ... I could picture it all! Thankyou. Never lose your sense of humour and you`ll cope with anything (that's what my mum used to say)! :o)

[Hidden in reply to dgex2010]

Thanks dgex! Yes, as they say, if you can't take a laugh you shouldn't have joined

[Judeth]

Love to know if it gets easier. I haven't progressed to self testing yet.

[Hidden in reply to Judeth]

I'll let you know

[Coco51]

Well done and thanks for making me smile. How much did the machine and the strips cost?

Best Janet

[Hidden in reply to Coco51]

Thanks, Janet! The machine's just under £300 from Roche, but they do 12 and 24 month interest-free deals which makes it pretty painless (unlike the finger pricking!)... The strips are mind-bogglingly expensive, £60-odd for 24, if the surgery hadn't agreed to get them for me it would have really put me off!