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Using Your Blood Thinning Meter - CoaguChek XS Introduction People who are taking anti-coagulation medication need to monitor how thin their blood is. Usually, a person does this by going to the lab regularly to test his or her blood. These tests are called INR and pro-time tests. Pro-time is short for prothrombin time. INR stands for International Normalized Ratio. Some patients can test their blood thinning level at home by using a special monitor. The CoaguChek XS® is a monitor that some people use at home to test their blood thinning level. The CoaguChek XS monitor measures the ability of the blood to clot in people who are taking anti-coagulation medications, such as Coumadin® or warfarin. It is easy to use. You just insert a test strip, apply a blood sample and read the result. If you and your doctor have agreed that you should test your INR or pro-time at home, this reference summary will help you learn how to use your CoaguChek monitor. In this reference summary, we discuss the different parts of the CoaguChek monitor and how to set up the monitor. After reviewing how you can get a drop of blood from your finger, we show you step by step how you can test your pro-time or INR. The CoaguChek System The CoaguChek monitoring system has 3 main parts. They are: 1. The meter, which gives you your blood test results. 2. The test strips, where you apply a drop of blood after inserting the strip in the monitor. 3. The lancing device, which you use to prick your finger to get a drop of blood. 1. 2. 3. This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition. ©1995-2016, The Patient Education Institute, Inc. www.X-Plain.com Last reviewed: 05/03/2016 ct330102 1 Your CoaguChek self-monitoring system should include a user manual, training materials, a log book and other materials. Check your CoaguChek kit for a full list. This photo shows the main buttons and parts of the meter, also called the monitor. Display Set Button Code Chip Slot Memory Button On/Off Button Test Strip Guide It includes: • The display. It shows results, information, symbols, and results that are stored in the memory. • The On/Off button. You press this button to turn the meter on or off. • The memory button, or M button. You press this button to confirm the code number displayed before you start each test. This button is also used to get results that are stored in the monitor’s memory. It can also be used to change the monitor settings. • The test strip guide. This is where you insert the test strip. • The code chip slot. Every bottle of test strips has its own code. It also comes with its own code chip. You should insert the code chip here every time you change the bottle of test strips. • The set button. You press this button to enter or change the monitor settings, like the date and time. Setting up the Meter The first time you use the monitor, you will have to insert the batteries and set the date and time. You can also select if you want the results in INR or pro-time format. For instructions on how to insert the batteries, check the user’s manual. This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition. ©1995-2016, The Patient Education Institute, Inc. www.X-Plain.com Last reviewed: 05/03/2016 ct330102 2 All settings are entered with the set button and the M button. 1. If the monitor did not automatically enter Set Mode when you turned it on, press the set button. The set button is on the left side of the monitor. This will put the monitor in Set Mode. You can also press the set button to change to Set Mode when the monitor is already turned on. 2. If the displayed setting is correct, you can press the set button to move on to the next setting. For instance, if the date is correct and you only want to change the time, press the set button. 3. Press the M button to change the setting that is flashing. You can press the M button repeatedly until you have reached the correct setting. You can also press it and hold it down until you have reached the desired setting. 4. Settings where there are only two options, like time, format, beep, and tone, can be switched on and off with the M button. 5. Press the set button again to accept and save the setting and move on to the next one. 6. You can only move forward from one setting to the next. You cannot move backwards. If you need to change something and are already past that setting, you will have to start the process over again. You can exit the set up process at any time by pressing the on/off button. All settings you have already entered will be remembered. You will need to set the date first and then the time. The monitor gives you the option of selecting a unit of coagulation. It can be INR or pro-time. Your health care provider will tell you which one you need. It also gives you the option of turning the beep sound off. Follow the instructions in the manual if you want to change these settings later. Inserting the Code Chip Every bottle of test strips has its own code. It also comes with its own code chip. You should insert the code chip in the code chip slot every time you change the bottle of test strips. The code chip provides the monitor with important information which it needs to perform the coagulation test. The monitor is ready to use once the code chip has been inserted. Each time you test, check that the correct code chip is inserted in the monitor. When you start each new pack of test strips, you must remember to remove the old code chip from the monitor and replace it with the new code chip that came with the test strips. This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition. ©1995-2016, The Patient Education Institute, Inc. www.X-Plain.com Last reviewed: 05/03/2016 ct330102 3 Each code chip belongs to a lot of test strips. Only remove the code chip when you are testing with test strips taken from a new pack or bottle that has a new code chip. To insert the code chip, first remove the old code chip if one is inserted in the monitor. Always make sure that the number on the code chip matches the number on the label of the test strip container. Using the wrong code chip can produce the wrong results, which could be life threatening. Second, slide the new code chip into the slot on the side of the monitor until you feel it snap into place. Every time you insert a test strip in the monitor, the display will show the number of the code chip that is inserted. Always compare the code number you see on the display with the number that is printed on the test strip container. If the two numbers are the same, confirm by pressing the M button. If the code numbers are different, the wrong code chip is probably inserted. Turn the monitor off and insert the correct code chip. When you use all the test strips from a bottle, throw away the old code chip so they don’t get mixed up. How to Get a Drop of Blood If it is the first time you are learning how to get a drop of blood from your finger, review this section. To get a drop of blood from your fingertip, you will need a sterile lancet and a blood sampler. You can use a lancet from a different manufacturer, but the test strips have to be from the same manufacturer as the CoaguChek monitor. This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition. ©1995-2016, The Patient Education Institute, Inc. www.X-Plain.com Last reviewed: 05/03/2016 ct330102 4 If you use a lancet that is different, follow the instructions that come with your lancet device. First you will need to insert a lancet into the blood sampler. A blood sampler is also known as a lancet device. To do this, follow these easy steps. 1. Pull the cap off the lancet device. 2. Insert a new white lancet. 3. Twist off the lancet’s protective cap. 4. Put the cap back on the lancet device. To place the cap back on, line up the notch on the cap with the center of the semi-circle. You may want to adjust how deep the lancet will lance the puncture site. To do this, twist the depth knob toward the smaller bumps for a shallow puncture or toward the larger bumps for a deeper puncture. You can start by setting the depth to 5 by turning the dial so that the center of the semi-circle points to 5. You can decrease the depth in future tests if you want to. Next, you will need to cock the blood sampler. To do this, press the plunger. A yellow dot will show up in the release button. Make sure to wash your hands and wash the puncture site. Use warm, soapy water. Rinse and dry the area well. It is important to make sure the area is dry or the test may not give accurate results. Massage your finger until you see more color in your fingertip. Next you will need to lance the puncture site. Keeping your hand down, press the tip of the lancet device firmly against the side of your fingertip. Press the release button. After you have lanced the puncture site, gently squeeze from the base of your finger until there is a drop of blood that hangs. This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition. ©1995-2016, The Patient Education Institute, Inc. www.X-Plain.com Last reviewed: 05/03/2016 ct330102 5 Testing Procedures 1. Wash your hands with soap and warm water. Make sure they are dry. 2. Place the monitor on a level, vibration-free surface or hold it in your hand so it is flat. Turn the monitor on by pressing the on/off button. You can also insert a test strip to turn it on. 3. Check that all the display symbols are displayed properly as shown on the picture. Results may be misread if anything is missing. 4. Check the battery level. If there are no bars left in the battery symbol, you cannot do any more tests. 5. Check that the date and time are correct. 6. You will see a flashing test strip symbol. This means the monitor is ready for you to insert a test strip. Remove a test strip from its container. After All Display Symbols you remove a test strip, close the container right away with the stopper. If you don’t close the lid, the test strips could get damaged. 7. Hold the test strip so the lettering “CoaguChek XS PT” is facing upward. 8. Slide the test strip into the test strip guide in the direction shown by the arrows. Slide the test strip in as far as it will go. A beep tone will let you know that the monitor recognizes the test strip. If you have turned off the beeping feature during set up, you will not hear a beep. 9. The code number of the code chip inserted in the monitor will flash on the display. Make sure that this number is the same as the code number printed on the test strip container. If the two numbers are the same, confirm by pressing the M button. The code number will stop flashing. If the code numbers are different, remove the wrong code chip and insert the code chip that came with the test strips you are using. Using the wrong code chip can produce results that are wrong, which could be life threatening. You may see an hourglass symbol on the display. This means the test strip is warming up. When it is finished warming up, you will hear a beep tone. This means you can now apply your blood sample. If you have turned off the beeping feature during the set up, you will not hear a beep. This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition. ©1995-2016, The Patient Education Institute, Inc. www.X-Plain.com Last reviewed: 05/03/2016 ct330102 6 The blood drop symbol and the application area will flash. This means your monitor is ready to perform the test and is waiting for blood to be applied. Your monitor will start a 120-second countdown. You must apply your drop of blood to the test strip before the time runs out. If you don’t, you will get an error message. 10. Now lance the side of a fingertip with the lancing device. Lancing the side of the finger does not hurt as much as other areas on the finger. Massage the lanced finger until a drop of blood is formed. Do not press or squeeze the finger or touch the blood. 11. Apply the first drop of blood directly from your finger to the semi-circular and transparent area of the test strip. You can also touch the blood drop against the side of the transparent area instead. Hold the blood drop to the test strip until the flashing blood drop symbol disappears and the monitor beeps. The monitor will not beep if this beeping feature was turned off during set up. Do not wait more than 15 seconds after lancing your fingertip to apply the blood sample. Waiting more than 15 seconds will make your sample start to clot and your monitor will give you incorrect results. If the beeping function is on, you will hear a beep tone when you have applied enough blood. The blood drop symbol will disappear and the test will start. Do not add more blood. Do not touch the test strip until the result is displayed. Your monitor will perform an automatic quality control check on the test strip. You should see the letters “QC” on the display. When the quality control test is over and if the strip has passed, you will see a check mark after the letters “QC”. After the “QC” test, your monitor will start the coagulation measurement. The hourglass will flash until the monitor is finished and has your result. This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition. ©1995-2016, The Patient Education Institute, Inc. www.X-Plain.com Last reviewed: 05/03/2016 ct330102 7 Your result will be displayed in the unit you chose when setting up the meter. It is automatically saved in the memory. You can change the unit between INR and protime by pressing the set button while the result is displayed. Enter the test result in your patient logbook then turn the monitor off by pressing the power button. Follow your health care provider’s directions about reporting the results to your doctor and what the results mean. Your doctor will tell you the range the test result should fall in. This range depends on the disease being treated. If your results are outside that range, call your health care provider immediately. Cleaning up Clean the monitor whenever it gets dirty. Turn off the monitor before cleaning it. Use only the following items for cleaning: • Ordinary lint-free swabs, which are available at pharmacies. • Warm water with or without washing liquid. • Soft, lint-free moistened cloths or cotton buds. Do not use sprays of any kind. Spray could get into the monitor and damage it. Clean the outside of the monitor with a lightly moistened cloth. Then dry the monitor with a fresh cloth. Caring for Your Monitor Check the test strip guide regularly to make sure it is still clean. If the test strip guide has blood or anything else on it, you must clean this area. Cleaning is simple if you follow a few easy steps. 1. Remove the measurement chamber cover by pressing upwards from the front. You can use your thumb nail. You can rinse the removed measurement chamber cover, after it is separated from the meter, with water. 2. Clean white areas that are easy to get to with a lintfree swab or moistened cotton bud. Make sure that no liquid gets in the monitor. Do not insert any objects in the test strip guide. It may damage it. This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition. ©1995-2016, The Patient Education Institute, Inc. www.X-Plain.com Last reviewed: 05/03/2016 ct330102 8 3. Once you are done cleaning the monitor, let the inside of the test strip guide dry for about 10 minutes. 4. After it is dry, re-attach the measurement chamber cover to the housing. Make sure that the test strip holder is in the correct position and properly attached. 5. Make sure that the cover is properly closed. You should hear it snap into place. To make sure that your CoaguChek XS System works correctly, please follow these guidelines: • Only use the monitor at room temperature between 18°C and 32°C. 18 to 32 C is about 65 to 89 degrees Fahrenheit. • Only use the monitor at a relative humidity between 10% and 85%. If it is very dry or very humid in the room where you are testing, the results may not be correct. • When testing, place the monitor on a level, vibration-free surface or hold it so it is almost flat. • If you don’t use the monitor for a long time, keep it in the carry-case that it came with. • Use the monitor only up to a maximum altitude of 4300 meters. • Do not use the monitor near strong electromagnetic fields. Strong electromagnetic fields may interfere with the proper operation of the monitor. To save power, the CoaguChek XS monitor automatically turns off after 3 minutes unless a button has been pressed or a new test strip has been inserted. When the monitor turns off, it stores all the results from previous tests in its memory. The monitor will quickly show the battery power level when it is turned on. The battery symbol is divided into four parts, which match to the battery power level. When replacing the batteries, you must insert the new batteries within one minute of removing the old ones to keep the date and time settings. If you take longer than this, you must re-enter the date and time. Use only alkaline-manganese batteries type AAA. Advanced Features The CoaguChek XS System has a number of built-in quality-control functions such as: • A check of the electronic parts and functions every time the monitor is turned on. • A check of the test strip temperature while a test is in progress. • A check of the expiration date and lot information on the test strip. This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition. ©1995-2016, The Patient Education Institute, Inc. www.X-Plain.com Last reviewed: 05/03/2016 ct330102 9 Sometimes an error message may show on the display of your monitor. A full list of display messages and symbols is in the user’s manual. The first thing you should do if you get an error message is try the solution suggested for that error. If the problem continues, contact your local customer support and service center. The CoaguChek XS monitor has a 100-value memory. It saves test results along with the time and date. You can erase the entire memory from your CoaguChek XS monitor. Check your user manual for more detailed information on how your monitor’s memory works. Conclusion Thanks to advances in technology, it is now possible to test your blood thinning level at home without having to go to the lab. Although blood thinning medications are an excellent treatment for many conditions, they come with a big responsibility. If your blood is too thin, you risk heavy bleeding. If your blood is too thick, you risk developing a clot which may cause a stroke. That is why you should follow the instructions given to you by your health care provider to test and report information about how thin your blood is. If your CoaguChek results are outside the therapeutic range, call your health care provider immediately. Review this reference summary and other training materials that came with your CoaguChek testing kit. Remember to ask your health care provider any questions you may have about your new meter or blood thinning medication and treatment. This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition. ©1995-2016, The Patient Education Institute, Inc. www.X-Plain.com Last reviewed: 05/03/2016 ct330102 10