Great Ormond Street Hospital for Children NHS Foundation Trust: Information for Families

INR tests at home for warfarin The International Normalised Ratio (INR) test measures how long it takes for the blood to clot. INR tests are a vital part of treatment with anti-coagulants such as warfarin. Some families may be able to do these INR tests at home, so avoiding regular trips to Great Ormond Street Hospital (GOSH) or their local hospital. This information sheet explains about carrying out INR tests, reporting results and what to do next. It should be read in conjunction with the information booklet provided by CoaguChek®, which is the machine used by GOSH.

What is an INR test and why is it important? INR test results are used to make sure that

Ideally the INR should be within the

the dose of warfarin is giving the right

range given and every time your

amount of anticoagulation. Having too

child has an INR, the dose could be

much warfarin can cause bleeding as the

increased, decreased or remain the same

blood becomes too thin and having too

depending on the result. Each time, your

little means that the blood will remain

anticoagulation contact will make sure

too sticky and at risk of clotting. Your

you understand how much warfarin to

child will be given a ‘target INR range’

give your child.

by the staff looking after your child. This target INR varies from child to child depending on his or her condition. Your child’s target INR will be written in his or her warfarin record booklet.

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© GOSH NHS Foundation Trust January 2015

Can everyone do INR tests at home?

 Carrying out a test

No, it is not suitable for everyone. At

 Contacting the team for dosing changes

GOSH, we will only recommend doing INR

We will also ask you to confirm that you

tests at home if your child:

have learnt these skills by signing a record

 has an agreed training plan between

form in your teaching information pack.

your family and the nursing team  you have completed a training package  has attended all scheduled INR tests and clinic visits If your child fits in to this category, please

 Understanding the results

A copy of this form will be sent to all healthcare professionals involved in your child’s care. Remember that we will make sure that you are confident in doing your child’s INR tests before you go home.

talk to us about the possibility of doing Once we have agreed that you and your

How do I do an INR test with the CoaguChek®?

child can do the tests at home, we need

Full information about doing an INR test

to liase with the doctors and nursing

is included with the CoaguChek® device

team in your local area to confirm that

but the main points follow. Remember

they support home INR testing. If this

that with some children, it is easier to get

is the case, we will then need to talk

a blood sample from their foot rather

to your family doctor (GP) to confirm

than fingers. We will show you the best

prescription of the supplies needed for

way for your child.

the CoaguChek machine, testing strips

1. Make sure you have all the equipment

INR tests at home.

®

and warfarin medication.

you need ready • CoaguChek® machine

Learning about the CoaguChek® machine Before you go home with the CoaguChek® machine, we will teach you how to use it safely. You will need to watch a DVD about the machine and read the written information produced by the

• Results booklet and pen 2. Wipe the area clean and wash your hands 3. Ask your child to wash his or her hands in warm water and dry them 4. Ask your child to shake his or her arms

manufacturer. You will be given the DVD

and wriggle his or her fingers (or toes if

and information to keep. The main things

this is where you will take the sample)

we will teach you are listed below.  Preparation of the equipment  Quality assurance of results  Safety Sheet 2 of 5

• Test strip

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5. Insert a test strip into the meter, which will switch on automatically 6. Confirm strip code and wait for the strip to warm up © GOSH NHS Foundation Trust January 2015

7. Prick your child’s finger (or toe) with the lancet and put a drop of blood on the test strip 8. The meter will tell you if you have put enough blood on the test strip 9. The meter will tell you if the INR test

What do I do with the results? We will advise you how often to do an INR test as this varies from child to child. If you are doing routine testing once a week, try to do the test during office

has been done correctly and give you

hours so that you can discuss the result

the result in a couple of minutes

with your anticoagulation contact. When

10. If your child’s target INR has been

you have done a test, you should ring

programmed into the machine and the

your anticoagulation contact with the

result is outside this range, the meter

test result. They will then check whether

will tell you

your child’s warfarin dose is correct. If

11. The meter stores up to 100 results automatically 12. Record the result in your yellow

you do need to change the dose, they will check that you understand how to take the new dose of warfarin.

warfarin booklet Remember that once you have pricked

Quality Control

your child’s finger, you only have 15

Please bring your CoaguChek® machine

seconds to put the blood sample on

to any appointments/admissions to carry

the test strip before it starts to clot.

out a test as usual. Sometimes an extra

If you run out of time or the machine

sample of the blood for testing in the

tells you that the sample is not big

laboratories may be needed. This extra

enough, you will need to start again

sample can be taken from the same

with a new test strip and pricking

finger but needs to be done within a few

another of your child’s fingers.

seconds of the CoaguChek® sample.

Parents have told us that using distraction techniques and rewarding testing can help children cope with the finger pricks. For more information about these, please see our Distraction therapy booklet available on our website or from the Pals office. Patients on warfarin will be invited for a

 The machine is sensitive to heat and moisture, so store it in a warm, dry place away from direct sunlight.  Everything you need to carry out INR

six-monthly review coinciding with clinic

tests at home is included in the storage

attendance and general review. Patients

bag so do not put it in another container.

with reduced oxygen saturation may require assessment three-monthly.

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Storing your CoaguChek® machine

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 Keep the machine and equipment out of reach of children.

© GOSH NHS Foundation Trust January 2015

Cleaning your CoaguChek® machine

How do I order new supplies?

 Put your used lancets and test strips in

Once you have the CoaguChek® meter,

a sharps bin. Your family doctor (GP)

you should be able to get all the supplies

or community team or anticoagulation

needed on prescription from your family

contact should provide this for you and

doctor (GP). An order form is included in

arrange disposal when full.

your information pack. If you have any

 After use, wipe the CoaguChek® machine over with a clean cloth,

difficulty getting supplies on prescription, please tell us.

dampened with warm water and a little

For anticoagulation advice and dosing of

washing-up liquid, before drying with

warfarin from INR results, please call 020

another clean cloth

7405 9200 ext. 5774.

 If blood gets inside the test strip guide, you will need to remove this part carefully for cleaning. This will be demonstrated during training and the instructions are given in the CoaguChek® user manual provided with the machine Notes

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© GOSH NHS Foundation Trust January 2015

Important information Child’s name Date of birth GOSH hospital number NHS number GOSH consultant Local consultant paediatrician Local consultant haematologist Diagnosis Operation date Date warfarin started Therapeutic range

Get urgent help if INR is less than 2 or more than 7

Frequency of testing when INR is unstable Frequency of testing when INR is stable Length of time to stay on warfarin Initial treatment managed by Ongoing treatment managed by Name of anticoagulation contact Telephone number of anticoagulation contact Name of hospital contact Telephone number of hospital contact Serial number of CoaguChek® machine Roche website: www.coaguchek.com/uk/?target=/en/patients Compiled by the Haematology, Cardiology and Neurology departments in collaboration with the Child and Family Information Group Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH www.gosh.nhs.uk Sheet 5 of 5

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© GOSH NHS Foundation Trust January 2015