Ansell.qxp 29/7/08 10:17 Page 24
Cardiac Monitoring
Table 3: Companies that Assist Patients in Getting an International Normalized Range Home Monitoring Instrument
Name of Company Supports Which Instruments? Website Phone Number
US
BloodRights INRatio
®
www.bloodrights.com 877-735-3837
QAS INRatio
®
www.qualityassuredservices.com
Protime
®
www.ptinr.com
Coaguchek
®
www.protimetest.com
www.coumadintest.com
Raytel INRatio
®
www.inrselftest.com 800-295-3530
Protime
®
Tapestry Medical Coaguchek
®
www.tapestrymedical.com 877-262-4669
Zycare INRatio
®
www.zycare.com 919-419-7228
Protime
®
Canada
ManthaMed Inc INRatio
®
www.manthamed.com 905-814-1040
QAS Protime
®
www.ptinr.com 800-298-4515
www.qualityassuredservices.com
Sorin Protime
®
www.sorin.com 800-387-4563 (Western Canada)
800-268-6552 (Eastern Canada)
Roche Coaguchek
®
450-680-4367
cirrhosis, or marked variation in PT values). For children or patients with phlebotomy and a subsequent telephone call regarding dosage changes, the
disabilities that would preclude their ability to competently perform their instrument can be overwhelming. All efforts should be made to facilitate this
own testing, the availability of a parent, spouse, or qualified care provider transition and to inspire confidence in the method. Once patients have
allows these patients to be considered for PST. performed the test, they must record their results. A calendar may function
as both a testing schedule and a place for recording results. The trainer must
There are two aspects of patient education: patients must be educated about verify that the patient understands the following before leaving the clinic:
anticoagulation so that they understand what, where, and why they are how to use the instrument, the days and times to perform the test, where to
performing the test, and they must also be trained in the use of the monitor. write down results, and what to do with the information (i.e. PSM versus
The challenge for the healthcare provider is to convey the necessary doctor or anticoagulation-based management). The trainer should try to
information to the patient and train the patient in the use of the monitor anticipate any problems and develop a plan to solve them. The trainer should
without conveying excessive information. Ideally, training would be provided not assume that patients remember everything they have been taught, even
by a multidisciplinary team including nursing, pharmacy, laboratory, and though they may seem to understand at the time. Patients should have a
dietary staff. Topics to be covered include: mechanism of anticoagulant point person to call if they experience any problems.
action; importance of maintaining a therapeutic range; interpretation of test
results; factors that affect the PT—diet, drugs, and liver function; bleeding Finally, the trainer must give patients the opportunity to express concerns
risks and monitoring; testing frequency; and indication and duration of and ask questions. It is also important for the trainer to reinforce the
therapy. Trainers should simplify the process as much as possible and provide incentive identified by each patient and the trainer at the beginning of
written instructions in short, clear, simply phrased sentences. The tasks the session. A transitional period is appropriate, during which patients
allocated to the patient should be clearly listed in simple, straightforward, perform PST measurements once a week with comparison testing carried
consistent terms, and should be located in an easily accessible place. The out by the physician. This allows for the evaluation of the results of patients
trainer should refer to the list throughout the training session. When compared with the results of professionals and verification of proper
instructing patients in the actual use of the instrument, the trainer must functioning of the device, and addresses patient questions. Once patients
remember that the majority of patients are not comfortable with electronics are placed on the PST program, INR determinations should be
and thus may be intimidated by the apparent complexity of the monitoring supplemented with clinic visits every six to 12 months. The implementation
device and its accompanying materials. The trainer should remember that of PST may seem daunting; however, multiple companies assist patients in
older patients often benefit from consistency, and their routine should be obtaining these devices. Table 3 lists these companies and contact
disrupted as little as possible. For a patient who is accustomed to laboratory information, as well as the devices the companies support. ■
1. Budnitz DS, Pollock DA, Weidenbach KN, et al., National surveillance evaluation of a new capillary blood prothrombin time monitoring 7. Anderson DR, Harrison L, Hirsh J, Evaluation of a portable
of emergency department visits for outpatient adverse drug events, system, Blood Coagul Fibrinolysis, 1995;6(8):726–32. prothrombin time monitor for home use by patients who require
JAMA, 2006;296:1858–65. 5. Kaatz SS, White RH, Hill J, et al., Accuracy of laboratory and portable long-term oral anticoagulant therapy, Arch Intern Med,
2. Ansell JA, Hirsh J, Hylek E, et al., The pharmacology and monitor International Normalized Ratio determinations: comparison 1993;153:1441–7.
management of the vitamin K antagonists, Chest, 2008; in press. with a criterion standard, Arch Inter Med, 1995:155:1861–7. 8. Lucas FV, Duncan A, Jay R, et al., A novel whole blood capillary
3. Bernardo A, Experience with patient self-management of oral anti- 6. McCurdy SA, White RH, Accuracy and precision of a portable technique for measuring prothrombin time, Am J Clin Pathol,
coagulation, J Thromb Thrombolysis, 1996;2:321–5. anticoagulation monitor in a clinical setting, Arch Intern Med, 1987;88:442–6.
4. Van den Besselaar AM, Breddin K, Lutze G, et el., Multicenter 1992;152:589–92. 9. Yano Y, Kambayashi, Murata K, et al., Bedside monitoring of
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