Rotating Lancing Sites and Bruising
| Author: Judy Kohn, RN, BSN, CDE |
| Last Updated: Tuesday, March 28, 2006 |
Q: "A friend of mine told me that I need to rotate my blood glucose testing sites. Was I wrong in thinking that only insulin injection sites had to be rotated? I do not use insulin. I commonly use the FreeStyle Flash® meter on my thigh to test because I get some bruising, but I don't want to go back to finger sticks."
A: After searching various American Diabetes Association resource books for a reference on the recommendation to rotate lancing sites and finding none, I've concluded this is one of those anecdotal pieces of advice that diabetes educators (myself included) have been in the habit of giving. Many of us have seen people who repeatedly lanced the same spot on their fingertip, only to discover that it became sore, and in very rare instances, infected. Other people reported that by lancing the same area, the skin became tough and calloused; some perceived this as a good outcome, as they said this toughened area didn't hurt as much when lanced. But most would then report that the area was so thick and calloused that they had difficulty obtaining a large enough drop of blood. For the above reasons, diabetes educators have always recommended that, when using fingertips, one should rotate the lancing sites.
Now, when you are using a blood glucose meter that lets you test using alternate sites on the body, such as the forearm, upper arm, thigh, calf, or hand, you have much larger surface areas from which to test, so it is less likely you would repeatedly lance the exact same spot. This makes it less likely that you would develop a callous and, if you are using a meter that has a very small sample size requirement, you do not need to obtain as much blood. Alternate site test areas do not have the specialized tactile nerve tissue that the fingertips have, so usually these sites are painless to test. Still, it makes reasonable sense to rotate the lancing sites somewhat, just to give each site a rest.
Things to Consider Regarding the Bruising:
- If you are taking aspirin or coumadin, you may be more prone to bruising.
- Age: as one gets older, the skin gets thinner, and this can cause some people to bruise.
- If you are using a FreeStyle system, do you have the lancing device dialed too deep? The most shallow penetration would be at setting #1. We recommend that you start with the setting of #2 for testing alternate sites, and #1 if testing on the finger.
- There have been occasional instances where a person didn't know to put the clear plastic cap back on the lancing device before lancing (and make sure you aren't using the grey cap, which would cause the lancet to go deeper, and is intended only for fingers).
- There are some people who just have a tendency to bruise no matter what the situation.
Recommended Procedure for the FreeStyle System:
- Wash the test site thoroughly with soap and water and then dry.
- To bring fresh blood to the surface of your testing site, rub the test site vigorously until you feel it getting warm.
- We recommend that you use FreeStyle lancets. Even some finer gauge lancets leave bruising.
- Avoid lancing areas with obvious veins or moles to avoid excess bleeding or bruising.
- Place the cocked lancing device firmly against the skin, but do not press into the skin. Pressing into the skin at this point may cause bruising or red marks and can impede blood flow to the skin.
- With the lancing device firmly against the skin, depress the release button and do NOT lift up. Continue to hold the lancing device and gradually increase pressure for several seconds.
- Lift the lancing device straight up; be careful not to smear the blood sample.
- Bring the test strip to the sample at a slight angle and gently touch only one edge of the test strip to the sample. Do not press the test trip against the sample; scrape the blood or use the flat side of the test strip.
- Wait until you hear the confirmation beep, or see the moving arrows, which means you have enough blood.
- The strip acts like a sponge and pulls the blood into the edge of the test strip.
Finally, if the suggestions provided above do not solve the problem, consider the following:
- Ask your diabetes educator to review your technique.
- Consider using all the other testing sites: thigh, calf, forearm, hand, or fingertips.
- Remember that Abbott Diabetes Care Customer Service is available 24-hours a day, 7-days a week, toll-free, at 1-888-522-5226.
Important Notice: The responses provided by the team of Diabetes Educators are based on their personal experiences and expertise as practicing diabetes healthcare professionals, and are not to be considered diabetes management advice from Abbott Laboratories. Remember that information provided by the team of Diabetes Educators is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your physician about any healthcare questions you may have, especially before trying a new medication, diet, fitness program, or approach to healthcare issues.
All tradenames and trademarks not owned by Abbott Laboratories are the property of their respective owners. For details on tradenames and trademarks and their respective owners, visit the non-Abbott trademarks listing.
