Lactate Sampling Tips You Wish You Knew Sooner!

So today we're going to talk about best practices in how to take lactate samples. This video is all about the tricks and tips you need to know in order to get really accurate and fast and clean and smooth lactate samples. So let's get straight into that. So let's start with gloves. First thing you should have is some gloves for your hand for your own protection. One of the mistakes with a gloves is that many people try to breathe into them in order to open them up.

You should not do that because the air that you exhale is saturated with water and therefore it makes actually makes it much more difficult to put the gloves on. What you can do is you can put a little bit of air into them and then just squeeze them or just shake them and then it's much easier to put them on. The next piece out of your kit for lactate testing we should be talking about is lanc sets.

Most people use these automatic security lancets. Those are great in terms of they're very secure. There's pretty much foolproof how to use them. The only downside is that those lancets have been developed primarily with glucose testing in mind for people with type 1 or type two diabetes. And the difference here is that for this use case, you normally only need one drop of blood for one single sample. The difference to what you are doing in exercise testing is you need several lactate samples throughout a whole exercise performance testing.

And so the hole, the opening in the skin that these automatic lancets are causing is relatively small. And they also have a very small needle because they can be used on the finger. So, this is more for one-time use. If you use those for lactate testing in exercise physiology, you will likely end up with a problem that you need to prick your athlete or client several times, which is really uncomfortable and disturbs the workflow.

The better choice is to use these manual one-time non-automated L sets because those make bigger openings and therefore you just need to prick your client or athlete normally once for the whole testing. So the next step is going to be pricking your athlete or client. We use the earlobe over the finger. Why do we use the earlobe? There's several reasons. One thing is it's often easier to access during exercise. The second thing is, it's just more convenient, because, you know, there might be some pain in the finger after you pricked it. And obviously you need, or the athlete or the client needs, the finger in day-to-day tasks, and that's not really the case with the earlobe.

The main reason however is that you get more accurate readings from the earlobe and this is of pinnacle importance to us accuracy. Why is that? First, it's easier to keep it clean, right? It's a finger, especially in cycling, but also in running. Think about other exercises like rowing or canoeing or whatever. The hands are involved often, right? Grabbing the handlebar, grabbing the handle, grabbing the pedal, whatever it is. And because they are involved in the actual movement in some one way or the other, you also have the problem that you can measure local blood flow restriction.

What I mean with that is that when an athlete, for example at the end of a test when the intensity is really hard, so at an all-out effort, strenuous exercise, an athlete might grab, for example, the handlebar very tight on the bike, or the shaft on a pedal. Or even in running, people might have really, like, you know, cramped and contracted hands, and this restricts the local blood flow. And then when you measure lactate in that situation, immediately after the exercise, you can measure slightly increased values, not because of the exercise intensity, but just because of the local blood flow restriction.

Okay. So science tells us that there's a difference between measuring at the finger and measuring at the earlobe and earlobe is a preferred way to do it. It's more convenient. It's easier to do. You get more accurate results. So before you prick the finger or in the preferred case the earlobe, you need to clean the skin. Alcohol swabs will do. You can either use one time alcohol swabs. I prefer having, you know, a big bottle of alcohol or some cleaning solution.

And you just need some normal paper towels and clean the earlobe really nicely and make it really clean. It's not like you can do too much of that. Okay. Next important thing is opening these manual lancets. So, these lancets are sterile, which means that there's no germs, no bacteria on it. And it's important to keep them sterile as long as possible. You want to hold them against the light so you can see the where the sharp end is.

And then open them so that the sharp end stays inside the paper for as long as possible and therefore stays sterile. Okay. Now, we are going to show you how to prick the earlobe. Take out the lancet. Don't touch it obviously. Right. When we want to prick the ear, we want to find a point which is the lowest point of the earlobe. Don't prick on the front end. Don't prick on the back end of the ear.

Right? The lowest point and just really down here. And there's one technique that's very important to learn not only for pricking the ear, but also for taking the lactate afterwards. And this is forming a triangle with your pointer finger and your thumb on the one hand. This goes on the upper part of the earlobe and then the middle finger of the other hand. You can see I hold the lancet. I still keep it sterile.

I don't touch it. And with that triangle I can grab the part of the earlobe which I want to prick. The biggest issue that with pricking is people are too careful. Taking lactate samples is not painful for the athlete or the client. What is painful is making squeezing which is a result of a not good enough opening. And the way how you get a good enough opening is forming this triangle squeezing a little bit.

So apply a little bit of pressure and then go all in with the lancet. There's no rush. Take it easy and release. When you're using manual lancets like shown here and like recommended, it's best practice you would have a sharp container to put in your used lancets. You can just order them online for a couple of bucks. It's not a big deal and they are large enough to store, I would argue, lancets for a lifetime.

If you're using handheld lactate meter like the lactate plus from Nova shown here, then you want to grab one of the strips and insert it with the sensor end, not the end that takes actually the blood sample. Okay? And in most of the meters like here in the lactate plus it will just turn on the device and it will be ready to take the blood sample. Now taking the lactate sample, the first thing that you need to do is you need to clean the earlobe.

It needs to be dry for example when you do test and swimming but especially it needs to be dry from sweat. So you first need to clean it again. You don't need alcohol swabs for that. Normal cotton swabs will do. Okay. But it needs to be dry and clean. And you need to make sure that there's no you know dried blood on the earlobe or other old blood that could you know actually clock your sensor.

Okay. Now in order to take the lactate samples you do what we just explained with pricking the ear. You form the triangle thumbs and pointer finger on the one hand and pointer finger or middle finger of the other hand. What is important and really helpful is to have your hand rest on the subject on the shoulder wherever to improve stability holding the lactate meter. Right? When I try to hold it free it's much more difficult to keep it stable.

So, I really want to lean onto the subject here in order to stabilize. Then form the triangle, squeeze a little bit, get the blood drop, release, and then take all the time that you need to get the blood onto the strip without touching the skin. In case you're using a tabletop lactate meter like the EKF Biosin Cine, then you will need to use glass capillaries like these ones. There are other types end to ends like this one.

There are some that you need to break whatever. What is important? There are few things that you need to take into account when using these glass capillaries. Okay. So, we start with taking the blood. You need to be even better with taking the blood samples in terms of forming the triangle because you need a little bit more blood. Normally 20 microL compared to a handheld device. So you take the blood and then what you want to do is you want to hold the capillary horizontal or pointing downwards when you take the blood.

Okay? But as soon as you stop you want to tilt it in this direction because otherwise you might get gaps into that. So you have air bubbles in it and then it's not accurate because the assumption is that you get exactly 20 microL of blood volume into these capillaries. And that's also why if you see a little bit of extra blood on the end, you want to clean that off before you use it. So once you have your capillary ready with the blood, you need to insert it in one of these tubes.

And when you do so before opening, ensure there is no liquid on the top end of the tube because it might spill out when you open it and you don't want that. You open it carefully. You insert the capillary with the blood, close it and shake it. There are professional shakers, shaking devices which is recommended. And if you don't have that, then shake at least for 20 seconds. There's one little trick here. When you have a subject or a client who is bleeding a lot, then what you can do is you can take a one of your cotton swabs and tear off a little piece.

Use a triangle again to get a little drop of blood and press this piece of the cotton swab against it and it will hold and therefore stop the bleeding and it will also not clock the opening until the next lactate sibling. Heat. Hey, Heat. Hey, hey, hey. Hey, hey, hey.