Abstract:
Bodily fluid is sampled by causing a syringe mounted in a housing to be displaced toward a skin surface. A suction element disposed on the housing is utilized to creates a suction in the area to be incised causing bodily fluid to pool. Additionally, the suction mechanism may be utilized to create a suction in the tube for drawing in bodily fluid through the piercing element and into the tube. The syringe remains in the resulting incision while the surrounding body tissue is stimulated by a stimulator ring to urge bodily fluid toward the incision. Simultaneously, the syringe may be moved relative to the incision to keep the incision open. Such movement of the syringe may comprise reciprocation in the longitudinal or lateral directions, or both. Alternatively, the movement of the syringe may comprise rotation about a longitudinal center line of the syringe, with the pointed end of the syringe being in the shape of one-half of a cone segment. The suction may then be applied to the area being incised to promote further pooling of bodily fluid. After the bodily fluid has been pooled, suction may be created in a collection tube disposed in communication with the syringe, to draw bodily fluid inwardly through the syringe.

Description:
PRIOR APPLICATIONS  
       [0001]    This application claims benefit to U.S. Provisional Applications: Ser. No. 60/296,950, 60/297,045, and 60/297,098 each filed Jun. 8, 2001; No. 60/263,533 filed Jan. 22, 2001; and U.S. patent application Ser. No. 09/528,097 filed Mar. 17, 2000; US97/08401 file May 16, 1997; US97/08400 filed May 16, 1997; Ser. No. 09/887,574 filed Jun. 21, 2001; Ser. No. 09/586,969 filed Jun. 5, 2000; Ser. No. 09/180,839 filed Nov. 16, 1998; Ser. No. 09/542,040 filed Mar. 31, 2000; Ser. No. 09/567,054 filed May 8, 2000; The entireties of each of which are herein incorporated by reference. 
     
    
     
       FIELD OF THE INVENTION  
         [0002]    The present invention relates to lancing devices and methods for obtaining samples of blood and other fluids from a body for analysis or processing.  
         BACKGROUND OF THE INVENTION  
         [0003]    Many medical procedures in use today require a relatively small sample of blood, in the range of 3-50 milliliters. It is more cost effective and less traumatic to the patient to obtain such a sample by lancing or piercing the skin at a selected location, such as the finger, to enable the collection of 1 or 2 drops of blood, than by using a phlebotomist to draw a tube of venous blood. With the advent of home use tests such as self monitoring of blood glucose, there is a requirement for a simple procedure which can be performed in any setting by a person needing to test.  
           [0004]    Lancets in conventional use generally have a rigid body and a sterile needle which protrudes from one end. The lancet may be used to pierce the skin, thereby enabling the collection of a blood sample from the opening created. The blood is transferred to a test device or collection device. Blood is most commonly taken from the fingertips, where the supply is generally excellent. However, because the patient must perform multiple tests daily, the fingertips become sensitive or calloused thereby making it difficult to obtain a sample. Additionally, the nerve density in this region causes significant pain in many patients. Therefore alternate sampling sites, such as earlobes and limbs, is sometimes practiced to access a bodily fluid sample.  
           [0005]    To reduce the anxiety of piercing the skin and the associated pain, many spring loaded devices have been developed. The following two patents are representative of the devices which were developed in the 1980&#39;s for use with home diagnostic test products.  
           [0006]    U.S. Pat. No. 4,503,856, Cornell et al., describes a spring loaded lancet injector. The reusable device interfaces with a disposable lancet. The lancet holder may be latched in a retracted position. When the user contacts a release, a spring causes the lancet to pierce the skin at high speed and then retract. The speed is important to reduce the pain associated with the puncture.  
           [0007]    Levin et al. U.S. Pat. No. 4,517,978 describes a blood sampling instrument. This device, which is also spring loaded, uses a standard disposable lancet. The design enables easy and accurate positioning against a fingertip so the impact site can be readily determined. After the lancet pierces the skin, a bounce back spring retracts the lancet to a safe position within the device.  
           [0008]    In institutional settings, it is often desirable to collect the sample from the patient and then introduce the sample to a test device in a controlled fashion. Some blood glucose monitoring systems, for example, require that the blood sample be applied to a test device which is in contact with a test instrument. In such situations, bringing the finger of a patient directly to the test device poses some risk of contamination from blood of a previous patient. With such systems, particularly in hospital settings, it is common to lance a patient, collect a sample in a micropipette via capillary action and then deliver the sample from the pipette to the test device.  
           [0009]    Haynes U.S. Pat. No. 4,920,977 describes a blood collection assembly with lancet and microcollection tube. This device incorporates a lancet and collection container in a single device. The lancing and collection are two separate activities, but the device is a convenient single disposable unit for situations when sample collection prior to use is desirable. Similar devices are disclosed in Sarrine U.S. Pat. No. 4,360,016, and O&#39;Brien U.S. Pat. No. 4,924,879.  
           [0010]    Jordan et al. U.S. Pat. No. 4,850,973 and No. 4,858,607, disclose a combination device which may be alternatively used as a syringe-type injection device and a lancing device with disposable solid needle lancet, depending on configuration.  
           [0011]    Lange et al. U.S. Pat. No. 5,318,584 describes a blood lancet device for withdrawing blood for diagnostic purposes. This invention uses a rotary/sliding transmission system to reduce the pain of lancing. The puncture depth is easily and precisely adjustable by the user.  
           [0012]    Suzuki et al. U.S. Pat. No. 5,368,047, Dombrowski U.S. Pat. No. 4,654,513 and Ishibashi et al. U.S. Pat. No. 5,320,607 each describe suction-type blood samplers. These devices develop suction between the lancing site and the end of the device when the lancet holding mechanism withdraws after piercing the skin. A flexible gasket around the end of the device helps seal the end around the puncture site until adequate sample is drawn from the puncture site or the user pulls back on the device.  
           [0013]    Garcia et al. U.S. Pat. No. 4,637,403 and Haber et al. U.S. Pat. No. 5,217,480, disclose combination lancing and blood collection devices which use a diaphragm to create a vacuum over the wound site.  
           [0014]    Erickson et al. U.S. Pat. No. 5,582,184 describes a means of collecting and measuring bodily fluids. This system uses a coaxial syringe and capillary tube disposed within a spacer member. The spacer member limits the depth of syringe penetration, and compresses body tissue around the syringe while the syringe is in the skin, for improving the flow of interstitial fluid to the syringe. A suction device draws bodily fluid through the syringe and into the capillary tube.  
           [0015]    Single use devices have also been developed for single use tests, i.e. home cholesterol testing, and for institutional use to eliminate cross-patient contamination multi-patient use. Crossman et al. U.S. Pat. No. 4,869,249, and Swierczek U.S. Pat. No. 5,402,798, also disclose disposable, single use lancing devices. U.S. Pat. Nos. 5,421,816; 5,445,611; and 5,458,140 disclose, as a replacement for invasive sampling, the use of ultrasound to act as a pump for expressing interstitial fluid directly through intact (non-lanced) skin. The amount of fluid which can be obtained in that way is very limited, however.  
           [0016]    The disclosures of the above patents are incorporated herein by reference.  
           [0017]    Even with the many improvements which have been made, the pain associated with lancing remains a significant issue for many patients. The need for blood sampling and the fear of the associated pain is also a major obstacle for the millions of diagnosed diabetics, who do not adequately monitor their blood glucose due to&#39;the pain involved. Moreover, lancing to obtain a blood sample for other diagnostic applications is becoming more commonplace, and a less painful, minimally invasive device is needed to enhance those applications and make those technologies more acceptable.  
           [0018]    An object of the present invention therefore, is to provide a device and a method for obtaining a sample of bodily fluid through the skin which is virtually pain free and minimally invasive.  
           [0019]    Therefore, it is another object of the invention to provide a lancet carrier which eliminates the above-mentioned shortcomings.  
           [0020]    Another object of this invention is to provide a method which can result in a sample of either blood or interstitial fluid, depending on the sample site and the penetration depth utilized. While there are no commercially available devices utilizing interstitial fluid (ISF) at this time, there are active efforts to establish the correlation of analytes, such as glucose, in ISF compared to whole blood. If ISF could be readily obtained and correlation is established, ISF may be preferable as a sample since there is no interference of red blood cells or hematocrit adjustment required.  
           [0021]    Another object of this invention is to provide a method which can draw a small but adjustable sample, i.e. 3 microliters for one test device and 8 microliters for another test device, as appropriate.  
           [0022]    Another object of this invention is to provide a method by which the drawn sample is collected and may be easily presented to a testing device, regardless of the location of the sample site on the body. This approach helps with infection control in that multiple patients are not brought in contact with a single test instrument; only the sampling device with a disposable patient-contact portion is brought to the test instrument. Alternatively, the disposable portion of a test device may be physically coupled with the sampler so the sample can be brought directly into the test device during sampling. The test device may then be read in a test instrument if appropriate or the testing system can be integrated into the sampler and the test device can provide direct results displayed for the patient.  
           [0023]    It is a further object of the invention is to provide a device for minimally invasive sampling comprising a reusable sampler and disposable sample collection.  
           [0024]    Yet another object of the present invention is to provide a method of increasing the amount of bodily fluid available for sampling.  
         SUMMARY OF THE INVENTION  
         [0025]    These and other objects are achieved by the present invention, one aspect of which relates to a method for sampling blood comprising the steps of placing a forward end of a housing against a skin surface, advancing a hollow piercing element forwardly to cut an incision through the skin surface, and depressing a ring of body tissue in surrounding relationship to the incision to spread apart sides of the incision while urging bodily fluid toward and into the incision. Simultaneously, the piercing element is moved within the incision to keep the incision open. A suction may be applied to the skin to aid the pooling of bodily fluid in the area of the incision. Additionally, a suction may be applied to the piercing element to draw in bodily fluid from the incision and into a tube communicating with the piercing element.  
           [0026]    Another aspect of the present invention relates to a sampling device for sampling bodily fluid. The sampling device comprises a housing, a piercing element carrier mounted in the housing and carrying a hollow piercing element. A tube communicates with the piercing element. A driver mechanism mounted in the housing drives the syringe carrier forwardly to cut an incision in the skin and maintain and end of the piercing element in the incision. A stimulator mechanism disposed on the housing depresses a ring of body tissue in surrounding relationship to the incision to spread apart sides of the incision while urging bodily fluid toward the incision. A syringe-moving mechanism disposed on the housing moves the end of the piercing element relative to the incision to maintain the incision open while the stimulator mechanism urges bodily fluid thereto. A suction mechanism disposed on the housing creates a suction to cause bodily fluid to pool in the area to be incised, as will be described in greater detail below. Additionally, the suction element may be applied to the tube and utilized for drawing in bodily fluid through the piercing element and into the tube.  
           [0027]    Still another aspect of the invention relates to a device for obtaining a sampling of a bodily fluid through the skin comprising a housing member containing a hollow piercing element for piercing the skin. A first spring member disposed in the housing urges the piercing element to protrude from a forward end of the housing sufficient to cut an incision through the skin. A stop member defines a maximum penetration depth of the piercing element. A second spring disposed in the housing partially retracts the piercing element while maintaining a front end of the piercing element in the incision. A tube communicates with a rear end of the piercing element. A suction mechanism creates a suction in the tube for drawing in bodily fluid through the piercing element.  
       
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0028]    The objects and advantages of the invention will become apparent from the following detailed description of preferred embodiments thereof in connection with the accompanying drawings in which like numerals designate like elements and in which:  
         [0029]    [0029]FIG. 1 is a longitudinal sectional view taken through a sampling device according to the present invention, with a syringe thereof in an armed state;  
         [0030]    [0030]FIG. 2 is a view similar to FIG. 1 after the syringe has been triggered and forms an incision in a skin surface;  
         [0031]    [0031]FIG. 3 is a view similar to FIG. 2 after a suction mechanism has been actuated to draw in bodily fluid through the syringe;  
         [0032]    [0032]FIG. 3A is a sectional view taken along the line  3 A- 3 A in FIG. 3;  
         [0033]    [0033]FIG. 4 is a schematic view of a syringe being reciprocated longitudinally within an incision according to the present invention;  
         [0034]    [0034]FIG. 5 is a schematic view of a syringe being reciprocated laterally within an incision according to the present invention;  
         [0035]    [0035]FIG. 6 is a schematic view of a syringe being oscillated in an elliptical direction according to the present invention;  
         [0036]    [0036]FIG. 7 is a schematic view of a syringe being rotated within an incision according to the present invention;  
         [0037]    [0037]FIG. 8 is a longitudinal sectional view of a lower portion of a modified sampling device according to the present invention, with a syringe disposed in a retracted state;  
         [0038]    [0038]FIG. 9 is a view similar to FIG. 8 after the syringe has been urged forwardly;  
         [0039]    [0039]FIG. 10 is a side elevational view of a lower end of a syringe having a stop member fixed thereto according to the present invention; and  
         [0040]    [0040]FIG. 11 is a sectional view taken along the line  11 - 11  in FIG. 10;  
         [0041]    [0041]FIG. 12 is a top view of a integrated testing/lancing apparatus according to one embodiment of the present invention;  
         [0042]    [0042]FIG. 13 is a cross-sectional side view illustrating an integrated lancet and test strip holder according to the present invention; and  
         [0043]    [0043]FIG. 14 is a side view illustrating the anti-coring needle in accordance with a lancing device of the present invention.  
     
    
     DESCRIPTION OF PREFERRED EMBODIMENTS  
       [0044]    For the purposes of promoting an understanding of the principles of the invention, reference will now be made to the embodiments illustrated and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended, such alterations, modifications, and further applications of the principles of the invention being contemplated as would normally occur to one skilled in the art to which the invention relates.  
         [0045]    Depicted in FIGS. 1-3 is a bodily fluid sampling device  10  comprising an outer cylindrical housing  12 . Screwed into an upper end of the housing  12  is a fixing sleeve  14  in which are formed upper and lower recesses  16 ,  18 . The upper recess  16  has an internal screw thread connected to an externally threaded stop ring  20  which can be adjusted to a selected vertical position relative to the housing.  
         [0046]    Slidably disposed for longitudinal movement within the fixing sleeve  14  is a hollow drive rod  22 . Screwed onto a lower end of the drive rod  22  is a syringe carrier  24 . Mounted in a lower end of the carrier  24  is a syringe  26  of the type which includes a longitudinal capillary passage  28  (see FIG. 4). That passage is preferably offset laterally with respect to a center axis of the syringe. In lieu of a syringe, any suitable type of hollow piercing element can be employed, such as a needle or sharp cannula, for example. An upper end of the syringe communicates with a sampling tube  30 , an upper end of the tube fitting into a lower recess  32  formed in the drive rod  22 .  
         [0047]    Intermediate its upper and lower ends, the drive rod  22  includes a radial enlargement  33  in which an outwardly open, annular groove  34  is formed that is sized to receive a pin  36  of a first trigger  38 .  
         [0048]    Slidably mounted within the sampling tube  30  is a plunger  40  having a soft tip  42  that snugly (sealingly) engages an inner surface of the tube  30 . An upper end of the plunger  40  is fixed to the lower end of a drawbar  46  which slides within a center bore of the drive rod  22 .  
         [0049]    Screwed to an upper end of the drive rod  22  is a mounting sleeve  48  in which a second trigger  50  is mounted for lateral sliding movement. Formed in the second trigger  50  is a center hole  52  that is larger than the outer diameter of the drawbar  46 . The drawbar  46  has a recess  54  sized to receive respective sides of the hole  52 .  
         [0050]    A drive spring  56  in the form of a coil compression spring acts between the enlargement  33  and the fixing sleeve  14 . Resting on the fixing sleeve  14  is a retraction spring  58  in the form of a coil compression spring. Acting between the enlargement  33  and the top of the plunger  40  is a suction spring  60  in the form of a coil compression spring.  
         [0051]    Mounted on the syringe carrier  24  is a piezoelectric transducer  66  which is electrically connected to a battery  68 . Piezoelectric transducers are conventional types of vibrators which can be oriented to produce vibrations in any desired direction. A lower end of the piezoelectric transducer  66  is in contact with the syringe for vibrating the syringe, i.e., either vertically (longitudinally), laterally, or elliptically (a combination of vertical and lateral vibrations).  
         [0052]    Disposed at a lower end of the housing  12  is a stimulator sleeve  70 . That sleeve has an annular lower face  72  of frusto-conical shape, and is screwed into a sleeve carrier  74 . Projecting from diametrically opposite positions of the sleeve carrier  74  are pins  76  which are slidably disposed in respective vertical slots  78  formed in the housing  12 .  
         [0053]    Rotatably mounted on diametrically opposite sides of the housing  12  are a pair of identical drive gears  80  (see also FIG. 3A). Formed in an inner surface of each drive gear  80  is a cam groove  82  in which a respective pin  76  projects. Mounted above the drive gear for rotation about a central longitudinal axis of the housing is a ring gear  84  which is rotated by an output pinion  86  of an electric motor  88 . The underside of the ring gear  84  is formed with teeth that mesh with teeth formed around the outer peripheries of the drive gears  80 . Therefore, rotation of the pinion gear  86  is transmitted to the drive gears  80  to rotate the drive gears. The accompanying rotation of the eccentric grooves  82  of the drive gears causes the pins  76 , and thus the sleeve carrier  74 , to reciprocate vertically, along with the stimulator sleeve.  
         [0054]    The operation of the sampling device  10  will now be explained. To arm the device, the mounting sleeve  48  is pulled upwardly by a user until a beveled face  90  of the enlargement  33  of the drive rod  22  cams the first trigger  38  laterally outwardly. When the groove  34  of the enlargement becomes aligned with the cammed-out first trigger  38 , the first trigger is urged inwardly by a spring (not shown) to insert the pin  36  into the groove  34  for retaining the drive rod  22  in the armed state (FIG. 1). Simultaneously, the drive spring  56  is compressed from a relaxed state, and the syringe carrier  24 , together with the syringe  26 , is raised. The drawbar  46  is retained by the second trigger  50 , with the suction spring  60  disposed in a compressed state.  
         [0055]    The lower end  72  of the housing  12  is placed against the skin surface S, preferably at a portion of the body having fewer nerve endings than, say the fingertip. A forearm would be a suitable location. Suction may be applied to the skin surface S at this time. The suction may be applied and held, or applied and released prior to the syringe cutting the skin. The trigger  38  is then pulled out against a spring bias to release the drive rod  22  and the compressed drive spring  56 . As a result, the drive rod  22 , the syringe carrier  24 , and syringe  26  are driven downwardly, so that the syringe cuts an incision I through the skin surface S, as shown in FIG. 2.  
         [0056]    During downward movement of the drive rod  22 , the mounting sleeve  48  engages an upper end of the retraction spring  58  and then abuts the stop ring  20 , thereby limiting the incision depth and slightly compressing the retraction spring  58 . The retraction spring  58  then moves the drive rod  22  slightly upwardly, but not enough to completely remove the syringe  26  from the incision I. Then, the motor  88  is actuated, either manually, or automatically in response to the firing of the syringe, to vertically reciprocate the stimulator sleeve  70 . Consequently, the lower face  72  repeatedly depresses a ring of skin and body tissue which surrounds the incision. Each depression of that ring causes the incision to bulge and the sides of the incision to be spread apart, and urges bodily fluid such as blood or interstitial fluid toward and outwardly through the incision I, as explained also in commonly assigned U.S Pat. Nos. 5,879,311, and 5,591,493.  
         [0057]    In order to enable the inwardly urged bodily fluid to pool at the incision (for subsequent sampling), the syringe  26  is vibrated relatively slowly by the piezoelectric transducer  66  to keep the incision open. As noted earlier, the direction of vibration can be determined by the particular orientation of the transducer  66 . In one embodiment, the direction of vibration is longitudinal or vertical (FIG. 4); in another embodiment the vibration is lateral (FIG. 5); in another embodiment the vibration is a combination of lateral and vertical, i.e., generally elliptical oscillation (FIG. 6).  
         [0058]    It will be appreciated that if the syringe were not moved within the incision, the presence of a stationary syringe within the incision could result in a closing of the incision by collagen in the skin, whereby bodily fluid could not pool at the incision.  
         [0059]    After a short period, sufficient to allow an ample amount of bodily fluid to pool at the incision, the second trigger  50  is manually actuated to release the drawbar  46 , causing the spring  60  to raise the plunger  40  within the tube  30 . That produces a suction in the tube  30  below the plunger  40 , which draws in a sample  91  of bodily fluid through the syringe  26  (FIG. 3).  
         [0060]    Then, the device can be removed from the skin, and the sample delivered to a suitable test site. Alternatively, the device may contain a test device in conjunction with the sampling device described above. Suitable test devices which may be incorporated with the sampler described above are shown and described in co-pending U.S. patent application No. (Insert)  
         [0061]    As an alternative to the reciprocation of the syringe, the syringe can be rotated about its own center axis while disposed in the incision I. In that regard, a rotatable syringe  92  as shown in FIG. 7 can be utilized in a device  10 ′ shown in FIGS. 8 and 9. That device  10 ′ is similar to that depicted in FIGS. 1-3 with the addition of a rotary gear  94  that is driven by a pinion  95  of a second motor  96 . The gear  94  includes an upwardly open recess  98  sized to receive, with a snug fit, a lower end  100  of the tube  30  in which the syringe  92  is disposed. Thus, when the syringe carrier  24 ′ is driven toward the skin, the lower portion  100  of the tube  30  enters the recess  98  to create a frictional engagement between the tube  30  and the gear  94  (see FIG. 9). By then rotating the pinion  95 , the gear  94 , the tube  30 , and the syringe  92  are rotated relative to the carrier  24 ′ about an axis coinciding with a center axis of the syringe  92 . The syringe  92  includes a pointed end  102  in the form of one-half of a cone. As the syringe rotates about its own axis, the semi-conical segment  102  cuts a conical recess  104  in the incision and keeps the incision open as the stimulator sleeve  70  reciprocates.  
         [0062]    Any of the syringes described thus far can be provided with a stop which would replace the stop ring  20 . Such a stop  110  is shown in FIGS. 10 and 11 in connection with the syringe  92 . The stop  110  comprises a disc fixed to the syringe. When the disc contacts the skin surface, no further entry of the syringe into the skin can occur. The stop ring  20  could also be used to open and close the incision to promote bodily fluid pooling.  
         [0063]    It will be appreciated that the present invention minimizes the pain experienced by a user, because it can be used to provide a sample of bodily fluid at an area of the body which contains fewer nerve endings than in an area such as the finger tips. By stimulating the body tissue surrounding the incision, while moving the syringe relative to the incision, bodily fluid is caused to pool in the incision, thereby providing an ample sample to be sucked through the syringe and into a collection tube. Thus, an area of the body less sensitive to pain can be used as a source of bodily fluid.  
         [0064]    Although the stimulator member  70  is disclosed as having a generally annular skin contacting surface, i.e., a surface which is symmetric about the center axis thereof, the member  70  could instead have an elliptical or polygonal end face whereby the ring of body tissue depressed thereby would have a corresponding shape.  
         [0065]    An alternative method according to the present invention includes the use of a suction device prior to use of the lancing device. The lower end of the housing  12  is placed against the skin surface S, preferably at a portion of the body where the sample is to be taken from. For example, a forearm would be a suitable location. A vacuum source is activated whereupon the skin S adjacent the lower end of the housing  12  is drawn into the frusto-conical shaped distal tip. The suction causes bodily fluid beneath the skin to pool in the area of skin S in contact with the testing device  10 . The vacuum is released thereby releasing the skin. The trigger  38  is then pulled out against a spring bias to release the drive rod  22  and the compressed drive spring  56 . As a result, the drive rod  22 , the syringe carrier  24 , and syringe  26  are driven downwardly, so that he syringe cuts an incision I through the skin surface S. During the downward movement of the drive rod  22 , the mounting sleeve  48  engages an upper end of the retraction spring  58  and then abuts the stop ring  20 , thereby limiting the incision depth and slightly compressing the retraction spring  58 . The retraction spring  58  then moves the drive rod  22  slightly upwardly, but not enough to completely remove the syringe  26  from the incision I. Then, the motor  88  is actuated, either manually, or automatically in response to the firing of the syringe, to vertically reciprocate the stimulator sleeve  70 . Consequently, the lower face  72  repeatably depresses a ring of skin and body tissue which surrounds the incision. The depression of the ring causes the skin adjacent the incision to bulge and the sides of the incision spread apart, such that bodily fluid is urged from the incision in response to the applied force.  
         [0066]    After a short period, sufficient to allow an ample amount of bodily fluid to pool at the incision, the second trigger  50  is manually actuate to release the drawbar  46 , causing the spring  60  to raise the plunger  40  within the tube  30 . This produces suction in the tube  30  below the plunger  40 , which draws in a sample  91  of bodily fluid through the syringe. The sample may then be delivered to an appropriate test media or testing device as described above.  
         [0067]    Additionally, as described above, the vacuum may be repeatedly applied to the skin prior to deployment of the needle to form the incision I. By repeatably applying a vacuum source to the skin S this encourages bodily fluid to pool in the location adjacent to where the incision is to be made. Because bodily fluid is pooled in this area prior to formation of the incision I, once the incision I is formed the a sample is bodily fluid is easily collected because of the large volume of fluid available within the area.  
         [0068]    It is further contemplated that the vacuum mechanism may be activated after the incision is formed to further express fluid from the incision. In addition to the vacuum source, it is also contemplated that a vibratory force, a heat force, and/or an ultrasonic force may be applied to the area to be lanced to further the expression of bodily fluid. Additionally, the vacuum may be repeatedly applied to the skin after the formation of incision I. Repeated application of a vacuum after the incision is formed encourages bodily fluid to continue to pool in the area adjacent to the incision, thereby aiding collection of the bodily fluid.  
         [0069]    Referring now to FIG. 12 there is shown yet another alternative embodiment of the present invention. As shown in FIG. 12 the test device  100  comprises a main body  120 , a test strip holder/tip assembly  130 , and a lancing device  150 . The functions of the testing device  100  are similar to that as described above with reference to testing device  10 . The testing device  100  is prepared for use by first inserting a disposable lancet/test strip holder and test strip into the lancing device  150 . The lancing device  150  is then prepared for use by pulling up on a driving mechanism (not shown) thereby compressing a driving spring (not shown). The device  100  is placed over an area to be lanced, wherein a vacuum mechanism disposed within the main body  120  and in communication with the tip assembly  130  is then activated. Skin S is drawn into the distal end of the device  100 . The vacuum mechanism may then be deactivated thereby releasing the vacuum force on the skin, or repeatedly activated and deactivated.  
         [0070]    After the vacuum device has been utilized, device  100  releases the driving spring, wherein a lancet is advanced through the patient&#39;s skin to form an incision I therein. The lancet may then be retracted from the incision I. Alternatively, it may be desirable to leave the lancet within or directly adjacent the incision for the reasons described above. Additionally, the vacuum device may be activated, activated and deactivated, or repeatedly activated and deactivated after forming the incision. Furthermore, a vibratory force may be applied to the lancet, the vibratory force may be applied vertically, horizontally, or any combination thereof.  
         [0071]    A sample of bodily fluid may then be withdrawn from the incision and transported to a test area. The sample may be withdrawn from the incision through a capillary tube having one end disposed within the end of the test device  100  and the other end in communication with a chemical pad of a test strip and or electrochemical measuring device. Alternatively, the test strip may include capillary means such as a capillary tube or a cascading capillary. In yet another alternative embodiment, the test strip may be disposed adjacent to the distal end of the testing device wherein the lancet passes through an aperture in the test strip. The test strip may further include a gasket and/or a deep dermal constriction device. Furthermore, by placing the strip against the patient&#39;s skin and lancing there through this eliminates the need for a capillary to transport the bodily fluid from the incision to the test strip. This may lead to shorter sample times and/or lessen the likelihood of a failed test due to inadequate sample delivery.  
         [0072]    In yet an additional alternative embodiment as shown in FIGS. 13 and 14, the test device  200  may include a test strip (not pictured) and lancet  220  which may be formed as an integrated unit. The lancet  220  may be embodied in the form of an anti-coring needle having a pre-bent radius of curvature R and a fluid inlet  223  such as that described in co-pending provisional patent application No. 60/297,098 filed on Jun. 8, 2001, the entirety of which is herein incorporated by reference. In this embodiment, the test device is placed over the area to be lanced, a vacuum is drawn on the skin thereby increasing the amount of bodily fluid adjacent the test device. The vacuum is release and the lancet is advanced thereby forming an incision within the patient&#39;s skin. Bodily fluid may then be withdrawn from the incision. The bodily fluid is then collected using one of the devices described above. After a sufficiently sized sample has been collected, the test device may be removed from the patient&#39;s skin, this may be prompted by a audible and/or visual marker. The test device will then deliver to the patient a visual indication of the test results.  
         [0073]    While the invention has been illustrated and described in detail in the drawings and foregoing description, the same is to be considered as illustrative and not restrictive in character, it being understood that only the preferred embodiment has been shown and described and that all changes and modifications that come within the spirit of the invention are desired to be protected.