939-528 201301A ABL800 FLEX Operator Training Guide_en_low
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Transcript of 939-528 201301A ABL800 FLEX Operator Training Guide_en_low
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Operator Training Guide
ABL800 FLEX analyser
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Index
1. What is What? 3
2. Syringe samples - Preanalytical errors 4 - 5
3. Syringe samples How to measure a patient sample 6 - 8
4. Syringe Samples Using FLEX Q Module 9
5. Capillary samples - Preanalytical errors 10 - 11
6. Capillary samples How to measure a patient sample 12 - 13
7. General information 14
8. Radiometer apps 15
Disclaimer: This workbook is for UK and Ireland use only
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Introduction - What is what?
Identify components of the analyzer
Touch screen
Thermal printer
Left cover
Waste container
Rinse solution
FLEXQ module
Barcode reader
AutoCheckmodule
Cal 1 solution Cal 2 solution
Cleaning Solution
Right cover
Syringe inlet
Capillary inlet
Cover with window
The parts and components of the analyser's rear panel
Screen, rear
Communication portsPower switchFan
Gas cylinders
3
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Syringe samples - Preanalytical errorsSample collection and handling CPA B9.7 (c)
1. Ensure you have the appropriate patient information Prevents mix-up or loss of samples
Avoids re-bleeding of patients
Prevents wrong treatment
Facilitate cross-charging
Avoids litigation
2. Use appropriate pre-heparinized sampler with dry electrolyte-balanced heparin Slows the clotting process
Different types of heparin:
Dry/Liquid/Balanced/Non-balanced
Dry electrolyte-balanced heparin (Na+, K+, Ca2+)
Heparin is the only anticoagulant recommended by
Radiometer
3. Collect the correct volume of blood Too much = increased risk of clotting
Too little = possible heparin binding effect
(may cause lower Ca2+ value)
Flush solutions used in A-lines must be removed
completely from the system to avoid dilution of
blood samples
It is recommended to withdraw a volume equal to
three to six times the dead space of the catheter
system (NCCLS)
4
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Syringe samples - Preanalytical errorsSample collection and handling CPA B9.7 (c)
4. Expel all air bubbles Through the vented safeTipCap
Air bubbles can falsely affect O2 and CO2 values
Cap syringe to avoid contact with air
STOP - Demo expelling air bubbles from syringe
5. Mix the sample manually or use the (FLEX Q Module) Invert the syringe 10-15 times
Roll between your fingers, not the palms of your hands
Use the FLEX Q Module
Reduce sedimentation
Haemolysis causes K+ and Ca2+
Be aware of possible mixtures of venous and arterial
blood
If a self-filling syringe does not fill quickly, it may be
because a vein (with a lower pressure) has been hit
In that case, a new sample should be taken
6. Analyse quickly the sample is still metabolising! Top Tip! The blood is still metabolising! The sample
continues to metabolise causing the following effects
pO2 since O2 will still be consumed
pCO2 since CO2 will still be produced
pH due to change in CO2 and glycosis
cCa2+ the change in pH will influence the binding of Ca2+ to protein
cGlu since glucose will be metabolised
cLac due to glycosis
5
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Syringe samples How to measure a patient sample?
STOP Demo the next 7 steps in order
1. Enter or scan logon barcode Sharing barcodes
Accountability and traceability
Operator records kept for 7 years for adults and 25yrs for children
2. Check the top left corner of the screen to ensure Ready mode The analyzer will always tell you what it is doing, e.g. QC measurement
6
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Syringe samples How to measure a patient sample
3. Introducing the sample
Place the syringe tip firmly in the inlet as shown. safePICO sampler: Do not remove the safeTipCap
Follow manufacturers guidelines for minimum volume of blood required in a syringe or blood collection tube (usually 0.7ml to 1.5ml)
Select the desired mode by pressing the appropriate button (your analyser will be set with the appropriate modes for your working area)
Select the start button that matches the sampler in use
If using test tube Hold at the syringe inlet. Press the start button
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4. Enter appropriate patient information Mandatory fields
What happens if you do not fill them in?
5. View results (on-screen, printout and Clinical Information System) Critical limits
Error messages and symbols
? = Error
Reference ranges
Review printout
6. Documentation and reporting of results - CPA B9.7 (i) Patient results log Result retrieval
Filtering results (if required)
Trend facility (if required)
Acid-Base chart
7. Log off the analyser What happens if you do not do it?
STOP Each trainee requiring assessment should repeat
these 7 steps as a practical exercise
Critical limit Critical limit
High parameter
value
Low parameter value
Range of indication
Reportable range
Critical range
Reference range
(no marking)
8
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9Syringe Samples Using FLEX Q Module
Place the sampler in a slot in the tray. A short
beep indicates the barcode has been accepted
The available measuring modes are shown; the
selected mode is highlighted
Press Proceed
Enter, if required, additional patient data or
mandatory data
Press Accept to accept all the data (patient data, measuring
mode, selected parameters, layout, etc.)
Remember to take the registration receipt printed out on the
analysers printer. If the analyser is not transmitting the results
this will allow you to return later and safely retrieve the patient
results from the analyser.
When the result is ready, it will be automatically transmitted to its
destination (usually via RADIANCE or AQURE).
The destination could be any data system examples being:
LIS Laboratory Information System
HIS Hospital Information System
CIS Clinical Information System
EPR Electronic Patient Records
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Capillary samples - Preanalytical errorsSample collection and handling CPA B9.7 (c)
1. Ensure you have the appropriate patient information Prevents mix-up or loss of samples Avoids re-bleeding of patients Prevents wrong treatment Facilitates cross-charging Avoids litigation
2. Use appropriate pre-heparinized 70 L capillary Slows the clotting process
For FBS (Fetal Blood Samples) samples always use a dedicated sampling pack e.g. Rocket Medical packs
Top Tip! Always collect everything you need before you start (70 L capillary, two end caps, magnetic wire, magnetic mixer and an ABL90 FLEX clot catcher)
3. Sample volumes of blood
FLEX ModeThis mode allows you to analyse a blood sample of 35 L and higher up to the maximum volume accepted by your analyser. Depending on the available sample volume, the FLEXMODE provides the highest number of parameters: from all available to as many as reliably possible.
Volume Range Parameters
30-40l pH/OXI
40-55l - 55l pH/OXI/ctBil
50-70l pH/OXI/BG
60-100l - 95l pH/OXI/ctBil/BG/Met
>90l - 95l pH/OXI/ctBil/BG/Met/Lyt
Measuring Modes
Volume Range Parameters
33 l OXi/ctBil
35 l Met
55 l pH/OXi/ctBil
95 l pH/OXI/ctBil/BG/Met
125l pH/OXI/ctBil/BG/Met/Lyt/Crea
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11
NOTE:
If FLEX mode is used then Bilirubin will NOT be measured
If the analyser measures creatinine then FLEX mode is not an option
On a creatinine analyser 125 l or 35 l capillary tubes are the only
volumes that can be used
125 l will give results for all parameters
On all models of analyser a 35l capillary tube can be used to measure just
Glucose and Lactate
4. Check that the sample is free of air bubbles Air bubbles can falsely affect O2 and CO2 values
Do not measure samples that contain air bubbles, re-sample
the patient
5. Insert the mixing wire and cap both ends of the capillary Mix GENTLY with the mixing wire and magnet
10-15 strokes running the mixing wire from end to end
This is thronly way to effectively mix blood and heparin within the capillary
STOP Demo how to mix a capillary sample
Top Tip! Mix gently to avoid haemolysis of the sample
Capillary samples - Preanalytical errors continuedSample collection and handling CPA B9.7 (c)
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12
Capillary samples How to measure a patient sample?
STOP Demo the next 8 steps in order
1. Enter or scan logon barcode Sharing barcodes
Accountability and traceability
Operator records kept for 7 years for adults and up to 25 years for children
2. Check the top left corner of the screen to ensure Ready mode The analyser will always tell you what it is doing, e.g. QC measurement
3. Introducing the sample Remove end caps and attach ABL800 clot catcher
Open the inlet flap for capillary tubes
Place the capillary in the inlet as shown
Select the desired mode by pressing the appropriate button
Press the Start button
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13
Capillary samples How to measure a patient sample? continued
4. Enter appropriate patient information Mandatory fields
What happens if you do not fill them in?
Results will be recorded but not visible or retrievable without advanced
user access
5. View results (on-screen, printout and CIS) Critical limits
Error messages and symbols
? = Error
Reference ranges
Review printout
6. Documentation and reporting of results - CPA B9.7 (i)Patient results log
Result retrieval
Filtering results (if required)
Trend facility (if required)
Acid-Base chart
7. Log off the analyser What happens if you do not do it?
STOP Each trainee requiring assessment should repeat these 8 steps
as a practical exercise
Reportable range
Range of indication
(no marking)
Critical limit Critical limit
Lowparametervalue
Highparameter
value
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14
General information
Changing printer paper Follow on-board tutorial or use instructions on outside of the printer cover
STOP Demo how to change printer paper
Cleaning the analyser Remember to clean the inlet and the FLEX Q Module
ComplianceInfection Control - CPA B9.7 (f)
Always comply with hospital guidelines regarding collection, handling
and disposal of blood
Password expiry why do we have it?
CPA B9.8 - On-going competency testing
What is hospital policy?
Who is your first point of contact?
Laboratory/POC
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Other
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Disclaimer: This workbook is for use in UK and Ireland only
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Radiometer apps
Blood GasHandbook
c
Radiometer's Blood Gas handbookThe blood gas handbook is now available foriPhone, iPad, Android and Windows Phone
15
FIND OUT MORE ABOUT PREANALYTICAL ERRORS IN BLOOD GAS TESTING
All-in-one app with tips on how to avoid errors, troubleshooting and skill test.
Blood Gas - Preanalytics
c
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Notes
Radiometer's Blood Gas handbookThe blood gas handbook is now available foriPhone, iPad, Android and Windows Phone
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Notes
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Notes
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Radiometer Limited, Manor Court, Manor Royal, Crawley, United Kingdom 2013. All Rights Reserved. 939-528. 201301A.
www.radiometer.co.uk