Policy No.: 12.12 Page No.: 1 of 6Originated: 8/95Revised: 07/11

TITLE: PROCEDURE FOR PERFORMING QUALITY CONTROLS AND OBTAINING OXYGEN SATURATIONS USING THE AVOXIMETER 1000 or 1000E WHOLE BLOOD OXIMETER

PURPOSE: To provide instruction for performing the measurement for oxyhemoglobin saturation (%HbO2) and the total hemoglobin concentration (THb) on the Avoximeter 1000 and 1000E in the Cardiac Catheterization Laboratory

SCOPE: Registered Nurses and Special Procedures Technicians

POLICY STATEMENT:Cath lab personnel who have completed their competency requirements can only perform the testing. Documentation of the certification is maintained in the Cardiac Catheterization Laboratory.

POLICY ELABORATION:I. PROCEDURE

A. Equipment and Suppliesa. AVOXimeter 1000 or 1000E whole Blood Oximeterb. Cuvettesc. Heparinized 1cc syringesd. Gauzee. Syringes for Controlsf. needlesg. Glovesh. Isopropyl Alcohol wipesi. Optical filters (yellow & orange)j. Level 1 and Level 3 controls

B. Forms or Records:a. AVOXimeter Liquid Quality Control Log Level 1b. AVOXimeter Liquid Quality Control Log Level 3c. AVOXimeter 1000E Day-of-Use Optical Yellow Filter Logd. AVOXimeter1000E Day-of-Use Optical Orange Filter Log

C. Storage of Cuvettes and Liquid ControlsCuvettes:

Policy No.: 12.12 Page No.: 2 of 6 Originated: 8/95Revised: 07/11

1.Cuvettes are to be stored at room temperature in a closed bag with the desiccant pouch.

2. The desiccant pouch must be blue, check pouch prior to using.Liquid Controls:

1. Store at room temperature for 12 months, provided the labeled expiration date is not exceeded.

2. Once removed from the refrigerator re-date the controls with the expiration date one year from the date removed.

3. Do not return to refrigerator once stored at room temperature. D. Cuvette Pathlength

1. Locate the pathlength located on the cuvette packaging label.2. Check the AVOXimeter for correct pathlength by:

a. Press the "Main Menu" Keyb. Press 1 to select "Calibration" and press

"Enter"c. Press 3 select "Cuvette Pathlength", and press

"Enter"d. Current pathlength will display on screene. If pathlength is correct, skip to 9f. To edit pathlength, us the back arrow to remove digitsg. Enter the correct pathlength, and press "Enter"h. At the "OK" prompt, press "YES" to enter pathlengthi. Press "Cancel" twice to return to the "Ready" mode.

E. Quality Control: 1. The Avoximeter 1000E performs an electrical "self-

check" to verify that the light source is operating properly every time the instrument is turned on.

2. Optical filters (Yellow and Orange)a. performed everyday with use of the device and

before beginning patient testing.b. Two different levels of controls representing the

concentration of different samples.c. Filters are designated by a specific serial number

of the instrument and cannot be interchanged.

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3.Daily Optical QC procedure:1- Press "Enter/On". The instrument will perform a self-test.2-QC Lockout is enabled and optical QC must be run every 24 hours.3- Place yellow filter into testing chamber.4- Record the THb and %HbO2 results on the correct log sheet.5- Repeat steps 3 and 4 using the orange filter.6-Verify the results are within the correct range.7- The department supervisor will periodically review the QC documentation.

4. Aqueous Liquid Controlsa. Liquid Controls are performed weekly using two

levels of liquid controls.b. Controls must be documented on the correct log

form.c. If refrigerated, four hours must be allowed for

sample to come to room temperature prior to testing.

5. Weekly Liquid QC Procedure:a. Each week two levels of liquid controls need to

be tested. Controls should be brought to room temperature (20-25degrees C) for 4 hours before use.

b. Instrument must be in "Ready "modec. Hold the ampule at the top and bottom and shake

for 10 seconds.d. Tap the ampule to restore liquid to the bottom of

the vial.

e. Snap off the top, using a gauze and discard of tip into biohazard container. Once opened the controls are stable for one hour.

Policy No.: 12.12 Page No.: 4 of 6 Originated: 8/95Revised: 07/11

f. Attach a needle to syringe and insert into Vial.g. Draw approximately 2-3cc of control material

into syringe.h. Carefully remove needle from syringe and

discard into biohazard container.i. Attach cuvette to syringe filled with liquid

quality control material.j. Hold syringe and cuvette at a 45 degree angle

and fill cuvette slowly to avoid bubbles.k. Fill cuvette until the liquid controls reaches the

dark blue vent patch. Do not overfill vent patch.l. Insert the cuvette by grasping the black cap and

inserting into the testing chamber.m. Record the THb and %HbO2 results on the

appropriate Quality Control Log.n. Verify the results are within the expected range

provided by the manufacturer's package insert.o. Periodic review of QC documentation will be

performed by the department supervisor. 6. Invalid Optical QC

a. Clean filter with Isopropyl Alcohol wipes b. Repeat test

7. Invalid Liquid QC a. Use a new cuvette and repeat test. b. Check for air bubbles or damage to cuvette.

8. Patient testing cannot be performed if one or more of the QC tests fail.

F. Patient Testing:a. Don glovesb. Press "Enter/On". The instrument will perform a self-

test.

c. Verify the Cuvette pathlength is correct for the cuvettes in use. Failure to ensure the correct cuvette will result in inaccurate patient results.

Policy No.: 12.12 Page No.: 5 of 6 Originated: 8/95Revised: 07/11

d. Collect patient specimen .5ml in heparinized syringe. Roll the blood specimen for 10 seconds between hands to fully mix the sample. Poorly mixed samples or clotted samples causes inaccurate results.

e. Expel a small amount of blood sample from syringe.f. Hold cuvette by the edges or by the black cap, attach to

syringe.g. Hold cuvette at a 45 degree angle downward. Slowly

inject the patient sample into the cuvette until it reaches the vent patch and doesn't overfill patch.

h. If the vent patch is over injected and the vent patch bulges outward, pull back slightly on the syringe plunger until the patch is flattened.

i. Check for bubbles in cuvette light path. If bubbles are present discard of cuvette.

j. Verify the instrument is ready to run and that the "Ready"-"Insert Cuvette" is displayed.

k. Hold the cuvette by the black cap, insert into the test chamber on the instrument's front panel.

l. Face the textured dark blue vent patch to the left when inserting the cuvette.

m. Test results are displayed in 10 seconds. A delay of greater than 30 seconds may yield an erroneous result.

n. Remove the cuvette by the black cap and dispose of in the trash. Never reuse cuvette.

o. Verbally communicate the results to physician and technician and request a read-back of results.

p. All results will be documented in the XIMS system in the Cardiac Catheterization Lab.

G. Calibration:

a. Calibration Verification will be performed, documented and analyzed by the POCC every 6 months.

H. Maintance:a. wipe off exterior of the AVOXimeter 1000E instrument with a disinfecting solution as needed.

Policy No.: 12.12 Page No.: 6 of 6 Originated: 8/95 Revised: 07/11

b. Clean the optical filters with Isopropyl Alcohol wipes. Be careful not to scratch filters. Document when cleaned on QC form

II. COMPETENCY VERIFICATIONA. All personnel using this equipment must complete competency

verification/skills checklist.

III. REFERENCESA. Operating Manual AVOXimeter 1000E

IV. OFFICE OF PRIMARY RESPONSIBILITYA. Cardiac Catheterization Laboratory/University Health System