Operator Training Guide

ABL800 FLEX analyser

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

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

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

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

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

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

7

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

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

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

10

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)

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

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

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

.

Other

.

Disclaimer: This workbook is for use in UK and Ireland only

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

Notes

Radiometer's Blood Gas handbookThe blood gas handbook is now available foriPhone, iPad, Android and Windows Phone

Notes

Notes

Radiometer Limited, Manor Court, Manor Royal, Crawley, United Kingdom 2013. All Rights Reserved. 939-528. 201301A.

www.radiometer.co.uk