Transcript ACE Alera Overview

ACE Alera
Objectives
1. Explain the procedure for preparing reagents,
calibrators, controls and specimen samples.
2. Identify key components of the ACE analyzer
and ISE modules and explain their purpose.
3. Identify each ACE consumable and its use.
4. Describe the role of the function keys when
operating the ACE system.
Objectives
7. Perform the four activities required for the ACE
system daily start-up.
8. Create QC, calibration and patient requisitions.
9. Place individual sample cups and tubes and create
loadlists for running batches of samples.
10. Examine patient reports to determine if the results
are possible and if necessary corrective actions are
required.
11. Recognize “flags” noted on a QC report and know
basic troubleshooting actions.
12. Complete daily shutdown activities.
Objectives
13. List the different malfunctions that one
might experience during operation.
14.List the possible causes for malfunctions and
the recommended corrective action.
15.Identify the five-step process to help identify
and resolve quality control problems.
Reagent Preparation
• Ready to use, liquid form
• Package insert details information regarding:
– Preparation and storage
• Room Temp (albumin, direct bilirubin, total bilirubin,
calium, creatinine, magnesium, total protein, ISE
calibrators A and B, ISE Cleaning and Conditioning, ISE
wash, System Diluent, reference Electrode Solution)
• Refrigerated( ALT, AST, CO2, Alkaline Phosphatase,
Amylase, Cholesterol, Creatinine Kinase, GGT, Glucose
and many more)
Reagent Preparation
• On a bottle is opened
– Date and time
– Initials
– Check for bubbles. If bubbles present, use a transfer
pipette to remove
• Place an evap-cap on the top of reagent container
• Bottle is then placed anywhere in the refrigerated
compartment
• Once the instrument door is closed, the ACE will read
the dot codes on the bottle of the reagent to
determine expiration dates and stability
Important reminder
• Fresh reagents require calibration
– GEMCAL
• QC verification
– Run 2 levels of control each day to verify
acceptable system performance
Specimen Preparation
• All serum specimens should be allowed to
fully clot for 30 minutes before centrifugation
• Glucose tests should be completed within 2
hours of sample collection unless the red
blood cells were separated from the serum or
plasma
• Specific requirements are listed in package
insert
Interferences
Condition
Definition
Causes
Visual Presentation
Hemolysis
Caused by ruptured RBCs that
release the hemoglobin
pigment into the serum or
plasma
Difficult venipuncture,
certain disease states
Sample can vary
from pink to dark
red
Lipemia
High levels of cholesterol or
triglyceride
Nonfasting
Sample can vary
from cloudy to very
turbid
Icterus
Presence of bilirubin in sample
Liver disease, certain
medications
Sample can vary
from bright yellow
to green to brown in
color
Drugs
Medications, dietary
components
ACE System
• Analysis module
• Computer workstation
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Computer
Monitor
Keyboard
Priner
Uninteruptible power
supply
Analyzer Module
Cuvette Loader
Sample/Reagent
Probe
Refrigerated
reagent
compartment
and sample
storage
ISE module
STEP module
Consumables: disposable products
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Plastic sample cups
Segments
Seglets
Well Segments
Cuvettes
Evap-caps
Biobags
ISE Components
• Valves
– Control the movement of fluid and air in and out of the
measuring chamber
• Sample sensor
– Detects proper aspiration and timing of all ISA fluids and
air
• Measuring Chamber
– Contains 3 electrodes that measure sodium, potassium
and chloride. The fourth electrode is the reference
• Peristaltic Pump and Tubing
• The pump transports liquids and air bubbles throughout the ISE
module
Daily Operation
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Daily Start-up
Create Requisitions
Load and Run Samples
Interpret Results
Daily Shut-down
Daily Start-Up
• Verify Power
Look for a green light to indicate power is on
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UPS
Monitor
Computer
Printer
Listen for fans
• Status Checks
Hit Status {F3} on keyboard, check reagent tray,
calibration, sample ring and hopper to check each
item
Prepare GEMCAL, QC products, reagents
Daily Start-Up
• Maintenance
– Hit Instrument Access {F12} to check, inspect and service:
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Clean reagent compartment condensation and camera lens
Re-fill container compartment
Fill Hopper
Empty cuvette waste box
– Perform a probe alignment and cleaning
– Clean the wash bath and probe pathway
• ISE daily maintenance
– Main menu, utilities, ISE, press enter three times to select
Calibrate, Condition, Clean
– Select Accept {F10} This will take about 13 minutes
Create Requisition
• Types
– Quality Control
• Used to order tests on QC materials
• Separate requisition is needed for each control
– Calibration
• Used to order tests for calibration
• One requisition is required for all calibrator materials in a run
• When?
– Calibration is expired
– New lot of reagents introduced
– Software/Hardware changes
– Patient
• Order tests on a patient
Creating a Requisition for a New
Patient
• Requires
– Patient first and last name
– ID
– Accession number
– Selection of tests to run
Loading and Running Samples
• Loadlist or worksheet
– List of each sample to be run
– Shows where to place each sample cup on the
segment
– Created prior to running samples
– Maximum of 15 samples
Loading and Running Samples
• Important Points
– Requisition must be created PRIOR to loading and
running
– All samples must be run within 4 hours of loading
Placing Sample Tubes
• STEP: Sample Tube Entry Port
– Allows sample to be introduced directly to system
– Detects level of sample and withdraws sample for
analysis
Results Interpretation
• Quality Control
– Verify that all results are in range, if not trouble
shoot.
• Patient
– Verify that no “flags” are present
• Examples: “H” or “L”
– Check for critical values
• Examples: “HH” or “LL”
Shut Down
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Instrument Access [F12]
– Containers
• Verify fluid(s) levels
– Segment
• Remove segments notated
as “inactive” or “done”
– Accept [F10]
Clean-Up
Back-up
– Main menu
• Utilities- backup
• Insert disk- hit [F10] then
accept
• Remove disk
Maintenance
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Daily
Weekly
Monthly
Bi-Annual