ABL800 FLEX analyser

Operator Training Guide

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

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
Cover with window

Thermal printer
Capillary inlet
Left cover

Syringe inlet
Right cover

Waste container
Cleaning Solution
Rinse solution
Cal 1 solution
FLEXQ module
Barcode reader

Cal 2 solution

AutoCheck
module

The parts and components of the analyser's rear panel

Screen, rear

Gas cylinders
Fan
3

Communication ports
Power switch

Syringe samples - Preanalytical errors

Sample 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)

Syringe samples - Preanalytical errors

Sample 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

cCa2+

due to change in CO2 and glycosis

the change in pH will influence
the binding of Ca2+ to protein

cGlu

since glucose will be metabolised

cLac

due to glycosis

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

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

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

Critical limit

Critical limit
(no marking)

Low
parameter
value

Reference range
Critical range

High
parameter
value

Reportable range
Range of indication

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

Syringe 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 errors

Sample 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 Mode

This 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

Capillary samples - Preanalytical errors continued

Sample collection and handling CPA B9.7 (c)

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

11

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

12

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

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

13

Critical limit

Critical limit

5. View results (on-screen, printout and CIS)

(no marking)
Low
parameter
value

Reportable range

Range of indication

High
parameter
value

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

Compliance
Infection 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

14

Radiometer apps

Blood Gas
Handbook
c

Radiometer's Blood Gas handbook

The blood gas handbook is now available for
iPhone, iPad, Android and Windows Phone

Blood Gas Preanalytics

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.
15

Notes

Notes

Notes

www.radiometer.co.uk

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