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ACE Alera. Objectives. Explain the procedure for preparing reagents, calibrators, controls and specimen samples. Identify key components of the ACE analyzer and ISE modules and explain their purpose. Identify each ACE consumable and its use. - PowerPoint PPT Presentation
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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.
Objectives7. 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
InterferencesCondition 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
– Computer– Monitor– Keyboard – Priner– Uninteruptible power
supply
Analyzer ModuleCuvette Loader
ISE module
Refrigerated reagent compartment and sample storage
Sample/Reagent Probe
STEP module
Consumables: disposable products
• 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
• 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• 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:
• 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• 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
• Daily • Weekly• Monthly• Bi-Annual