ACE Alera

1. ACE Alera

2. 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. • Describe the role of the function keys when operating the ACE system.

3. Objectives • Perform the four activities required for the ACE system daily start-up. • Create QC, calibration and patient requisitions. • Place individual sample cups and tubes and create loadlists for running batches of samples. • Examine patient reports to determine if the results are possible and if necessary corrective actions are required. • Recognize “flags” noted on a QC report and know basic troubleshooting actions. • Complete daily shutdown activities.

4. Objectives • List the different malfunctions that one might experience during operation. • List the possible causes for malfunctions and the recommended corrective action. • Identify the five-step process to help identify and resolve quality control problems.

5. 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)

6. 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

7. Important reminder • Fresh reagents require calibration • GEMCAL • QC verification • Run 2 levels of control each day to verify acceptable system performance

8. 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

9. Interferences

10. ACE System • Analysis module • Computer workstation • Computer • Monitor • Keyboard • Priner • Uninteruptible power supply

11. Analyzer Module Cuvette Loader Sample/Reagent Probe Refrigerated reagent compartment and sample storage ISE module STEP module

12. Consumables: disposable products • Plastic sample cups • Segments • Seglets • Well Segments • Cuvettes • Evap-caps • Biobags

13. 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

14. Daily Operation • Daily Start-up • Create Requisitions • Load and Run Samples • Interpret Results • Daily Shut-down

15. 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

16. 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

17. 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

18. Creating a Requisition for a New Patient • Requires • Patient first and last name • ID • Accession number • Selection of tests to run

19. 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

20. 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

21. 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

22. 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”

23. 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

24. Maintenance • Daily • Weekly • Monthly • Bi-Annual