Radiometer 800 Series Blood Gas Analyser Competency Assessment

Radiometer 800 Series Blood Gas Analyser Competency Assessment During this session you will be presented with key information about the test to read through, followed by a list of questions that you must answer correctly

The purpose of this competency test is to assess whether point of care test users are competent to perform the test Test Principle • 12 Radiometer 800 Series Blood Gas Analyser are employed across the trust • Blood gas, co-oximetry, electrolyte and metabolite analysis is performed on patient whole blood samples at the point of care for rapid patient management. Results are used to assess acid base balance. • The Radiometer 800 series blood gas analyser electrodes use potentiometry for measuring p. H, p. CO 2 and electrolytes, and amperometry for measuring p. O 2. • Arterial, venous or capillary blood is drawn into a heparinised syringe or capillary tube, mixed thoroughly, and introduced to the sample port. • The sample passes a system of electrodes specific for each analyte of interest, and also passes through the co-oximeter to give a full result profile.

Specimen collection and preparation • The following guidelines must be followed to maintain the accuracy of results • It is essential that the patient sample is drawn into a heparinised syringe or capillary to prevent the formation of clots in the sample. A syringe containing dried electrolyte balanced heparin is the preferred option for adult samples. • WHY? - Heparin binds positive ions (Sodium, Potassium and Calcium). Positive ions that bind to heparin cannot be detected by the electrodes. Electrolyte balanced heparin already has the binding sites occupied by positive ions preventing those ions in the patient sample from binding and not being detected. The outcome is a more accurate and precise result. • IMPORTANT- using non-heparinised syringes or capillaries will lead to blockages in the sample pathway or effect the performance of the electrodes • This will lead to avoidable downtime for the analyser and a reduction in test availability • Once the sample has been obtained, air bubbles must be removed to prevent gas exchange between the atmospheric air and the blood sample. • Immediately prior to analysis the sample must be thoroughly mixed through two planes, by inversion and rolling between the palms

Specimen collection and preparation • If a capillary tube is being used gently roll between the fingers and use a mixing flea and accompanying magnet to mix the sample taking care to cap the ends of the capillary tube • Special care must be taken to prevent haemolysis of the sample as this will effect the accuracy of the results i. e. potassium will be spuriously elevated • If a syringe containing liquid heparin is being used the heparin must be expelled prior to drawing the blood sample. This is essential to avoid any dilution effect in small volume samples • Samples should be analysed within 10 minutes. If analysis is delayed the sample can be kept on ice or refrigerated for up to 30 minutes. If the sample isn’t kept on ice the red cells will continue to use oxygen (p. O 2 ↓) and produce carbon dioxide (p. CO 2 ↑) leading to inaccurate results • TIP- Check the availability of the analyser before taking the sample. The analyser may be performing a calibration which may take up to 10 minutes to complete.

Test Procedure • Only trained users should perform this test, and any other point of care test • Refer to the manufacturer’s instructions, the standard operating procedure or the quick guide before testing • Mix the sample thoroughly before testing • The analyser is password protected to only allow trained users access to the system. • ESSENTIAL- Do not share barcodes or passwords with anyone. Doing so breaches the Point of Care Testing policy and the applicable trust information security policies • Remember to log off the system when you have completed a test. • Any test performed while you are logged onto the system is your legal responsibility. You will be held accountable for any adverse clinical incidents that occur as a direct result of you allowing another staff member to use your barcode or password.

Test Procedure • At the analyser, first check that the system is in ‘Ready’ mode • Check that the traffic light symbol is green or amber. The analyser is OK to use if either colour is displayed • If the traffic light symbol is red check the parameter bar to see if all or some of the tests are effected. • If all are effected then you should not attempt to use this analyser. Report the fault to the Point of Care Testing team 09. 00 -17. 30. • If one or more tests are red use your professional judgement to assess whether those tests are essential. You may still use the analyser as any test that is green or amber will still be available. • If all tests are red, use the BUDDY system- use the nearest blood gas analyser. Report the fault to the point of care testing team 09. 00 -17. 30. • NOTE- If the p. H is red then use a different analyser as the p. H is used to calculate a number of the other results.

Test Procedure • To begin testing lift the inlet flap (blue with syringe icon or capillary icon depending on sample type) • Mix sample thoroughly as previously described • Attach the syringe or capillary to the appropriate port. The syringe port is facing you and the capillary port is to the right side of the inlet gasket. • Syringes- Pull back the plunger so that the sample is drawn back to the end of the luer creating an air gap. This also prevents blood being displaced into the inlet gasket avoiding blockages Capillaries- attach a clot catcher supplied which also creates an air gap • Creating the air gap is essential. The sample pathway is filled with rinse solution to stop the system from drying out and the introduction of the air gap enables the sensors in the inlet port to distinguish between the rinse solution and the blood sample

Test Procedure • Press the START button on the touch screen of the analyser • Select the correct volume mode and sample type (syringe/capillary) • The sample probe will automatically descend into the syringe stopping at the plunger. The sample is aspirated from the side of the probe • Capillary sample are drawn into the analyser by a vacuum. • You will be prompted to enter the patient details in the patient demographic screen. The hospital number and surname are mandatory fields and must be filled in for the result to be displayed. • You may also enter further details which may effect the results such as patient temperature and oxygen percentages

Test Procedure • ESSENTIAL- You must ensure that you enter the correct details for the patient sample. Entering the incorrect details of another patient will mean that the results will be sent to i. CM (i. Soft Clinical Manager) instantaneously and filed in that patient’s health record • If this occurs contact the i. CM team immediately for the removal of the results from the incorrect patient file. Inform the Point of Care Testing team on ext 52299 and raise a DATIX incident documenting the error • Not entering the patient details correctly will lead to an incomplete patient health record as the results will not match with the patient in i. CM. • On completion of the analysis an audible beep can be heard and the report is printed. At this point it is safe to remove and dispose of the sample in the clinical waste bin. • Ensure that the inlet flap is lowered. The system will flush through with rinse solution to remove any residual sample

Results • The printout is produced only when the mandatory fields have been completed • The report will list the available test results including p. H, electrolytes, metabolites and co-oximetry along with any reference ranges defined on the analyser • The unit of measurement is also displayed for each analyte • The following symbols may be displayed next to or instead of a result– ? Usually means that the measurement was unstable, the test was unavailable, or the sample was insufficient – ↑ The result is elevated compared with the reference range – ↓ The result is low compared with the reference range

Reporting results • Results must be recorded in the patient health record, including securing the printout in the notes • Blood gas results can also be recorded on the adult admission record part B • Blood gas results are instantaneously sent to i. CM when the analysis is complete • Any errors in patient data being entered should be reported immediately to the i. CM team and the Point of Care Testing team • The recording of results will be audited by the Point of Care Testing team.

Quality Assurance • To maintain and monitor performance monthly external quality assurance (EQA) samples are analysed on each blood gas analyser • The EQA samples must be performed following the same procedures used for patient samples • The performance of the analyser is fed back to the ward manager or a named individual responsible for the analyser • Poor performance will trigger an investigation into the cause of the issues, to include re-training and close monitoring. • Repeated poor performance may result in the removal of the test.

Non conformance • Failure to follow trust procedures will result in the generation of Non-Conforming Work Reports (NCWRs) in the laboratory quality management system (QMS) or recorded as a clinical incident in Datix. • The Point of Care Testing team regularly report to the Medical Devices Strategy Group (MDSG) and the Effective Care Group as part of trust clinical governance • Poor compliance with any trust policy covering point of care testing will be reported to the Effective Care Group.

Competency Test Please read the question carefully before selecting your answer. A 100% pass rate has been set. 1. What is the name of the blood gas analyser commonly used in the trust a) the Radiometer 800 series blood gas analyser b) the Siemens 1200 blood gas analyser c) the Roche b 123 blood gas analyser 2. Which is the preferred type of sample syringe? a) plain syringe, no anticoagulant b) liquid heparin syringe c) dried electrolyte balanced heparin syringe 3. How quickly after the sample is obtained should the analysis be performed? a) not more than 10 minutes b) up to one hour c) 30 minutes at room temperature

Competency Test 4. How is the blood gas analyser accessed and by whom? a) it is password protected for trained users only b) it is open access for all staff c) only doctors can use the analyser 5. What is the importance of removing any air bubbles from the sample? a) to prevent an air bubble from entering the system b) to prevent gas exchange between the sample and air in the bubble c) to reduce the volume of the sample 6. An air gap must be created by drawing back the plunger. Why is this important? a) it helps to mix the sample b) it ensures the accuracy of results c) it helps the analyser distinguish between the rinse solution and the sample

Competency Test 6. The analyser flushes the sample pathway with rinse solution after each sample. Why? a) it prevents the sample pathway from drying out b) it removes any residual sample from the sample pathway c) both a) and b) are correct 7. Heparin binds which of the following? a) metabolites b) gases c) positive ions 8. What is the recommended syringe sample mixing procedure? a) invert multiple times b) invert sample and roll between fingers or palms c) roll between the palms or fingers

Competency Test 9. If the incorrect patient details are entered, what action should you take? a) contact the i. CM team immediately and report the error to the Point of Care Testing team b) amend the printout and affix to the patient record c) ignore it and test the sample again entering the correct details 10. All tests on the parameter bar are red. What do you do next? a) use the analyser b) report this to the point of care testing team c) try to intervene yourself d) use another analyser (BUDDY system) and report the fault to the point of care testing team