ADVIA® 2120i Hematology System Troubleshooting Online Training

Welcome to ADVIA® 2120i Hematology System Troubleshooting Online Training course. This course is designed to: Teach troubleshooting steps Present common hotline call situations Select Next to continue. Describe how to backflush flowcell and shuttle reaction chamber pathways Describe how to use the online Operator's Guide Identify and correct vacuum errors Identify the steps to replace the perox lamp and maximize its output List the steps to replace the hemoglobin lamp and adjust the hemoglobin baseline Recognize the causes of IFR and CHCMCE flags and correct them State general troubleshooting steps Upon successful completion of this course, you will be able to: Select Next to continue. Congratulations.  You have completed the ADVIA 2120i Troubleshooting online training course.  Listed below are the key points that have been presented.  Take time to review the material before you proceed to the final quiz. State general troubleshooting steps Isolate the problem Is the problem related to one channel or maybe one side of the analyzer? Are any QC parameters out of range? What does the Analyzer Status screen indicate? Does the Message Log or Status Messages indicate a problem? Does the Service Log indicate maintenance is up to date or that maintenance was just performed? When observing samples running, is there any leaking? Do you see air bubbles in the syringes? Are the reactions shuttling properly? Use the online Operator's Guide as a troubleshooting resource The online Operator's Guide has an entire chapter called "Troubleshooting the Analyzer."  Within this section are step by step cleaning procedures, alignment procedures and troubleshooting tips. You'll also find morphology flags and sample/system flags with causes and corrections. The affected parameters are listed. Replace the hemoglobin lamp and adjust the hemoglobin baseline The hemoglobin lamp is replaced and the baseline adjusted when the reading drops below 2.5. The replacement is done while the analyzer is off, but the adjustment is performed while the analyzer is in the Ready to Run state. Since the baseline reading is taken with hemoglobin reagent, it is important that there no air is present in the hemoglobin reagent line. Replace the perox lamp and maximize its output The perox lamp is also replaced while the analyzer is off and aligned while the analyzer is in the Ready to Run state when the reading drops below 90. It is important to check the Perox gains after replacing the perox lamp. Backflush flowcells and shuttle reaction chamber pathways Backflushing a flowcell and cleaning a shuttle reaction chamber pathway may be necessary to correct an irregular flow rate and poor results. Recognize the causes of CHCMCE flags and correct them CHCMCE flags are generated when the MCHC result and the CHCM result have a difference greater than 1.9. These may come from the hemoglobin channel or the RBC channel. It may be a sample related condition or a system related condition. Recognize the causes of IFR flags and correct them Flow rate histograms are a 10 second snapshot of the sample stream and sheath reagent as they pass through the flowcell. An irregular flow rate may result from an obstruction in the flowcell, worn plungers, a bad sheath filter, and other situations. Recognize and correct vacuum errors There are 2 vacuum readings on the analyzer. Both are seen on the analyzer status screen. They also must be within 5" Hg or else a UFC Vacuum Out of Range error is generated.  Select Next to continue. The ADVIA® 2120i Hematology System Operator's Guide assists in troubleshooting. There is an entire chapter named "Troubleshooting the Analyzer." There are sub-sections within this chapter such as: Alignments and Adjustments Cleaning Procedures Repair and Replacement Troubleshooting Tips Morphology Flags Sample/System Flags Troubleshooting the Analyzer - Operator's Guide Learn about troubleshooting the analyzer using the online Operator's Guide. Instructions:If media does not automatically start, select the play arrow to begin.Flash File:/content/generator/Course_90006036/OpGuideTroubleshooting_demo_800x600_9/OpGuideTroubleshooting_demo_800x600_9.swfHTML5 File:/content/generator/Course_90006036/OpGuideTroubleshooting_demo_800x600_9/index.htmlPDF File: While operating the ADVIA® 2120i Hematology System you will be alerted to suspected abnormal sample or system conditions. Error information may display on the Run Screen as a flag, or appear on the status line as a message (i.e.,QC is out). To determine the cause of the error, ask the following questions: Is the error system or sample related? Is the error happening to all samples or just one? Is the error limited to one method, or one side of the system? Determine if maintenance is up to date Select Next to continue.   The hemoglobin lamp needs to be replaced when the power low error occurs, error code HGB-PL. A power low error indicates the transmission reading is less than 2.5 (The range is 2.5 - 4.1).   Note: If the transmission reading is less than 2.5, a refresh must be performed first to verify the cuvette is receiving reagent.   Replacing the Hemoglobin Lamp Learn how to replace the hemoglobin lamp.   Select the play arrow to begin the video. When complete, select the X in the upper-right corner to close the window and continue.    The hemoglobin lamp needs to be adjusted after it is replaced.  The acceptable range: 2.5 - 4.1 Adjusting the Hemoglobin Lamp Learn how to adjust the hemoglobin lamp. Instructions:If media does not automatically start, select the play arrow to begin. Flash File:/content/generator/Course_90006036/sim_ADVIA2120_HgbBaselinePeak_800x600_9/sim_ADVIA2120_HgbBaselinePeak_800x600_9.swfHTML5 File:/content/generator/Course_90006036/sim_ADVIA2120_HgbBaselinePeak_800x600_9/index.htmlPDF File: The perox lamp will need to be maximized after it is replaced. Maximizing the lamp output is performed in the Adjust Lamp/Temp tab in the Procedures menu. The acceptable range: 1.9 - 4.9   Maximizing the Perox Lamp Learn how to maximize the perox lamp. Instructions:If media does not automatically start, select the play arrow to begin.Flash File:/content/generator/Course_90006036/sim_ADVIA2120_PeroxLampAdjust_800x600_9/sim_ADVIA2120_PeroxLampAdjust_800x600_9.swfHTML5 File:/content/generator/Course_90006036/sim_ADVIA2120_PeroxLampAdjust_800x600_9/index.htmlPDF File: The perox lamp is replaced when a power low error occurs, error code PX-PL. This occurs when the reading is less than 90. The acceptable range: 90 - 125   Replacing the Perox Lamp Learn how to replace the perox lamp.   Select the play arrow to begin the video. When complete, select the X in the upper-right corner to close the window and continue.   The backflushing of flowcells and the cleaning of shuttle reaction chamber pathways are troubleshooting procedures used to correct impeded flow through the flowcells and slow flow of the reaction to the flowcell. This may include: Improper shuttling Irregular flow rates Poor sample results   Note: Please refer to the Operator's Guide for the valves involved in the backflushing of the perox flowcell and the cleaning of the other shuttle chamber pathways.   Backflush RBC flowcell Learn how to backflush the RBC flowcell. Checklist TitleChecklist TypeChecklist ContentRemove fitting at V23HTML   Unscrew the white knurled nut fitting on Valve 23. Select each checkbox to learn more about backflushing the RBC flowcell.  Attach syringe of 25% bleach solutionHTML Attach the white fitting to a Flowcell Cleaning Syringe filled with 25% bleach solution.   Remove sample tubing from sample syringeHTML Disconnect the sample tubing from the top of the syringe and place the sample tubing into a beaker to catch fluid as you back flush the flowcell.   Flush bleach through flowcellHTML Gently push the plunger on the syringe to flush the bleach solution through the RBC flowcell.    Flush deionized water through flowcellHTML Repeat with deionized water.   Reattach sample tubing to top of sample syringeHTML Reattach the sample tubing to the top of the sample syringe. When complete, select the X in the upper-right corner to close the window and continue.   Cleaning RBC shuttle chamber pathway Learn how to clean the RBC shuttle chamber pathway. Checklist TitleChecklist TypeChecklist ContentAttach syringe to white knurled nut fittingHTML Analyzer status should be Ready to Run. Attach the syringe filled with 25% bleach solution to the white knurled nut fitting that you disconnected from Valve 23.  Select each checkbox to learn more about cleaning the RBC shuttle chamber pathway. Open Valves screenHTML At the Utilities menu, select Exerciser to open the Exerciser tab. Open the Valves screen.   Open V9 and V10 and flush with bleach solutionHTML Open V9 and push the syringe to fill the RBC chamber with 25% bleach solution, then open V10 to drain. Close V9 and V10. Repeat with deionized waterHTML Repeat step three with deionized water.  Refill syringe with 25% bleach solutionHTML Refill the syringe with 25% diluted bleach solution.   Flush bleach solution through V20, V21, V22HTML To flush the RBC Vacuum Shuttle Chamber (VSC), open V20 and V22. Gently push the plunger to fill the chamber with bleach solution until it flows up the vent line above the VSC. Empty the chamber by opening V21.  Close V22 before next step. Repeat with deionized waterHTML Repeat step 5 with deionized water. When complete, select the X in the upper-right corner to close the window and continue.   Have a look at some tomosynthesis images compared to the corresponding 2D mammography images. Do you remember the 56 year-old patient with a 28mm invasive ductal carcinoma from a previous slide? A tomosynthesis scan of the breast of this patient has been performed in addition. On the single tomosynthesis image, displayed on the right hand side, the tumor is much more clearly visible than on the respective 2D mammogram. This 59 year-old patient underwent a mammography screening that showed multiple calcifications. In the tomosynthesis image the grouping of the calcifications is easier to assess.  The patient had a 40mm ductal carcinoma in situ. This 60 year-old patient was not suffering from any symptoms. The mammography image shows an area of about 1cm with calcifications in the left upper quadrant of the left breast. A clearly delimited lesion was found in the same area. The calcification can be seen easily in the tomosynthesis images.  No lesion is associated with the calcification. The lesion can be viewed optimally in another image plane. Flow rates monitor the hydraulic integrity of the analyzer. A flow rate histogram is a 10 second snapshot of the sample stream as it flows through the flowcell. The histogram shows the uniformity of the cell-counting rate. If the flow rate is irregular you will get an IFR (irregular flow rate) flag.   Flow Rate Histograms Learn about regular flow rate histograms. Tab TitleTextPerox Histogram The Perox histogram shows the uniformity of the cell-counting rate.  Baso Histogram The Baso rate histogram shows the uniformity of the cell-counting rate.      RBC Histogram The RBC rate histogram shows the uniformity of the cell-counting rate.    Retic Histogram The Retic rate histogram shows the uniformity of the cell-counting rate.    Hemoglobin Transmission Histogram The hemoglobin transmission histogram shows the uniformity and the amount of the light transmission through the hemolysed sample and through the rinse solution during a cycle. When complete, select the X in the upper-right corner to close the window and continue.    A CHCMCE flag is a comparison error of the MCHC value and the CHCM value. The flag is triggered if the difference between the MCHC and CHCM values is greater than 1.9. MCHC is a calculated result, Hgb/(RBC x MCV). CHCM is directly measured. CHCMCE Flags Learn about CHCMCE flags. Tab TitleTextHemoglobin CHCMCE Flags One sample related condition for a CHCMCE flag generated in the hemoglobin channel is lipemia.  Lipemia will increase the hemoglobin result, thus increasing the MCHC result, and MCH result. For lipemic samples ONLY, substitutions are allowed. You may substitute the cellular hemoglobin result for the hemoglobin result. The CH result could also be substituted for the MCH result and the CHCM result for the MCHC result. Note: These substitutions should be verified by completing a comparison study for your records.   A CHCMCE flag generated from the hemoglobin channel may also be system related. If the hemoglobin results are low, the sample shear valve may need cleaning. Are the hemoglobin results high because of air bubbles in the hemoglobin reagent lines? Try priming the hemoglobin line with EZ Kleen, followed with deionized water and finally by hemoglobin reagent. Be sure to prime all air out of the hemoglobin reagent lines.  RBC CHCMCE Flags A CHCMCE flag generated from the RBC channel may be sample related or system related. The two sample related conditions that cause this flag are hemolysis and cold agglutinins. Hemolysis will decrease the RBC result, thus increasing the MCHC result. A specimen reorder is the only course of action to be taken to correct this situation. Cold agglutinins will decrease RBC results, increase MVC results and decrease the MCHC result. Warming the sample may correct this issue. If it is determined that the CHCMCE flags are system related, clean the sample shear valve for RBC results or back flush the flowcell and clean shuttle reaction chamber pathways for MCV and CHCM results.  When complete, select the X in the upper-right corner to close the window and continue.       UFC Vacuum Out of Range error may indicate that the vacushield (vacuum pump filter) needs to be replaced. Replacing the Vacushield Learn how to replace the vacushield. Checklist TitleChecklist TypeChecklist ContentTurn analyzer offHTML When replacing the vacushield, the analyzer should be Off. Select each checkbox to learn more about replacing the vacushield.  Remove vacushieldHTML Remove the vacushield from the analyzer and discard.   Replace VacushieldHTML Install the new vacushield. Ensure the words FLUID SIDE are oriented toward the waste container. Turn the analyzer On.   Verify vacuumHTML   Check the vacuum in the Analyzer Status screen. It should be 20" Hg +/- 1. Adjust if necessary. When complete, select the X in the upper-right corner to close the window and continue.   By the end of this course you will be able to : •Identify patient positioning and set-up for imaging •Identify different sequences used for breast MR implant imaging •Perform system adjustments for different types of implants •Demonstrate suppression techniques •Identify visual differences between silicone and saline implants There are 5 examples of Irregular Flow Rates (IFR): RBCIFR BIFR RTCIFR PXIFR  HGB-IFR Irregular flow rate histograms Learn about irregular flow rate histograms. Tab TitleTextIFR caused by poor Sheath Delivery This is an example of poor sheath delivery. Look at the sheath filter. Is it full? It should be filled with sheath. Check the delivery of sheath by disconnecting the line at the top of the filter and priming. If when priming, the delivery of sheath is a steady stream, the sheath filter may need to be replaced.   IFR caused by poor Sample Delivery This is an example of poor sample delivery. It may be caused by debris in the flowcell obstructing the delivery. To resolve, back flush the flowcell.   IFR caused by Air in Sample Stream This is an example of having air bubbles in the sample stream. Check the side fitting on the syringe. Are there crystals trapped in the fitting? Is it loose? Try to track the origin of the air bubbles.   IFR caused by improper Plunger Maintenance This is an example of an IFR that may be caused by plungers needing to be replaced. This can also occur if the plungers were replaced but the stop gap pin wasn't used properly.   IFR caused by Air in the Hgb Reagent This final example shows the foot of the hemoglobin bed cut off. There might be some air in the reagent line. Prime the reagent sufficiently. When complete, select the X in the upper-right corner to close the window and continue.   Let's take a look at how we can navigate through Sample, Result, and Patient screens to find information. Select the link below to learn more. Vacuum readings are monitored and displayed on the Analyzer Status screen. Examples of vacuum errors include: Vacuum out of range UFC vacuum out of range Compressor time out These errors may be due to: Vacuum gauge being out of range Crimped tubing An open spigot on the manual waste container A clogged vacushield Vacuum Errors Learn about vacuum errors. Tab TitleTextVacuum Out of Range The vacuum reading should be 20" Hg +/-1. If it drops below 19 or rises above 21, a vacuum out of range error occurs and you will need to adjust the vacuum. The regulator knobs are accessed behind the right side panel. With the analyzer status screen open, adjust while the system is in the Ready to Run state. Give the reading a few seconds to register.   UFC Vacuum Out of Range A UFC Vacuum Out of Range is received when the difference between the UFC vacuum and the system vacuum is greater than 5" Hg. There are a number of reasons that may cause this error: An open, or partially open spigot on the manual waste container Crimped lines on the waste container Waste line tubing, or vacuum line may not be seated properly in the container A "bad" clogged vacushield      Compressor Time Out If the system is turned off and turned back on too quickly, residual vacuum remains in the waste container. The Compressor Time Out error occurs and the system does not initialize. Manually disconnect the vacuum line on the top of the waste container allowing the vacuum to dissipate.  When complete, select the X in the upper-right corner to close the window and continue.