POINT OF CARE TESTING ABBOTT i-STAT System

Objectives: Identify the i-STAT System Features Collect and Handle Samples Perform a Patient Test Conduct Quality Control Troubleshoot the i-STAT System 2

i-STAT System Bedside Testing The i-STAT 1 Analyzer is intended for use with i-STAT cartridges for the in vitro quantification of various analytes in whole blood. Analyzers and cartridges should be used by healthcare professionals trained and certified to use the system and should be used according to the facility’s policies and procedures. The policy is located in our hospital’s page (The Landing under Policytech.) The i-STAT System incorporates a comprehensive group of components needed to perform blood analysis at the point of care. A portable handheld analyzer, a cartridge with the required tests, and 2-3 drops of blood will allow the caregiver to view quantitative test results for blood gas, chemistry and coagulation tests in approximately two minutes depending on the cartridge type in use. 3

Components of the i-STAT System 1. Cartridge : It is where the blood analysis takes place. 2. Handheld : Displays result and collects patient and operators information. 4

Components of the i-STAT System 3. Downloader : Allows integration of date with other system. 4. Printer : Prints test results for review. 5

The i-STAT System Process 1. Enter information into the handheld. (Operator, Patient and Lot Cartridge numbers.) 2. Obtain the blood specimen, then fill the cartridge. 6

The i-STAT System Process 3. Insert cartridge, results will appear in minutes. 4. Download results or transmit it by wireless connection. 7

Handheld External Components Handheld (Front)Handheld (Bottom) Cartridge Port : where you put an i-Stat cartridge after filling it with the patient’s sample. 8

Handheld External Components 9 Handheld (Top)

Battery Compartment Battery Compartment: - Uses either the 9-volt lithium disposable batteries. - Abbott rechargeable battery pack. Change the batteries when: -“Low Battery” message is displayed. - When the batteries is not sufficient to finish the test it stops the testing cycle and displays the “DEAD BATTERIES” screen. 10

Battery Compartment 11 To Remove and Replace Batteries: 1. Slide open the battery compartment 2. Tilt the handheld battery slide out the battery carrier. 3. Remove the batteries by pushing sideways with thumb. Repeat for the other battery. (Refer to the picture of the battery carrier for proper battery insertion.) 4. Insert new batteries into the carrier. 5. Replace the carrier with gold dots facing down and red dot facing the screen. 6. Slide the carrier back into the compartment and then slide the compartment door back into place.

The Infrared Communication Window Designed for communication with: - Downloaders - Printers Accomplished by aligning infrared communication windows to each component. 12

The Barcode Scanner Used to scan : -Operator IDs -Patient IDs -Cartridge lot number barcode (It is the most reliable way of entering data into the handheld) To Scan: 1.Hold the handheld inches away from the barcode 2.Press and hold down the SCAN key to enable the barcode scanner. ( The handheld emits a visible red beam.) 3.Laser beam must cover the entire length of the barcode. 4. Wait for the beep or for the laser beam to disappear. 5.Release the SCAN key 6.Repeat if prompted. 13

The Barcode Scanner If the scan is unsuccessful, try again: Make sure the barcode is completely covered by the red beam. Press and Hold the scan key. Tilt the barcode away from strong light sources. Important things to remember : The scanner will remain active for a maximum of 3 seconds each time you press and hold the scan key. To scan you must press and hold the scan key. The laser beam emits out of the handheld at a downward angle to improve scanning ergonomics. Once the barcode is red the handheld will move on to the next input screen. You will not see what you have just scanned, just follow the prompts. 14

Handheld Display Screen The handheld displays: -Test results -Entry prompts - Troubleshooting guidance 15

Handheld Keys ARROW KEYS Right arrow key is for navigating pages within a test result. Left arrow key is backspace to clear keypad entries. MENU KEY Toggles between the Test and Administration Menus Escape key POWER KEY Press to turn on the handheld Press and hold to turn off the handheld. 16

Handheld Keys : ABC KEYS Press the ABC key to enter letter mode. Use the Arrow keys to scroll through the list. Select the letter by pressing the ABC key again. If another letter is required, again press the ABC key to reenter letter mode. NUMERIC KEYS Use to enter numbers and decimal points Press desired number to enter Press and hold “0” key to enable backlight. NOTE: Data entry is possible only when prompted. 17

Handheld Cartridge Port Accepts either: i-STAT Cartridges Electronic Simulator 18

Handheld Test Menu ADMINISTRATION MENU Analyzer Satus Data Review A. ANALYZER STATUS SCREEN Press MENU to get to the Administration Menu Press 1 for Analyzer Status Information includes: - Total records - Unsent records Handheld stores 1,000 test records. B.DATA REVIEW Press 2 for Data Review Seven options for grouping and filtering stored data. View or print any stored record. TEST MENU When you turn on the Handheld the first menu this is the first Menu that you will see. Test Menu has 2 options: PRESS: 1 = Last Result 2 = i-STAT Cartridge (To begin a patient test) 19

Cleaning the Handheld Clean the handheld with PDI SANI CLOTH every after patient analysis. 20

Internal Electronic Simulator Performs internal checks every 8 hours to ensure proper and accurate functioning. Provides independent check of the handheld’s ability to take accurate and sensitive readings. Checks whether test needs to be performed each time cartridge is inserted. Performed automatically when needed before the sample is tested. Adds 20 seconds to testing cycle. WHAT TO DO IF INTERNAL SIMULATOR FAILS: The i-STAT will not allow testing if the internal simulator fails. If it fails repeat testing with another set of cartridge. If it fails the second time report it to the POCC immediately. 21

I STAT Cartridge Overview and Handling Self contained lab analyzers. Analysis, sample manipulation and waste are confined within the cartridge. Refrigerated storage: - May be used until the expiration date - Refrigerated storage range is 2-8C. Room Temperature Storage: - 14d = 14 days - 2m = 2 months - Room temperature storage range is 18-30C. Prior to patient testing cartridges must be brought to room temperature before use - 5 minutes for a single cartridge - 1 hour for a box of cartridges After removing cartridges from refrigeration: - They cannot be put back into the refrigerator. - The room temperature expiration date must be written on the box or individual pouch. Once marked it must remain in Room Temperature until used. Cartridge disposal: Follow your hospital’s disposal guidelines for products used with blood. 22

Cartridge Component SAMPLE CHAMBER - includes the sample well and the channel leading up to the fill mark which is indicated by an arrow. SNAP CLOSURE - The closure creates an airtight seal which is necessary for proper fluid movement within the cartridge SENSORS - Perform the measurement of a patient sample CALIBRANT PACK - Used to perform a one point calibration. 23

Cartridge Handling Carefully tear open the cartridge pouch where indicated. Hold the cartridge by the sides or the bottom Do not touch the sensors or apply pressure to the center of the cartridge. Seal the cartridge by touching only the plastic tab and the sides of the cartridge, fold the snap closure over the sample well. Do not press directly over the sample well. Press the tab until it clicks into place. Slightly lift finger or thumb and ensure cartridge is closed. Push the sealed cartridge into the handheld port until it clicks into place. To avoid permanent damage to the handheld, do not remove cartridge until testing process is complete. The handheld should remain level until a result is obtained. 24

SAMPLE COLLECTION TECHNIQUES i-STAT System may be used with : Arterial samples Venous samples Capillary Samples 25

GENERAL SAMPLE COLLECTION TECHNIQUES ENSURE A QUALITY SAMPLE IS OBTAINED 1. IV LINE – Avoid drawing from an arm with an IV line. -IV solutions dilute sample 2. INDWELLING LINE – Always draw sufficient waste to remove intravenous solutions (Heparin or medications that may cause contamination to the sample.) 3. Tourniquet – If applied for more than 1 minute, release and reapply after 2 to 3 minutes to avoid hemolysis. 4. Avoid extra muscular activity – Clenching and unclenching fist as they may increase POTASSIUM results. 5. Avoid Hemolysis – Always allow residual alcohol to dry - Discard sample from traumatic draw. 26

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