Chemistry Analyzers: Bench Workflow
When working in a Clinical Chemistry Laboratory, it is essential to find your groove and get a good workflow going so that you can be as efficient as possible and provide excellent patient care. This is internally very rewarding and the more organized you are, the better and more thorough you can perform your work. The information on this link pertains to the current laboratory I work in and how we typically plan our day and how I perform my workflow. It takes a lot of time and effort to learn and to remember all the steps involved, which is why I create these websites for students and trainees because it is a lot to remember. Having an online atlas to refer to can be very helpful. Not everyone performs their workflow this way and not every laboratory will have the same instruments or equipment, but this is a general outline of basic Chemistry laboratory tools and supplies and workflow.
Your Daily Preparation (Prep):
You should establish your own routine that works for you when you come into work before you start your bench. This aids in organizing your workflow and gives you an overview of the things you need to do to get everything ready before you begin.
- Gather needed supplies, writing tools, paper, notes, etc...
- Check your email for any updates, changes, guidance, or directions for that day
- Wipe down your area with cavicide or bleach wipes or spray (laboratory bench worktop, chair, computer, phone, instruments)
- Check Chemical solutions to see if anything needs to be replaced, updated, replenished, reconstituted, poured up (bleach solution, washes, detergents, etc...)
- Check the instruments for supplies and see what is low or needs to be replaced. Print out the "reagent load list" and jot down notes of all the things that are going to expire or need to be replaced.
- Check the first instrument you plan to work on to see how many patient tests are running and have left to run. Put the instrument in "offline" mode and wait until it is in "ready" status or in "scheduled pause" before beginning to add any supplies, solutions or reagents to the analyzer. In the meantime, you can check your bench supplies.
- Check your supplies and tools on your bench and replenish or wash any needed items:
- sample cups (these are plastic little cups to pour QC and calibrator materials into)
- disposable pipettes
- Falcon tubes (these are plastic test tubes)
- short sample tubes (these are plastic test tubes for smaller sample amounts)
- A1C tubes (these are plastic tubes that are pointed at the bottom)
- Parafilm (to cover samples or seal them)
- bulk reagents, washes, solutions, and the containers they are in
- funnels
- graduated cylinders
- absorbant pads (like paper towels but thicker)
- KIM wipes (dust-free, lint-free wipes to clean or wipe up drops)
- test tube racks
- gloves
- test tube caps
- filters
- sterile urine cups (for deionized water)
- sterile swabs (to clean small parts, probes, pipettors with)
- wooden sticks (to remove bubbles or sample clots)
- staples
- labels
- scissors
- tools
- sample cups (these are plastic little cups to pour QC and calibrator materials into)
- Check trash, Biohazard bins and sharps containers in your area. If they are 75% full, remove the bags, tie appropriately, and discard them in the designated area. Place new bags or bins in your area.
- Our laboratory uses Abbott Architect analyzers. Not every laboratory uses these chemistry analyzers. For these purposes, I will discuss how we prepare our Abbott Architect analyzers:
- Observe the "Plan My Day" tab (reset the time for 24 hours) to see what will be expiring soon, if any calibrations are coming up, if any maintenance is due, etc...
- Go over the "Reagent Load Status" page you printed out. This is a map for the assays on the machine, their positions, names, stability, expiration date, and lot numbers. I like to circle and highlight and write down what needs to be added, removed, replenished and updated on the analyzer.
- SUPPLIES:
- Bulk Reagents: These are the large solutions, such as ICT Fluid, Acid Wash and Alkaline Wash.
- When putting these on, make sure the lot numbers and expiration dates match. If not, it is a different lot and you need to manually enter the two numbers before you update supplies.
- Recap and discard old ones into the Biohazard bin.
- Date opened or onboard and some form of ID to link it to you needs to be put on the reagents.
- If there is a label, peel it off and scan it for inventory purposes.
- When putting these on, make sure the lot numbers and expiration dates match. If not, it is a different lot and you need to manually enter the two numbers before you update supplies.
- Other Solutions: These are solutions you pour into wedges and place on the analyzer, including things like saline (HIL reference), water bath additive, 0.5% acid wash, detergent A, 10% detergent B, and ICT cleaning fluid.
- Remove any bubbles.
- Recap and discard old ones in the Biohazard bin.
- Write the following information on the wedge:
- Name of reagent
- Lot number
- Expiration date on the bottle
- New expiration date once you've opened it
- Date onboard
- Tech number or form of ID
- Storage temperature
- Volume
- Name of reagent
- Use a reagent adaptor if needed
- Remember some of the solutions are diluted so make sure you are using the correct solution and that it is not expired
- NEVER top off an old solution with more new solution or mix old and new solutions or reagents. Always REPLACE them.
- Update or reset supplies and put these in the same positions the old ones were in
- Remove any bubbles.
- Reagent wheel (iSR 8000):
- Falcon Tube in position 32 (Detergent A); Write reagent name, date onboard, and tech number or ID on the tube
- Falcon Tube in position 31 (0.5% acid wash); Write reagent name, date onboard, and tech number or ID on the tube
- Sample Cup: ICT cleaning fluid in position 1; Write reagent name, date onboard, and tech number or ID on the cup
- Discard old ones
- Update Supplies
- Falcon Tube in position 32 (Detergent A); Write reagent name, date onboard, and tech number or ID on the tube
- Bulk Reagents: These are the large solutions, such as ICT Fluid, Acid Wash and Alkaline Wash.
- UPDATE SUPPLIES:
- Instrument needs to be in READY status in order to press this button
- Instrument needs to be in READY status in order to press this button
- Observe the "Plan My Day" tab (reset the time for 24 hours) to see what will be expiring soon, if any calibrations are coming up, if any maintenance is due, etc...
- REAGENTS:
- Determine which reagents need to be removed or added and mark, highlight or write them down.
- On each new reagent, you will write the date onboard and your tech number or ID
- Old reagents need to be recapped and discarded in the Biohazard waste bin.
- Reading the "Reagent Load List":
- Review the stability. If <1 (1 day or 24 hours), remove the reagent and add a new one.
- Review the expiration date to see if anything is about to expire.
- Review the status to see if the reagent is OK, empty, low, expired or disabled. Troubleshoot reasons as needed and come up with a plan about what you are going to do. Is the reagent old? Low? Was QC out?
- Review the number of tests left. Even if it says OK, if a reagent is getting low but does not say it yet, go ahead and add another one or remove/add. Use your judgement based on the reagent recommended addition sheet located in the maintenance book at each analyzer in our particular lab.
- Review and note the lot number and expiration date so you can check right away if the new reagent is a new lot or not.
- New lots require that the information and set points are added to/updated in the analyzer.
- New lots require a lot-to-lot comparison to see if anything has changed (matrix and proteins sometimes do.). Ranges may need to be adjusted.
- New lots require that the information and set points are added to/updated in the analyzer.
- Review the reagent load list names to make sure all reagents are onboard and you aren't missing anything.
- Review reagent positions to make it easier when reloading to put those that have assigned spaces back in the same position.
- Remove any bubbles with wooden sticks.
- Invert those that need to be inverted first.
- Protect reagent bottles from tipping over, from light, from air and moisture and extremes in temperature.
- Look for any residue on bottles that should not be there. This may indicate contamination.
- Make sure reagent bottles are in the correct space for their size or have adaptors if needed and fit snugly in the position.
- Reconstitute any reagents that need to be reconstituted or poured up into new wedges. Some are lyophilized (freeze-dried powders) that need to be reconstituted with pipettes and deionized water.
- Remove old wedges, recap and place in the Biohazard waste bin.
- Scan reagents.
- Carefully replace any removed lids.
- Review the stability. If <1 (1 day or 24 hours), remove the reagent and add a new one.
- Wipe the instrument down and clean up any drips. Wipe the computer and keyboard at the analyzer and the stand as well.
- Perform Daily Maintenance.
- Perform Daily Maintenance.
- Determine which reagents need to be removed or added and mark, highlight or write them down.
- DAILY MAINTENANCE:
- System
- Daily Maintenance
- Perform
- Continue
- Use deionized water and sterile swabs to clean the sample pipettor and R1/R2 probes when prompted
- Continue
- When complete, remove ICT cleaning fluid in sample cup.
- When complete, remove ICT cleaning fluid in sample cup.
- Continue
- Use deionized water and sterile swabs to clean the sample pipettor and R1/R2 probes when prompted
- Continue
- Perform
- Daily Maintenance
- System
- WEEKLY MAINTENANCE:
- Performed weekly (on weekends in our lab)
- Highlighted in maintenance book
- Analyzer computer guides you through the steps
- Performed weekly (on weekends in our lab)
- CALIBRATIONS:
- Check the calibration history and status and "Plan My Day" to see what is about to or has already expired for the next 24 hours
- Order the calibrations. Make sure the lot and expiration dates match what is in the computer. If not, manually enter this information and update set points.
- Print out the Order Status to see which order to put your calibrators on the wheel.
- Put the DET A in position 32, 0.5% acid wash in position 31, then calibrators can go on
- Make sure calibrations are successful and say "active" versus "failed".
- If a calibration fails, reorder it and rerun it.
- If you calibrate anything, you have to order ALL levels of QC afterwards regardless of which one had failed.
- File these calibration sheets.
- If a calibration fails, reorder it and rerun it.
- Make sure any new lots are calibrated.
- Add about 4-5 drops or what is in the package insert or shown on the barcode into sample cups.
- Gently mix the calibrator.
- Calibrators are sensitive to bubbles. Remove all bubbles before running them.
- Calibrators need to be run in sequential order.
- Calibrators are sensitive to date/time.
- Make sure if they have expired you throw them out.
- Get out new ones.
- Write on them the date opened, date they expire, and your tech number or ID.
- When opening a new box, write on it date opened, date expires or circle it, and your tech number or ID.
- Make sure if they have expired you throw them out.
- Calibrators are in amber glass vials to protect them from light.
- Calibrators are refrigerated and sensitive to temperature. Return them to the fridge immediately.
- Make sure calibrations are successful and say "active" versus "failed".
- Leave some form of communication in the form of a note and/or email if something needs to be calibrated or defaulted or updated in the analyzer, which must be in ready status in order to do so.
- Put your machine back into running once your wheel is on and ready to run calibrations.
- ALWAYS pour calibrations up in order. For this reason, I like to write on the sample cup what I am pouring up.
- AVOID bubbles.
- Check the calibration history and status and "Plan My Day" to see what is about to or has already expired for the next 24 hours
- QUALITY CONTROL (QC):
- Make sure calibration was successful
- Get QC material out of refrigerator.
- Throw out any old/low/expired QC and thaw any new QC needed.
- Needs to thaw about an hour
- Gently mix
- Write on the QC bottles the date opened, date expires, and your tech number or ID
- Write on the QC bottles the date opened, date expires, and your tech number or ID
- Needs to thaw about an hour
- Put DET. A in position 32, 0.5% acid wash in position 31, then QC can be loaded.
- Configure any new lot QC or set points
- Default the lot
- Add amount of drops required from package insert or listed on barcodes
- Immediately put QC back in fridge when complete.
- Use a special form to fill out and perform any lot-to-lot comparisons.
- Use a special form to fill out if blind sampling is required.
- Use a special form to fill out if analyzer troubleshooting is required or Abbott Technical Support is required.
- Make sure calibration was successful
- AS NEEDED MAINTENANCE:
- Cuvette wash
- If the lid is bumped or the light is not solid green when it is opened or it prompts you to do so, then perform a cuvette wash, which takes about 20-25 minutes.
- Instrument will be in STOPPED mode
- Initialize
- Will be in READY mode
- Put back into RUNNING when cuvette wash is done
- Put back into RUNNING when cuvette wash is done
- Will be in READY mode
- Initialize
- Instrument will be in STOPPED mode
- If the lid is bumped or the light is not solid green when it is opened or it prompts you to do so, then perform a cuvette wash, which takes about 20-25 minutes.
- Other
- Cuvette wash
- FAILED QC:
- RSV (repeat with same vial)
- RNV (repeat with new vial)
- RNV (repeat again with new vial of fresh or thawed QC)
- Calibration performed (calibrate the assay) then RNV
- Troubleshooting
- IF a new lot test is being run, you can choose "Supervisor to review and establish a mean"
- Reorder all levels of QC if you calibrated something. Reorder the failed level if you did not calibrate.
- Log all information on the maintenance log book and QC worksheet and be sure to update it as you retest/rerun and when it comes back in.
- IOM Computer:
- Disable/Enable QC tests and SAVE/refresh
- Overview: put instrument back online when 1st QC run is complete and as you rerun the QC that was out.
- See if you need to blind sample anything or perform a comparison, precision test, or repeat.
- Disable/Enable QC tests and SAVE/refresh
- Blind Sampling:
- Rerun patient samples run on the assays of the failed QC since the previous QC run (check the date/time) and highlight/print them out then pull them off the track.
- Use sample cups to assign them a random number or name when you program them, but run exactly as you would a patient sample.
- Print out results
- Fill out the special form required.
- Print QC results from the previous run to the current run that is back in and attach it to a maintenance form with all the troubleshooting listed on it.
- Rerun patient samples run on the assays of the failed QC since the previous QC run (check the date/time) and highlight/print them out then pull them off the track.
- RSV (repeat with same vial)
- TROUBLESHOOTING: