Clinitek Status

POCT

Learning Objectives

Essential criteria for assessment:Present for training sessionPractical Assessment – 1 supervised testShow knowledge and understanding of:

Urine dipping techniqueEntering dataChanging the paperMaintenance Trouble shooting

Understand own continuous development responsibilities tomaintain competency.

What information about the body can we

obtain from urine ?

The parts of the body urinalysis can give us information about include:

KidneyLiver

Urinary Tract InfectionBlood

Carbohydrate metabolismNutritionMuscles

Pregnancy Testing (hCG)

Pregnancy Testing should be performed prior to treatments / Pregnancy Testing should be performed prior to treatments / investigations with risk to foetus/patient. investigations with risk to foetus/patient.

hCGhCG is produced by the embryo and released into the maternal blood stream and eventually excreted in the urine.

hCG blood test is more sensitive than hCGhCG blood test is more sensitive than hCG urine test but the urine test is easier to carry out on a ward.

Concentration of urine varies based on the patients activity level (dehydration) and water consumption (hydration), so the concentration can also vary for hCGhCG even in same individual.

Sample Collection

First voided morning urine is best for routine analysis as it is the most concentrated.

If possible, void directly into a clean, dry container/bedpan.

It is best to test samples immediately. If this is not possible the test must be completed within 4 hours providing the samples are stored in clean plastic containers.

When disposable cardboard containers are used samples must be analysed immediately as containers may leach contaminants into the sample providing incorrect results.

Strip and cassette storage

All strips and cassettes should be ordered from pharmacy storesand be stored on the ward based on the following criteria:

Multistix 10SG & 8SG• Sensitive to moisture in atmosphere – ensure lid is replaced

securely after each test.• Expiry date on side of vial and box.• Store at room temperature.• The difference between the two sets of strips is that the 10SG also tests for

UBG and Billi.

hCG test cartridges• Stored at room temperature.• Expiry date on individual foil wrappers and side of the box.• Sensitive to moisture in atmosphere - ensure foil wrapper is not damaged

prior to analysis.

Potential sources of error are:Stale specimen, Poor technique, Improper recording, Unclean containers, Incorrect storage, No routine Quality Control or Interfering substances.

To combat these Biochemistry POCT ask that ward staff do notdo any of the following:

Touch the test pads.Leave cap off the strips for prolonged periods of time.

Remove the desiccant packet from containers.Take out more strips than required for each patient.

Use out of date strips.

How to analyse a sample

Patient Sample

All urine samples should be checked before being analysed and the flow diagram on the following slide should be followed.

Samples should be:Labelled [3 unique identifiers/addressograph].Freshly expelled from the body.Room temperature [Do not refrigerate].

Samples should not be:Very pale/dilute.Heavily blood stained [<1g/dl Hb]

Multistix Technique

Set the test table up correctly, ensuring the table insert has the strip side is facing upwards.

Completely immerse the reagent strip into the urine.

As you withdraw the sample run the edge against the rim of container to remove any excess urine.

Holding strip horizontally blot the edge on a tissue. Do not draw the strip across the tissue as this may

damage the pads and give incorrect results.

Please try not to bend the strips whilst sampling. A bend in the strip may cause it to get lodged

inside the analyser and prevent it from working.

Place the strip along the centre of the table all the way up to the white line.

Follow the diagrams from slide 14 onwards for details on how to add patient and operator ID.

Clinitest hCG Technique

Set the test table up correctly, ensuring the table insert has thecassette side is facing upwards.

Fill the mini-pipette (found within the foil packet) with enough urine so that the lower of the two bulbs is filled.

Transfer the urine from the mini-pipette into the well of the cartridge ensuring the well is full before beginning sample analysis (may require 2-3 pipettes).

Follow the diagrams from slide 14 onwards for details on how to

add patient and operator ID.

StatusReady 11:36AM 07/09/09

Strip TestCassette Test

InstrumentSet Up

Recall Results

To begin testing select the type of test you wish to carry out from the two selections available.

Operator ID

Last Operator:

Enter NewOperator ID

Press Enter New Operator ID to enter your initials as operator ID.

The last operator will be displayed in the Last Operator box. Repeated Operator ID input will not be required during a clinic.

CA B D E F G H

KI J L M N O P

SQ R T U V W X

.Y Z _ -

Enter Operator ID

12

3

Enter

x

Type in your Operator ID using the onscreen keyboard.

Patient Information

Last Operator:

Enter New Patient

Recall Patient

Enter patient ID by either pressing Enter New Patient or Recall Patient to use the information input on that patient’s last result.

CA B D E F G H

KI J L M N O P

SQ R T U V W X

.Y Z _ -

Enter Patient ID

12

3

Enter

x

If Enter New Patient was pressed type in your Patient ID using the onscreen keyboard.

Select Patient

Select

SHEPPARD, ANDREW ……………………………SMITH-MOORHOUSE, RUPERT…………………COLEMAN, ROB…………………………………….

New Patient

If Recall Patient was pressed use the up and down arrows on the right of the screen to highlight your patient from their last result and press Select.

Prepare Test

Help

START

?

Multistix® 8 SG

Adjust test table insert for strip testsTouch START to begin

Place your test on the table, ensuring that the strip selection [shown in the black box at the top of the screen] matches that of the strips being used, and press START. The test will be analysed after an 8 second wait.

Waste Disposal

Urine samples should be discarded in the sluice and any containers as

are to be disposed of as clinical waste following Trust guidelines.

Multistix strips and cassettes should be disposed in a clinical waste bin.

Troubleshooting

&

Maintenance

Troubleshooting

The majority of the trouble shooting and

maintenance is carried out by Biochemistry

POCT, but there are a couple of things you

can do to help us out.

Maintenance - Cleaning the table

It is recommended that you clean the test table at least once a week by putting it under a running tap, ensuring that the whole table is wet.

Using a tissue thoroughly dry the table ensuring that you don’t touchthe white section with your bare hands as this may affect calibrations.

The test table should be wiped with a dry tissue between each patient.

Check that the calibration strip on the instrument is clean EVERY day.

If the calibration strip is not clean then it should be cleaned using a soft cloth ensuring that you do not scratch it.

Maintenance - Changing the paper roll

From the back of the analyser, lift the white lid at the top up and lower the grey lid just below it down.

Under the white lid there is a grey lever which needs turning upwards through 90° torelease the printer head, with the lever released remove the old roll from the grey section.

The ink is only on one side of the paper, not in the printer and installing the paper incorrectly will result in nothing being printed.

To check which side of the paper the ink is on scratch it with your fingernail. If grey marks are left behind then you’ve scratched the side with the ink on and this side needs to be facing the front of the analyser.

Drop the new roll into the grey section of the analyser and with the loose end follow the back of the analyser and push the paper through the slot at the top. After flicking the lever back down feed the paper through the slot in the white lid and close everything up.

Ordering details

Paper rolls for the urine machines are to be ordered by individual wards and can Beordered by ringing Protech Medical Ltd on01457 852220.

The part number is PT 58/29 The strips are ordered through Pharmacy.

Contacting Biochemistry POCT

For any other problems regarding the Clinitek Status

please contact Biochemistry POCT on:

Ext 22338Rob Coleman 80-2320Andy Sheppard 80-2310Lindsey Riley 80-

2311

Or e-mail us using “Point of Care” on GroupWise.

Quality Control

Biochemistry POCT will run all QC and EQA samples and ward staff are not expected to carry this out for themselves.

QC is run on a 2 monthly basis, this consists of a Positive and Negative solution being run through the analyser.

EQA is run on a 2 monthly basis and consists of a single Sample being run through the analyser.

Auditing

Once every 2 months (at the same time as the QC and EQA) your analyserwill be audited for the following criteria:

Patient ID being correctly inputStrips being in dateAnalysers settings being correct (time, date, strips, etc)General cleanlinessAssociated paperwork present (SOP, Flowchart, etc)Training records kept up to date

A copy of the audit will be sent to matron and ward sister so that theyare aware of how the ward is doing.

If there is cause for concern regarding the machines performance then POCT will let youknow.

An additional yearly audit will be carried out by Siemens.

Key Trainer Responsibilities

Your responsibilities as key trainers are to:

Ensure that every member of ward staff who needs to use the analyser is trained to do so.

Send the details of all members of staff trained on your ward to theemail address “point of care” to be entered onto the database and the electronic staff record (ESR) by POCT staff using the form provided.

Training records need to be kept locally and will be inspected during auditing.

Teaching Resources

All the information you may need (including this presentation) to train your colleagues can be found on the trust website alongside theStandard Operating Procedure.

http://www.pathology.leedsth.nhs.uk

On the website highlight Point of Care in the blue bar along the top of the screen and scroll down to the sections headed Urine Testing and Training Resouces for Key Trainers – Urinanalysis.