Clinitek Status

1. Clinitek Status POCT

2. Learning Objectives Essential criteria for assessment: Present for training session Practical Assessment – 1 supervised test Show knowledge and understanding of: Urine dipping technique Entering data Changing the paper Maintenance Trouble shooting Understand own continuous development responsibilities to maintain competency.

3. What information about the body can we obtain from urine ?

4. The parts of the body urinalysis can give us information about include: Kidney Liver Urinary Tract Infection Blood Carbohydrate metabolism Nutrition Muscles

5. Pregnancy Testing (hCG) Pregnancy Testing should be performed prior to treatments / investigations with risk to foetus/patient. hCG is produced by the embryo and released into thematernal blood stream and eventuallyexcreted in the urine. hCG 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 hCG even in same individual.

6. 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.

7. Strip and cassette storage All strips and cassettes should be ordered from pharmacy stores and 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. 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.

8. 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 not do 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.

9. How to analyse a sample

10. 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]

12. 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.

13. Clinitest hCG Technique Set the test table up correctly, ensuring the table insert has the cassette 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.

14. Status Ready 11:36AM 07/09/09 Instrument Set Up Recall Results Cassette Test Strip Test To begin testing select the type of test you wish to carry out from the two selections available.

15. Operator ID Last Operator: Enter New Operator 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.

16. Enter Operator ID 1 2 3 A B C D E F G H I J K L M N O P Q R S T U V W X x Y Z . _ - Enter Type in your Operator ID using the onscreen keyboard.

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

18. Enter Patient ID 1 2 3 A B C D E F G H I J K L M N O P Q R S T U V W X x Y Z . _ - Enter If Enter New Patient was pressed type in your Patient ID using the onscreen keyboard.

19. Select Patient SHEPPARD, ANDREW …………………………… SMITH-MOORHOUSE, RUPERT………………… COLEMAN, ROB……………………………………. New Patient Select 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.

20. Prepare Test Multistix® 8 SG Help Adjust test table insert for strip tests Touch START to begin ? START 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.

21. 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.

22. Troubleshooting & Maintenance

23. 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.

24. 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 touch the 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.

25. 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° to release 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.

26. Ordering details Paper rolls for the urine machines are to be ordered by individual wards and can be ordered by ringing Protech Medical Ltd on 01457 852220. The part number is PT 58/29. The strips are ordered through Pharmacy.

27. Contacting Biochemistry POCT For any other problems regarding the Clinitek Status please contact Biochemistry POCT on: Ext 22338 Rob Coleman 80-2320 Andy Sheppard 80-2310 Rupert Smith-Moorhouse 80-2311 Lindsey Riley 80-1801 Or e-mail us using “Point of Care” on GroupWise.

28. 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.

29. Auditing Once every 2 months (at the same time as the QC and EQA) your analyser will be audited for the following criteria: Patient ID being correctly input Strips being in date Analysers settings being correct (time, date, strips, etc) General cleanliness Associated 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 they are aware of how the ward is doing. An additional yearly audit will be carried out by Siemens.

30. 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 the email address “point of care” to be entered onto the database and the electronic staff record (ESR) by POCT staff using the form provided.

31. Teaching Resources All the information you may need (including this presentation) to train your colleagues can be found on the trust website alongside the Standard 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.