Sysmex i2000 – CBC Analyzer

Standard Operating Procedures^[1]

A. Running Maintenance

1. Check all reagent levels/expiry dates and lot numbers on the instrument.
   • Check all reagents to ensure there is sufficient supplies for the day.
   • On the main screen click ‘Controller’ and then click on “reagent replacement’.
   • Highlight the reagent and document the lot number and expiry on the maintenance sheet.
2. Dust all exterior surfaces with distilled water.
   • Apply a little distilled water to a wipe or gauze and whipe down the entire outside surface of the analyzer.
   • Discard the towel in the appropriate waste container (yellow biohazard bucket).
   • Also wipe out the left and right rack pools.
   • Clean the drip tray located under the aspiration probe.
   • If contaminated with blood it must be disinfected.
3. Perform an auto-Rinse.
   • On the main screen press Auto rinse icon to perform the test.
   • The analyzer will go through a series of checks to make sure it is functioning properly.
   • This will take a couple of minutes.
4. Empty the liquid waste located under the bench on the back side of the analyzer.
   • Carefully remove the cap with the waste line hose and place it in the small container provided.
   • Carefully carry the waste to the ‘dirty sink’ and turn on the water.
   • Slowly pour it down the sink. Let the water run for a few minutes to help flush the waste properly.
   • Return the waste container to the analyzer and make sure the cap/hose is securely fastened.
5. Check the sample racks.
   • Examine all the sample racks to make sure there are no defective units.
   • Any broken units could cause the racks to jam up and damage the analyzer.
   • Make sure there is no blood on the racks and if there is they must be decontaminated before use.

B. Running QC

Manufacturer’s controls (e-check) must be run at least once per day (24 hours) and is usually done following maintenance. Most labs may run these controls every shift. Manufacturers controls are stored in the fridge and cannot be used beyond the expiry date indicated on the vial. When controls are opened, the date, time and initials of the technologist who opened it must be noted on each vial.

1. Bring the three e-check manufactures controls up to room temperature before running (15-30 minutes).
2. Verify the lot numbers and expiry dates of the e-check controls.
3. Hand mix the controls using the proper process. Mix by hand (one at a time) as follows:
   • Roll the tube slowly between the palms of the hands eight times in an upright position.
   • Invert the tube and slowly roll it between the palms eight times.
   • Gently invert the tube eight times.
4. Place the control vials in the CBC rack with the barcodes facing outward and visibly seen in the open area so the barcode reader can read the identifying information.
5. Place the rack of tubes onto the loading zone on the right-hand side of the analyzer, making sure that the labelled bar codes are facing in towards the analyzer.
   • Ensure the notch on the sample rack fits on the notch on right side of the sample loading area.
6. Double click on the “Sampler” icon, depicted by a rack of tubes. This will open-up a box.
7. In the “sampler NO” section place the name of your lab group.
   • Or add your name/initials if working by yourself.
   • Do NOT change any other values in the rack # or tube position.
8. Under the “Discrete” section, click on the test(s) that you are performing.
   • For controls you will always be running a CBC and Diff unless you are informed otherwise.
9. Press “start sampler” and the analyzer will start moving the rack forward and then to the left.
   • Press OK to the box that pop’s up to verify the data you have entered.
   • The rack will be taken into the instrument and analyzed one at a time.
   • When the analysis is complete the rack will be ejected.
10. Remove the rack of samples from the left-hand side of the analyzer, once all samples have been aspirated.

Reviewing QC Results

1. Click the QC icon on the top tool bar. This will open the QC file for review.
2. Select Level 1 from the drop-down box to open the QC data for that level.
   • On the right side of the screen scroll to the top of the screen.
   • Each CBC parameter will be listed on the left side of the list along with the mean and acceptable range.
   • This screen also displays the lot information and expiry.
3. The most recent running should be plotted on the right of Levey Jennings graph.
   • Confirm this by checking the date/time of the running at the top of the data display.
4. An individual data point will be displayed by a dot on the graph.
   • If the QC was outside acceptable limits a red X will be displayed.
5. Scroll down on the right side of the screen to ensure each parameter is within acceptable range.
6. Repeat this process for each level of QC.
7. NOTE: All control values must be within acceptable limits before patient samples are analyzed.
   • Let your instructor know if you QC results are not acceptable.
   • Typical process is you must rerun the control.
   • If control values are still not acceptable, then you will need to open a fresh control and rerun.
   • If still not acceptable then you must follow-up with some troubleshooting to identify the cause, before continuing to use the analyzer.

c. Running Patients

Running Patient Samples (Manual/Single Presentation) Mode

1. If the patient’s specimen is accompanied with a requisition, make sure all information matches correctly.
   • Patient’s name, DOB, HCN and MRN
2. On the main screen in the Upper left corner of the tool bar click on the manual icon depicted by a hand holding a tube.
   • This will open the drop-down box.
3. In the “sampler NO” section type in the patient’s MRN number followed by your initials. (Example: 12345 EM).
4. Under the “Discrete” section, click on the test(s) that you are performing, as requested.
5. Once the patient information is entered press start sampler and the instrument will prepare itself for manual aspiration.
6. Using gauze, carefully uncap the patient blood sample and submerge the secondary aspiration probe into the blood.
7. Press the green button behind the probe and the analyzer will aspirate the blood (150uL).
   • When finished, you will hear a beep and then you can remove the probe from the sample.
   • If you do not hear the beep, then the automatic probe wash will gently move your hand away, as it washed the probe.
8. Carefully recap the tube.
9. To view patient results you can double click on the explorer icon (magnifying glass) on the top tool bar and then highlight the sample you want to view.
   • The most recent samples will be at the top of the list.
   • The results can be seen on the right side of the screen.
   • To view your results up in the Browser, highlight the patient and double click.
10. There is no printer, so you will have to manually transcribe the patient’s information from the tube and the results from the screen, on the worksheet entitled, “Waterfront Hospital Hematology Laboratory Report Form: CBC”.
11. Sign and date on the worksheet and attach it to the patient’s lab report.