A25 User Manual English USER MANUAL English TEUS00015-00-ING January-2005 User Manual 2 Dear Customer, Thank you for purchasing our A25 automatic analyser. We are sure that its specifications will make it a valuable instrument in your laboratory. Although its operation and use is logical and straightforward, using a programme that runs under Windows, please read this manual carefully. It will help you with both installation and correct programming, use and maintenance of the instrument, enabling you to get maximum performance from its multiple possibilities. 3 User Manual 4 TABLE OF CONTENTS Introduction .............................................................................6 1. Description of the instrument ............................................7 1.1. Components ............................................................................................................... 7 1.1.1. Operating arm ............................................................................................................................. 7 1.1.2. Dispensing system ...................................................................................................................... 7 1.1.3. Reactions rotor and reading ..................................................................................................... 8 1.2. Working theory ........................................................................................................... 9 1.3. Start-up ....................................................................................................................... 9 1.4. Functional specifications .......................................................................................... 9 2. General operation method................................................ 12 2.1 Program Installation .................................................................................................. 12 2.2. Operation procedure ................................................................................................ 12 2.2.1. Introduction ............................................................................................................................... 2.2.2. Start-up procedure, operation and shutdown. ...................................................................... 2.2.3. Monitor ...................................................................................................................................... 2.2.4. Programming ............................................................................................................................ 2.2.5. Save/load test file ..................................................................................................................... 2.2.6. Preparation of the work session ............................................................................................. 2.2.7 Memorising sessions .............................................................................................................. 2.2.8. Current results........................................................................................................................... 2.2.9. Current and past alarms .......................................................................................................... 2.2.10. Past results .............................................................................................................................. 2.2.11. Patient data ............................................................................................................................. 2.2.12. Configuration .......................................................................................................................... 2.2.13. About ........................................................................................................................................ 2.2.14. Utilities ..................................................................................................................................... 2.2.15. Internal quality control .......................................................................................................... 12 13 14 16 21 21 25 25 26 26 27 28 30 30 32 3. Calculation and measurement procedures ..................... 35 3.1. End point................................................................................................................... 36 3.1.1. Absorbance ............................................................................................................................... 36 3.1.2. Concentration ........................................................................................................................... 36 3.1.3. Replicates .................................................................................................................................. 36 3.2. Bireagent differential ................................................................................................ 37 3.2.1. Absorbance ............................................................................................................................... 37 3.2.2. Concentration ........................................................................................................................... 37 3.2.3. Replicates .................................................................................................................................. 37 3.3. Fixed time .................................................................................................................. 37 3.3.1. Absorbance ............................................................................................................................... 37 3.3.2. Concentration ........................................................................................................................... 38 3.3.3. Replicates .................................................................................................................................. 38 3.4. Kinetics ..................................................................................................................... 38 3.4.1. Variation of the absorbance per unit of time ......................................................................... 38 3.4.2. Concentration ........................................................................................................................... 39 3.4.3. Replicates .................................................................................................................................. 39 5 User Manual Introduction The A25 analyser is an automatic analyser for random access In Vitro Diagnosis specially designed for performing biochemical and turbidimetric clinical analyses.The instrument is controlled on-line in real time from an external dedicated PC. The analyser performs patient-by-patient analyses and enables the continual introduction of samples. The results are shown immediately after each measurement. The high-speed preparation of the reactions makes it ideal for medium-capacity automated laboratories. The flexibility of the samples and reagents racks system enables the perfect adjustment of the capacity of the analyser to the specific needs of each laboratory. diluted. The analyser automatically orders the tests of each patient to avoid incompatibilities between reagents and to optimise performance. From the Monitor screen, which is particularly graphic, the analyser keeps the user informed about its functioning status and the result-obtaining process. All these characteristics, together with the variety of possible analysis modes (final monoreagent or bireagent point (monochromatic or bichromatic), bireagent differential, fixed monoreagent or bireagent time and monoreagent or bireagent kinetic), make the A25 analyser an instrument that is highly versatile and effective for clinical analysis laboratories. In each of the elements of the A25 analyser, BioSystems has used leading edge technology to obtain optimum analytical performance, as well as taking into account economy, robustness, easy use and maintenance. A threeaxis Cartesian operating arm prepares the reactions. Dispensing is performed by means of a pump with a ceramic piston via a detachable thermostatised needle with Fuzzy Logic control. A washing station guarantees that the needle is kept perfectly clean throughout the process. The reactions take place in a thermostatised rotor in which absorbance readings are taken directly by means of an integrated optical system. The elaborate computer programme enables the easy control of the extensive functionality of the analyser. The user interface is flexible, simple and very graphic, clearly separating the daily routine tasks from the less frequent tasks. All the data and results are stored securely, with the possibility for exportation. Various initialisation, functioning and shutdown options can be configured for the analyser. The user can programme an indefinite number of measurement procedures (techniques), technique profiles and reagent racks, depending merely on the computer’s hard disk capacity. The analyser works with 5 sample types: serum, urine, plasma, cerebrospinal and supernatant liquid. Each measurement procedure can be adapted to each one. During a work session, the user can continually introduce normal or urgent samples in the analyser without interrupting the measurements in progress. The samples may be pre6 1. Description of the instrument The A25 analyser prepares the reactions by means of a three-axis Cartesian operating arm. This arm supports and displaces a dispensing needle which pre-thermostatises the preparations at 37º. The dispensing is carried out by means of a low-maintenance ceramic piston pump. The analyser can carry out one preparation every 15 seconds. The preparations are dispensed in a reactions rotor thermostatised at 37ºC. The optical absorbance readings are taken directly on this rotor. of the instrument. If the user wishes to manually move the arm to its resting position, he or she must ensure that the needle is at its highest position. For this, it must be raised completely by pressing the vertical chain of the operating arm upwards as shown in the photograph. The return system prevents the needle from descending and the user can then move the arm with no danger of damaging the needle or injuring him or herself on it. The operating arm only makes the preparations if the general cover of the analyser is closed. If the cover is raised while it is functioning, the arm automatically aborts the task in progress and returns to its parked position to avoid injury to the user. 1.1. Components The A25 analyser is made up of three basic elements: the operating arm, the dispensing system and the reading and reactions rotor. 1.1.1. Operating arm This is a three-axis XYZ Cartesian mechanism. The X and Y axes move the dispensing needle over the analyser horizontally and the Z axis moves it vertically. It is operated by three step-by-step motors. In each 15-second preparation cycle, the operating arm performs the following actions: first of all, it sucks in the reagent from the corresponding bottle. Next, the needle is washed externally in the washing station and sucks in the sample from the corresponding tube. It is washed externally again and dispenses the sample and the reagent into the reactions rotor. Finally, it is exhaustively washed internally and externally before proceeding with the next preparation. The arm has a system for controlling vertical movement to detect whether or not the needle has collided into anything on descending. If a collision occurs, as may be the case if, for example, a lid has been left on a bottle of reagent, the arm automatically restarts, verifies the straightness of the needle and continues working issuing the corresponding alert to the user. A return system on the vertical axis automatically raises the needle in the case of a power failure, preventing it from descending and colliding with an object at the bottom or with the housing 1.1.2. Dispensing system This system consists of a thermostatised needle, supported and displaced by an operating arm and connected to a dispensing pump. The needle is detachable to enable cleaning and replacement. The analyser has capacity level detection to control the level of the bottles and tubes and prevent the needle from penetrating too far into the corresponding liquids, thus minimising contamination. An automatic adjustment system informs the user if the needle is not mounted or if it is too bent. The needle has a sophisticated Peltier thermostatisation system, with Fuzzy Logic control, capable of thermostatising the preparations at approximately 37º in less than 6 seconds. Dispensing is carried out by means of a low maintenance ceramic piston pump driven by a step-by-step motor. It is capable of dispensing between 3 and 1250 µL. The dispensing system of the analyser uses system liquid which the user must prepare by adding 6 ml of concentrated system liquid supplied with the analyser to the corresponding container filled to the top with distilled water (approx. 2700 ml). Analyses must never be made using distilled water only in the dispensing system, since the analytical performance and the lifetime of the system may notably be lowered. The exterior of the needle is kept constantly clean by means of a washing station, which consists of a font specially 7 User manual take the optical reading is 200 µl. The wells have a maximum useful capacity of 800 µl. When the reactions rotor is completely full, the user must change it for one that is empty, clean and dry. The reactions rotors may be reused if they are appropriately cleaned immediately after use. The Cleaning the semi-disposable reactions rotor section in the Installation and maintenance manual describes how to clean the rotors. The rotors must be rejected if they are noticeably deteriorated. The user has a test in the computer programme, which he or she may use to check the condition of the rotor. The rotor is driven by a step-by-step motor with a transmission. A Peltier system with PID control thermostatises the rotor at 37ºC. designed to clean and dry the needle, integrated in the racks tray. A system of membrane pumps supplies the font with system liquid and transports the waste to its container. The A25 analyser has a tray with 6 free positions for racks of reagents or samples, plus three fixed positions for bottles opposite the washing station. Each reagents rack can carry up to 10 reagents in 20 ml or 50 ml bottles. Each samples rack can contain up to 24 tubes of samples. The samples can be patients, calibrators or controls. The analyser can be configured to work with 13 mm or 15 mm diameter tubes of samples with a length of up to 100 mm or with paediatric wells. Any possible configuration of racks can be mounted An optical system integrated in the rotor takes the readings directly on the reaction wells. The light source is a 20 W halogen lamp. The detector is a silicon photodiode. The wavelength is selected by a drum with 9 positions available for optic filters. The filters are easily changed by the user from the exterior of the analyser, without the need for disassembling the filter drum. A step-by-step motor positions the drum. The optical system is capable of taking 5 readings per second, with or without a filter change in between. The light beam of the lamp passes through a compensated interferential filter to select the desired wavelength and through focalisation lenses. It then passes through the rotor well and finally reaches the photodiode, where the light signal is turned into an electric signal. A sophisticated analogical digital integrator-converter system converts the electric signal into a digital value with which the analyser obtains the absorbance values. The optical system continues to work when the general cover of the analyser is open, whereby the analyser can continue to take readings while the user handles, for example, the sample tubes or the reagent bottles. The rotor cover must be in place for the optical system to work correctly. A detector tells the analyser of the presence of said cover. The analyser aborts the readings if the user removes the rotor cover while the optical system is taking photometric measurements. If the rotor is not covered, the analyser informs the user so that he or she places the rotor cover when it sends samples to be analysed. The analyser also issues an alert if there is no reactions rotor in it. from 1 rack of reagents (10 reagents) and 5 racks of samples (120 samples) to 5 racks of reagents (50 reagents) and 1 rack of samples (24 samples). Any reagent may be placed in the fixed positions, but it is recommendable to use them for the bottles of distilled water, saline solution for the automatic pre-dilutions and washing solution. The rack tray detects and identifies the type of racks. In this way, if the physical disposition of the racks does not coincide with that programmed on the computer, the analyser alerts the user. On the left of the analyser are system liquid containers (marked in blue) and waste containers (marked in red). The analyser constantly controls the level of these containers and issues the appropriate alerts if the system liquid is nearly empty or if the waste container is full. 1.1.3. Reactions rotor and reading The preparations are dispensed in an optical quality methacrylate reactions rotor thermostatised at 37ºC. The optical absorbance readings are taken directly on this rotor. Each reaction can be read for 15 minutes. The readings are taken as they are programmed in each measurement procedure. The reaction wells have been designed to enable the mixture of the sample and the reagent during the dispensing. Each rotor has 120 reaction wells. The length of the light path is 6 mm. The minimum volume required to 8 1.2. Working theory section for routine start-up. The analyser must be in standby mode, i.e. plugged into the mains and with the switch in the (I) position. The computer must be started up and the programme launched. From the Monitor screen of the programme, click on the Warm up button to start initialisation. The analyser automatically carries out all the checks required for correct functioning and continually informs of its status through this screen. No manual adjustment is necessary. If, for any reason, user intervention is necessary, the analyser issues the corresponding alert through the computer. Once warm-up has finished, the analyser is in standby mode, ready for work. The A25 analyser is an automatic random access analyser specially designed for performing biochemical clinical analyses. The analyser performs patient-by-patient analyses and enables the continual introduction of samples. The analyser is controlled from a dedicated PC that is permanently communicated to the instrument. The programme, installed on the computer, keeps the user constantly informed of the status of the analyser and the progress of the analyses. As results are obtained, the computer shows them to the user immediately. When a Work Session is begun, the analyser proposes performing the blanks, calibrators and controls programmed for the measurement procedures it is to carry out. The user may choose between performing the blanks and the calibrators or not. If they are not performed, the analyser uses the last available memorised data. The controls can also be activated or not. During a session, while the analyser is working, the user can introduce new normal or urgent samples to be analysed. Each time a new sample is added, the analyser automatically proposes the possible new blanks, calibrators or controls to be performed. A work session can remain open for one or more days. When a session is closed and another new session is opened (Reset Session), the analyser again proposes performing the blanks, calibrators and controls. It is recommended that the session is reset each working day. 1.4. Functional specifications All the functions of the analyser are controlled from the programme installed on the computer. This programme has a flexible, simple and highly graphic interface, with a clear separation between routine and less frequent tasks. Its flexibility makes routine use of the analyser extremely simple. It is also possible to access numerous functions to fully customise the functioning of the analyser. All the data and results are stored securely, with the possibility for exportation. The configuration and programming data can be easily updated or stored. The analyser determines the concentrations of the analytes based on optical absorbance measurements. To measure the concentration of a certain analyte in a sample, the analyser uses a pipette to take a specific volume of the sample and the corresponding reagent, quickly thermostatises them in the needle itself and dispenses them into the reactions rotor. The very dispensing speed together with the geometry of the reaction well causes the mixture to be shaken and the chemical reaction begins. In the bireagent modes, the reaction begins when the analyser later dispenses a second reagent in the same reaction well. The reactions can be biochemical or turbidimetric. In both cases, the reaction or the chain of reactions produced generate substances that attenuate certain wavelengths, either by absorption or by dispersion. Comparing the light intensity of a certain wavelength that crosses a well when there is a reaction and when there is not a reaction can determine the concentration of the corresponding analyte. This comparison is quantified with the physical magnitude called absorbance. In some cases, the concentration is a direct function of the absorbance, and in other cases, it is a function of the variation of the absorbance over time, depending on the analysis mode. Power off Sleeping Shutdown Stand by Running Sampling Stop 1.3. Start-up Once the analyser has been installed, it can be started up. The steps to be followed for the first start-up are the same as those indicated in the Start-up and shutdown procedure Alarm Mode 9 Warming up User manual - Several calibrators (Multipoint calibrator). This can be specific (for a certain test) or multiple (common for several tests). Up to 8 points and up to 3 replicated points for each one. Calculation of the Calibration Curve (spline, linear regression, quadratic or polygonal regression, with linear or logarithmic axes). STATUSES OF THE ANALYSER - Sleeping Mode: The analyser is connected to the mains with the switch in (l) position, but it is not working. The analyser can be left in this status indefinitely. Power consumption is minimal - Warm-up: Transitory status during which the analyser initialises all its elements and performs the checks required to be able to begin analyses. Once warm-up has finished, the analyser is in standby mode, ready for performing analyses. PROGRAMMING - Tests: unlimited number, depending on the hard disk capacity of the computer. Programmable for 5 sample types: serum, urine, plasma, cerebrospinal and supernatant liquid. - Shutdown: Transitory status during which the analyser appropriately switches off all its elements to maintain them in optimum condition for future analysis work. Once finalised, the analyser is in standby mode. - Test profiles: unlimited number, with an unlimited number of tests. - Standby mode: The analyser is in communication with the PC. If the initialisation process has taken place, the analyser is ready to perform analyses. - Multiple calibrators: up to 10. - Multiple controls: up to 20. - Running Mode: The analyser is performing analyses (preparations and readings or readings only if there is no preparation pending). - Contaminations: unlimited number. - Reagent racks: unlimited number. - Sampling stop: The analyser can be taking readings, but the operating arm is parked and the pending reactions are not prepared. In this status, the user can handle the bottles and containers of the analyser with no risk, in order to, for example, add a new sample. OPERATION MONITOR SCREEN - Warm-up and shutdown process of the analyser . - Cancellation of the preparations and readings in process (Abort) - Alarm Mode: If during any of the operations, an anomaly occurs requiring the intervention of the user and whose correction is essential for the process to continue, the analyser enters alarm mode and issues the corresponding alert through the PC. - Real-time monitoring of the status of the analyser and development of the work session. Display of the tasks sent to the analyser and the advance of their execution. - Mains disconnection: Switch (0) (Power Off): The switch is in the (0) position. The analyser is completely off. It can then be disconnected from the mains. - Access to the results of the measurements, with the possibility of automatic printing. - Alerts and alarms. Access to detailed explanations. ANALYSIS MODES - Access to introduction of new samples at all times. - Final point. Monoreagent or bireagent. Monochromatic or bichromatic. - Interruption and renewal of the preparation of reactions (Sampling stop / Continue). - Bireagent differential. - Fixed time. Monoreagent or bireagent. PREPARATION OF THE WORK SESSION - Kinetic. Monoreagent or bireagent. Readings every 15 s, up to 15 min Linear regression analysis, with linearity evaluation. Automatically extracted kinetic blank. - Sample types: Normal patient, urgent patient, blank, calibrator and control. - One patient can have up to 5 different types of samples. - Easy allocation of the tests and profiles to be performed on one or several samples. CALIBRATION TYPES - Factor - Up to 50 replicates for patient samples. Up to 3 replicates for blanks, calibrators and controls. - Single calibrator (Single-point calibrator). This can be specific (for a certain test) or multiple (common for several tests). 10 CONFIGURATION - Automatic allocation of blanks and calibrators. Possibility of storing the results of blanks and calibrators. - Partial or total sending of work to the analyser. - Options of the user programme (languages, printing, reports). - Possibility of introducing patient data while the analyser is performing the analyses. - Options for the functioning of the analyser (washing, sample tubes, filter drum, cover detection, rack detection). - Automatic selection of the reagents required and indication of the minimum required volumes. UTILITIES - Analyser test, preparation and maintenance utilities (needle disassembly, supply, washing, rotor verification, lamp change, PC-analyser communications, demonstration). - Graphic, automatic or manual allocation of sample and reagent positions in the racks. - Printable summary of positions to enable the positioning of the samples and the reagents in the racks. - Verification of the correspondence of the programmed racks with the racks of the analyser. QUALITY CONTROL - Analytical limitations control for each test: blank, linearity, detection, factor. - Automatic reordering of the tests of each sample to optimise work and avoid contamination between programmed tests. - Internal quality control with up to 2 control materials per test. Manual or statistical calculation. Levey-Jennings graphics and Westgard algorithm. - Automatic verification of the resources available on the analyser to be able to proceed with the required analyses. Issuing of alerts with instructions for the user if his or her intervention is required. PROCESSING OF RESULTS - Current or historical reports, by patients or test, with possibility of repetition to confirm results. - Current or past reports, by patients or by tests. - Patient database. - Internal quality control reports. - Alarm and alert records. - Exportation of results. 11 User manual 2. General operation method This chapter gives the basic instructions for using the instrument. Although the operation of the analyser is very simple and intuitive, it is recommended you read this chapter carefully to make the most of its features effortlessly and as quickly as possible. corresponding blanks, calibrators and controls. The user can choose to perform them or reuse the data from the previous session. Until the work session is restarted, the analyser will not propose the repetition of the blanks, calibrators and controls that have already been carried out, even if the analyser is switched off, maintaining all the information of the session in progress. To obtain maximum quality of the analytical results, it is recommended that you perform all the corresponding blanks, calibrators and controls in each working day. This implies restarting the work session daily and always choosing to perform new blanks, calibrators and controls. 2.1 Program Installation For the program installation, you must carry out the following steps: a) Initiate the computer b) Uninstall the old version with the Windows option Add and Remove programs c) Insert the D-ROM with the new version. d) Press Start, select Execute and write: name of the CDROM unit:\setup (for example: D:\Setup). Once the samples have been introduced, the user must allocate positions to the samples and to the required reagents and physically place them in the analyser. The Positions screen distributes the samples and the reagents in the different racks of the analyser tray. This distribution can be made automatically or manually. From version 2.5.0, the program keeps a copy from all the data files of the previously installed version, in the subdirectory \previous of the application directory (generally c:\program files\A25). Should there be an error during installation, the user can install the previous version again and recover the old data. Follow the steps to recover a previous version: As soon as the required elements have been distributed, the work session can be started. The Monitor screen is automatically displayed, containing a summary of the main information received from the analyser and showing the progress of the work session. From this screen, it is possible to access other screens that offer more detailed information about results and alarms. The user can cancel the work session if he or she detects that the results are incorrect. a) Uninstall the version of the problem. Do not erase the created subdirectories or the files generated by the application. b) Install the previous version c) Execute it. When initiating the application, it will restore the old data files. This process will solely be made from version 2.5.0 on. At any moment, the user can introduce urgent samples or add new normal samples to the work session in progress from the Introduction of new samples screen without losing the information of the samples that have been sent previously. If the sample is normal, it is added at the end of the list. If it is urgent, and there are no other urgent samples in progress, the current sample is interrupted and the urgent one is introduced in first place. If there are already other urgent samples, it is added to the end of the group of urgent samples. If a new sample is added, with a test that has not yet been performed in the current session, the analyser will propose new corresponding blanks, calibrators and controls. The user again has the possibility of choosing whether to perform them or not. 2.2. Operation procedure 2.2.1. Introduction The operation of the analyser is flexible and simple using the user programme from the dedicated PC. This programme is subdivided into different screens that provide specific functionality. They are described in more detail in the following sections. The system can automatically block samples or tests in accord with the information received from the analyser. This can happen, for example, when a sample or a reagent has run out. When the user corrects the problem and notifies the analyser from the Positions screen, the blocked samples or tests are automatically unblocked and the affected samples are turned into pending samples, and are analysed later. Firstly, the user must switch on the analyser and launch the user programme, and warm up the analyser from the Monitor screen. To start a work session, the samples that are to be analysed must be introduced through the Introduction of New Samples screen, indicating the measurement procedures desired. Each measurement procedure or test is defined by a set of parameters that can be programmed by the user from the Tests programming screen. The user can access the results as they are obtained and print the results of the patients whose tests have already finalised. In accord with the tests to be carried out, the analyser automatically proposes the performance of the The basic screens of the user programme are as follows: 12 - Monitor screen: Main screen that appears when the user programme is launched. It displays the status of the analyser and the work session in progress. It lets the user intervene in the progress of the work session. It contains the main buttons for controlling the analyser. issues the corresponding alert through the computer. Once warm-up has finished, the analyser is in standby mode, ready for work. Once the work session has been prepared from the corresponding screens and warm-up has finalised, click the Start button on the vertical bar for the analyser to start performing the analyses. On beginning the analyses, the analyser enters running mode. If during the running mode you wish to physically introduce a sample or a reagent in the analyser, click on the Sampling Stop button on the vertical bar menu and the analyser enters running mode with readings only, without the preparation of samples (Sampling stop). The user can then raise the cover and place the sample or reagent in safety. Closing the cover and clicking on the Continue button on the same bar, the analyser returns to running mode. When the analyser ends the analyses, it automatically returns to standby mode. If you wish to abort the preparation of new reactions as well as the readings in progress, click on the Abort button located on the same bar. In this case, the analyser requests confirmation and, if the response is affirmative, it aborts the preparations and readings in progress, and returns to standby mode. - Programming screens: These enable the programming of tests, profiles, multiple calibrators, multiple controls, contaminations and reagent racks. - Work session preparation screens: These enable the preparation of the work session and the storage of data that may be used in later sessions. Basically, the user can introduce new samples to be analysed and position the corresponding samples and reagents in the analyser. - Results screens: These make it possible to view the results and see and print the reports with the results obtained in the current or previous sessions. The reports can be organised by patients or by tests. It also allows managing sample repetitions - Alarms screens: These give detailed information about the alarms and alerts occurring in the current session or in previous sessions and enable the printing out of reports. - Patient data screen: This enables the introduction and modification of the patient data sent to the analyser. To switch off the analyser, click on the Shutdown button on the vertical menu bar from standby mode. The programme asks for confirmation and if the response is affirmative, it performs the shutdown sequence and returns to sleeping mode. The analyser can be left in this status indefinitely. Power consumption is minimal. The user programme can be closed and the computer switched off. If you wish to switch off the analyser completely, for example to carry out a maintenance operation or repair a breakdown, the switch must be put in the (0) position (Power off) and the mains cable unplugged. - Configuration screens: These make it possible to configure the working mode of the user programme and the analyser. - Utility screens: These let the user access the different test, preparation and maintenance utilities of the analyser. - Quality control screens: These enable access to the internal quality control results of the analyser. The following sections describe these screens and their functionality in more detail. You can access any of them easily from the main menu and specific buttons. If during any of the operations, an anomaly occurs requiring the intervention of the user and whose correction is essential for the process to continue, the analyser enters alarm mode and issues the corresponding alert through the PC. Once the user has solved the problem and has indicated this to 2.2.2. Start-up procedure, operation and shutdown. Before starting up the analyser, the user must check that the waste container is empty, that the system liquid container is full and that a reactions rotor is correctly installed. To start up the analyser, the analyser must be in sleeping mode, i.e. plugged into the mains and with the switch in the (I) position. Reboot the computer and launch the user programme. The computer automatically communicates with the analyser, which changes to standby mode. The screen that appears when the programme is launched is the Monitor screen. The programme shows horizontal and vertical button bars. The horizontal bar enables access to the main functions of the application, whereas the vertical bar enables the control and functioning of the analyser. Click on the Warm up button on the vertical bar menu to begin Warming up. The analyser automatically performs all the checks required for its correct functioning and the programme continually informs the user of the status of the analyser. No manual adjustment is necessary. If, for any reason, user intervention is necessary, the analyser 13 Statuses of the analyser LED Sleeping Mode Orange Warm-up Green Shutdown Green Standby mode Green Running Mode Green Running mode with readings only (Sampling Stop) Red Alarm Mode Flashing red Mains disconnection: Switch (0) (Power Off): Off User manual the analyser, the analyser checks that it has indeed been solved and returns to the previous mode. new rotor is placed in position, which enables the cancellation of the standby. The three-colour LED indicator (green, orange and red) located on the front right of the analyser indicates the current status of the analyser. - The status of the cover of the analyser (open or closed) and the rotor cover (in position or not in position). The analyser also issues an alert if there is no rotor placed in the analyser. - Control of the useful lifetime of the lamp. 2.2.3. Monitor - The status of the thermostatisation systems of the needle and the rotor. This is the main screen that appears when the user programme is launched. This lets the user supervise and intervene in the progress of the work session or any other task sent to the analyser. It displays the status of the analyser and the work session in progress, providing graphic information about any alarm produced. The content of this screen is as follows: - The levels of the waste and system liquid containers - The status of the racks tray. The analyser alerts the user if the configuration of the racks in the analyser does not coincide with the programmed configuration or if some of the reagents or samples have run out. - Other alarms. - Status of the analyser and the work session. - The list of samples in the current work session. This list presents all the samples to be performed in the current work session, in accord with the order of execution. To indicate the status of each sample, a colour code and icons are used: - Vertical button bar which enables the control of the functioning of the analyser. - Horizontal button bar which provides access to the main function of the application. - Pending (yellow): Samples that have not yet been analysed. - In progress (red): Samples that are being analysed. - Finished (green): Samples that have been completely analysed without incidences in any of the tests performed. The results of these samples are accepted automatically. - Finished with incidences (green + attention icon): Samples with which not all the analyses programmed have been performed due to an incidence of some kind. - Blocked (Blocking icon): Samples to which no analysis has been possible due to an incidence of some kind (lack of sample, lack of reagent, error in the performance of the blank or calibrator…). 2.2.3.2. Blocking pending samples 2.2.3.1. Status of the analyser and the work session. From the monitor screen, you can block samples pending to be analyzed. When pressing the button details, the monitor screen opens and each patient with all his programmed test visualizes. If you double-click on any test, an icon of a hand will appear showing that this test is blocked. The whole patient can also be blocked by double clicking on the patient code. Blanks, calibrators and controls can not be blocked. By double clicking on the same sample a second time, you can unblock it. Real-time monitoring of the status of the analyser and development of the work session. - The total time of the programmed work session and the number of rotors necessary for it to be carried out. - The status of the analyser at any given moment: Sleeping, Warm-up, Shutdown, Standby, Running, Sampling Stop or Alarm. The transitions between the statuses in some cases are automatic and in others they are requested by the user. 2.2.3.3. Vertical button bar for the control of the analyser - The warm-up time control, which enables the cancellation and control of the performance of the photometric base lines. This bar contains the main buttons for the control of the functioning of the analyser, which enable the user to change its status and perform different actions. This bar can also be accessed directly from the positioning screen of the - The status of the reactions rotor: number of wells used, number of free wells and graphic bar of the percentage of wells used. The thermostatisation time control when a 14 reagents and samples in the racks. The buttons are as follows: Configuration A25: This enables access to the analyser configuration screen. Connection: This re-establishes the connection between the computer and the analyser if the analyser has been accidentally switched off or the computer has been disconnected (it changes from Sleeping to Standby). If the analyser is in sleeping mode and the computer programme is launched, the connection is made automatically. Test programming: This enables access to the test programming screen. New sample: This enables access to the introduction of new samples screen. Warm Up: This initialises the analyser (performs Warming up and leaves the analyser on standby ready for work). Position: This enables access to the screen for the positioning of reagents and samples in the rack tray. Start: The analyser begins to perform the programmed analyses (changes from standby to running). Monitor: This enables a return to the monitor screen from any other screen. Continue: This continues the preparations if they have been stopped by the analyser or by the user. (It changes from Sampling Stop to Running). It also continues when new samples are added to a finished session. (It changes from Standby to Running). Current results: This enables access to the current results screen. These can be displayed in order of patients or tests in real time during the execution of the analyses. It also allows managing sample repetitions Profile programming: This enables access to the profile (group of tests) programming screen. Current alarms: This enables access to the current alarms screen which offers more detailed information about the alerts and alarms that have appeared on the Monitor screen during the current session. Sampling Stop: This enables the interruption of the preparations without interrupting the readings of the samples in progress and the reception of results from the analyser (it changes from Running to Sampling Stop). Utilities: This enables access to the utilities screen. Reset Session: This restarts the work session. Abort: This aborts the work session, both readings and preparations, i.e. it cancels the execution of the analyses in progresses (it changes from Running, Sampling Stop or Standby by Rotor End to Standby and considers the session as finished). 2.2.3.5. Special buttons in monitor screen New Rotor: This button indicates to the analyser that a new empty rotor has been installed. This is active only when the analyser is on standby. The analyser controls the time required for the thermostatisation of the new rotor, which is approximately 5 minutes. The user can cancel this waiting time if a previously thermostatised to 37ºC rotor is introduced. Printing final reports: This button allows printing each patient’s results which are finished before ending the whole list. It will only print those finished patients with a printer symbol in the printing column. Preparation table per well: Button to open a window that shows in each rotor well which sample, test and replicate have been prepared. Legend of icons and monitor colours: This button opens an extra window that explains what each colour and symbol means. New System Liquid Container: This button tells the analyser that the system liquid container has been refilled. The analyser then automatically supplied the dispensing system to prevent the accumulation of air, which is detrimental to the execution of the analyses. It is active when the analyser is on standby, running or sampling stop mode, but the supply is carried out on standby or running only. Details: This button allows opening the monitor screen and visualizing the programmed tests for each patient. By pressing again the same button, you can recover the previous screen. Shutdown: It performs the shutdown process of the analyser (it changes from standby to sleeping and performs shutdown). 2.2.3.4. Horizontal button bar This button bar provides access to the main functions of the application and is accessible from all the programme screens, not only from the monitor screen. These functions and others whose use is not as frequent can also be accessed through the dropdown text menu at the top of the screens. The buttons are as follows: 15 User manual 2.2.4. Programming Save: Clicking this button after modifications have been made provisionally stores the new parameters. Various screens enable the programming of the parameters of tests, profiles, multiple calibrators, multiple controls, contaminations and reagent racks. These parameters are usually constant over long periods of time once the analyser has been adapted to the needs of the laboratory where it is being used. Programming requires knowledge of the analyser and the analysis process. It is not possible to modify any of the programmed parameters while they are being used in a work session. OK: Clicking this button definitively stores all the changes made in the tests file. Cancel: This enables the recovery of the initial tests file, without taking into consideration the changes made since the tests programming screen was opened. Programmable parameters The parameters programmable for each test are as follows: 2.2.4.1. Test programming General This screen enables the programming of new tests, the querying or modification of parameters of tests that have already been programmed and the elimination of tests that are no longer used. It also enables the ordering of the list of tests and the printing of their parameters. The default tests are those pre-programmed by BioSystems to use the line of reagents adapted to the analyser. The total number of programmable tests is unlimited and depends only on the capacity of the computer. The screen is divided into two parts: - Test name: Test name with up to 16 characters. - List of tests. - Units: Units that are used to express all the concentrations associated with the test. One of the memorised units can be selected or a new one introduced. - Analysis Mode Final monoreagent point, Final bireagent point, Bireagent differential, Monoreagent fixed time, Bireagent fixed time, Monoreagent kinetics, Bireagent kinetics. - Sample type: Each test may contain specific parameters for five different sample types: Serum (SUE), Urine (ORI), Plasma (PLM), Cerebrospinal (LCR) or Supernatant (SBN) liquid. The Delete Type button can delete all the data related to a certain sample type of a test. - Information about parameters, grouped together in five folders: General, Procedure, Calibration, Controls, Options. - Turbidimetry test: It shows the program that the programmed test is a special one. The analyzer makes a different cycle with turbidimetry tests. The parameters of a test can be queried by selecting it on the list with a click. If you wish to modify the parameters of a test, select it with a double-click or pressing Enter. None of the programmed parameters of a test can be modified if it has been programmed in a work session. The list of tests can be ordered by dragging a test to the new position in the list or alphabetically by clicking on the list header. - Reaction type: Increasing or decreasing. - Decimals: Number of decimals to be used to express the concentration in the reports. - Replicates: Number of times each preparation is carried out for the patient samples (from 1 to 50). The final result obtained is the average of the replicates performed and accepted. If a test parameter is modified, the results stored for the blank and calibrator are automatically reset and must be redone. - Name of the Associated Constituent. Optionally, it is possible to introduce the name of the constituent measured with the test. If introduced, it will appear in the reports. Buttons Various buttons let the user perform the following actions: New: This enables the creation of a new test and the introduction of its parameters in the corresponding folders. The programme introduces some parameters by default to speed up this process and checks that the data introduced is within the expected margins. If this is not so, it sends the user alerts (the alerts appear on the status bar and do not allow further introduction of data until the incorrect data has been put right).In order to identify the created test as a user test different from the original tests, the colour of the test icon changes to orange. The original tests are blue. Print: This prints out the parameters of the selected tests. Delete: This deletes the selected tests. 16 - Calibration curve: For Multipoint Calibrator (Multiple or Specific). It can be polygonal, linear regression, spline or regression parabola. The x and y axes can be normal or logarithmic. Procedure - Reading type: Monochromatic or Bichromatic (for End Point only) - Volumes of Sample and Reagents: Sample volume (between 3 µl and 40 µl), Reagent 1 volume (between 10 µl and 440 µl), Reagent 2 volume (between 10 µl and 200 µl). The Reagent 2 volume will be active or not depending on the analysis mode used. The programme controls that the total volume of the reaction is between 200 µl and 800 µl. - Calibrator replicates: number of times the calibrator is measured (1, 2 or 3). The final result obtained is the average of the replicates performed and accepted. - Blank replicates: number of times the blank is measured (1, 2 or 3). The final result obtained is the average of the replicates performed and accepted. - Alternative calibrator: Option that enables the analysis of a certain type of sample using the results of the calibration of another different sample type. For example, it enables the use of calibration for serum to analyse a urine sample. - Washing Volume: Internal washing volume of the needle which the analyser performs automatically after the preparation of the test (1200 µl, 1000 µl or 800 µl). - Pre-dilution Factor: Pre-dilution factor of the sample. Predilution can be carried out automatically or by the analyser or manually by the user. Controls - Automatic repetition: It shows the program to repeat that test automatically if the result is out of the limits. - Number of controls: Number of controls the analyser proposes for each work session (0, 1 or 2). - Postdilution Factor: It is the factor of sample postdilution when it makes an automatic repetition. - Rejection criteria: Criteria for rejecting an analytical series (between 0.1 and 4 standard deviations). - Filters: One or two filters to be chosen in accord with the reading type. Only filters that are physically in the filter drum can be chosen (they can be revised from the Configuration screen of the A25). - Replicates: number of times the control is measured (1, 2 or 3). The final result obtained is the average of the replicates performed and accepted. - Control type: Multiple or Specific. If the control is specific, - Times: Depending on the analysis type, the corresponding boxes are activated to programme the different reading or dispensing times of the second reagent. The times can be introduced in seconds or in cycles. Each cycle is equal to 15 s. Calibration - Calibration type: Factor, Multiple Calibrator or Specific Calibrator. If factor is used, its value must be introduced in the corresponding field. If the calibrator is specific, the fields appear to introduce the concentration values, depending on the number of calibrators. For multiple calibrators, this data is introduced on the multiple calibrators programming screen, which is accessed directly from this screen. 17 User manual the fields appear for introducing Name, Batch, Maximum Concentration and Minimum Concentration for each of the controls. For multiple controls, this data is introduced on the multiple controls programming screen, which is accessed directly from this screen. unlimited and depends only on the capacity of the computer. The screen contains: - List of profiles - List of programmed tests - List of tests in the selected profile - Calculation Mode: This indicates the method used for deciding if a series of results is accepted or rejected. It can be manual or statistical. In statistical mode, the user must introduce the number of series. The Internal Quality Control section gives a detailed explanation of its functioning. The parameters of a profile can be queried by selecting it on the list with a click. If you wish to modify the parameters of a profile, select it with a double-click or pressing Enter. It is not possible to modify any of the programmed parameters of a profile while they are being used in a work session. The list of profiles can be ordered by dragging a profile to the new position in the list or alphabetically by clicking on the list header. Options - Blank absorbance limit. In kinetic or fixed time tests, this limit refers to the initial reading of the programmed absorbance. - Kinetic blank limit. Buttons - Linearity limit. Various buttons let the user perform the following actions: - Detection limit. New: Enables the creation of a new profile. - Factor limits. Add tests (Arrow >) and remove tests (Arrow <): It is possible to add or remove tests to or from a profile that is being edited by selecting the desired tests from the test or profile lists and clicking on the corresponding button. - Reference interval. - Limits of repetition - Perform blank without distilled water: When this option is activated, the analyser performs the blanks without using distilled water as a sample, i.e. it dispenses reagent only. Print: Prints the content of one or more profiles. Delete: This deletes the selected profiles. Save: Clicking this button after modifications have been made provisionally stores the new parameters. - Contaminations: This button enables access to the contaminations programming screen. OK: Clicking this button definitively stores all the changes made in the profiles file. 2.2.4.2. Profile programming: Cancel: This enables the recovery of the initial profiles file, without taking into consideration the changes made since the profiles programming screen was opened. This screen enables the programming of test profiles. A test profile is a set of tests identified by a name. Using programmed test profiles simplifies the preparation of the work session. On allocating a profile to a sample, all the tests contained in said profile are automatically allocated to it. Each profile has one single sample type associated to it. If you wish to create the same profile for different sample types, a profile must be programmed for each different type. The total number of programmable tests is 2.2.4.3. Programming of Multiple Calibrators A multiple calibrator can be used to calibrate more than one test. Up to 10 multiple calibrators can be programmed. Each of these calibrators can be monopoint or multipoint, i.e. a single calibrator or several calibrators may be used. 18 it with a click or using the cursor keys. To edit the calibration parameters of a test, select it with a double click or by pressing Enter. Buttons Various buttons let the user perform the following actions: New: Enables the creation of a new calibrator. You must introduce the name, batch and number of calibrators. Print: Prints out the data of the selected calibrators. Delete: Deletes the selected calibrators from the grid. Save: Clicking this button after modifications have been made provisionally stores the new parameters. OK: Clicking this button definitively stores all the changes made in the calibrators and tests file. Cancel: This enables the recovery of the initial tests and multiple calibrators files, without taking into consideration the changes made since the multiple calibrators programming screen was opened. The multiple calibrators programming screen can be accessed only from the tests programming screen, from the Calibration tab. The screen contains: - Calibrator grid: - List of tests with multiple calibrator 2.2.4.4. Programming of Multiple Controls - Information about parameters A multiple control can be used to control more than one test. Up to 20 multiple controls can be programmed. The multiple controls programming screen can be accessed only from the tests programming screen, from the Controls tab. The calibrator grid displays the name of the calibrator, the batch and the number of calibrators. The number of calibrators ranges from 1 (single calibrator) to a maximum of 8. The list of tests with multiple calibrator shows the tests programmed to be calibrated with a multiple calibrator. The display shows the name of the test, the sample type, the name of the allocated calibrator and its batch. To allocate or change the calibrator of a test, click on the name or batch of the calibrator and choose the desired calibrator from the list that drops down on the row corresponding to the test. If a calibrator that has already been allocated to one or more tests is modified, the allocations are deleted. Once a calibrator has been allocated to a certain test, the user must programme the test calibration parameters: The screen contains: - Control grid - List of tests with multiple control - Information about parameters The control grid displays the name of the control and the batch. The list of tests with multiple control shows the programmed tests to be controlled using a multiple control. The display shows the name of the test, the sample type, the name of the allocated control and its batch. To allocate or change the control of a test, click on the name or batch of the control and choose the desired control from the list that drops down on the row corresponding to the - Concentration data: Assigned values of calibrator (monopoint) or calibrators (multipoint) concentration for the test, introduced from greater to smaller. The corresponding factors are calculated automatically from the concentrations introduced. - Calibration Curve Data: For multipoint calibrators, the curve type (polygonal, linear regression, spline or regression parabola) and the type of x and y axes (normal or logarithmic) must be selected. By selecting a calibrator with a click or with the cursor keys, it is possible to query its data and the tests allocated to it. The allocated tests appear selected on the tests list. If you wish to modify the parameters of a calibrator, select it with a double-click or pressing Enter. The data can be modified on the grid itself. It is not possible to modify any of the programmed data of a calibrator while it is being used in a work session. The calibrator grid can be ordered by dragging a calibrator to its new position in the grid. The calibration parameters of a test can be queried by selecting 19 User manual test. If a test requires 2 controls (generally 2 levels: high and low), each one must be allocated separately. If a control that has already been allocated to one or more tests is modified, the allocations are deleted. Once a control has been allocated to a certain test, the user must programme the test control parameters: - Concentration data: Allocated values of maximum and minimum control concentration for the test. By selecting a control with a click or with the cursor keys, it is possible to query its data and the tests allocated to it. The allocated tests appear selected on the tests list. If you wish to modify the data of a control, select it with a doubleclick or pressing Enter. The data can be modified on the grid itself. It is not possible to modify any of the programmed data of a control while it is being used in a work session. The control grid can be ordered by dragging a control to its new position in the grid. The control parameters of a test can be queried by selecting it with a click or using the cursor keys. To edit the control parameters of a test, select it with a double click or by pressing Enter. - List or programmed reagent racks - Information about parameters The parameters interface contains a list with all the reagents associated with the tests programmed in the analyser, the name of the selected rack and an image of this rack showing the real positions of the reagents, their names and volumes. The bottles on the racks can be added, removed or reordered by dragging them with the mouse. The bottle type (50 or 20 ml) may be changed using the corresponding button. Its parameters may be queried by selecting a programmed rack with a click or using the cursor keys. If you wish to modify a programmed rack, select it with a double-click or pressing Enter. A programmed rack cannot be modified while it is being used in a work session. The list of programmed racks can be ordered by dragging a rack to the new position in the list or alphabetically by clicking on the list header. Buttons Various buttons let the user perform the following actions: New: Enables the creation of a new control. You must introduce the name and batch. Print: Prints out the data of the selected controls. Delete: Deletes the selected controls from the grid. Save: Clicking this button after modifications have been made provisionally stores the new parameters. OK: Clicking this button definitively stores all the changes made in the controls and tests file. Buttons Cancel: This enables the recovery of the initial tests and multiple controls files, without taking into consideration the changes made since the multiple controls programming screen was opened. Various buttons let the user perform the following actions: New: Enables the creation of a new programmed rack. Print: Prints out the data of the selected programmed racks. Delete: Deletes the programmed racks selected on the list. 2.2.4.5. Reagent Rack Programming Save: Clicking this button after modifications have been made provisionally stores the programmed rack. Programming a reagent rack consists of saving a certain configuration of reagent bottles of a rack, identified by a name. When preparing a work session, to position the reagents, you can load a programmed rack and the saved reagent distribution is automatically allocated. If the user frequently uses the same reagents, it is very practical to use programmed racks to speed up the work. An unlimited number of reagent racks can be programmed, depending on the capacity of the computer only. The rack programming screen can be accessed directly from the programming menu of the main programme menu. From the positioning screen, it is also possible to save sample racks with a specific identifying name. It is not possible to access sample racks from the reagent racks programming screen. It may be useful, for example, to save a calibrator and control rack that is used frequently. The reagent rack programming screen contains: OK: Clicking this button definitively stores all the changes made in the programmed racks file. Cancel: This enables the recovery of the initial programmed racks file, without taking into consideration the changes made since the racks programming screen was opened. 2.2.4.6. Contaminations programming To obtain correct analytical results, it is recommendable to not execute certain pairs of tests one after the other. This is due to the fact that the reagent used in the first test may affect the measurement procedure of the second test. Even though the needle of the analyser is washed after each preparation, a minimum residue from the reagent of the first test may alter the analytical results of the second. 20 OK: Clicking this button definitively stores all the changes made in the contaminations file. Cancel: This enables the recovery of the initial contaminations file, without taking into consideration the changes made since the contaminations programming screen was opened. 2.2.5. Save/load test file The user can save the test programming in an external file, he has only to execute the option Save Test File of the programming menu. This option saves all the test data in a compressed file. It is the program itself the one that compresses and decompresses the file with no need of the user’s intervention. Each contamination consists of a pair of tests that should or should not be performed in the order indicated. The contaminating test (first test) and the contaminated test (second test). The analyser automatically reorders the tests to be performed on each sample in such a way that the programmed contaminations are avoided. If, in any case, this reordering is not possible, the analyser automatically introduces a special exhaustive washing cycle between the corresponding tests. If two tests mutually affect each other, two contaminations must be programmed, one for each execution order. The contaminations programming screen can be accessed through the tests programming screen, from the Options tab, or directly from the programming menu on the main programme menu. A contamination cannot be modified while one of the tests involved is being used in a work session. The screen contains: In order to load a new test file, the user has to execute the option Load Test File of the programming menu and then all the tests of the application are automatically replaced. This process is only active with the following options: - When working without passwords or as Supervisor user. - When the analyzer is in SLEEPING or STANDBY state - When there is no working list. If you have a programmed list, make a RESET. 2.2.6. Preparation of the work session The Introduction of New Samples and Reagents and Samples Positioning screens help the user to prepare the work session conveniently, easily and quickly. Furthermore, it enables the storage of data that can be used in later sessions. - List of Contaminations - List of Contaminating Tests (first tests) - List of Contaminated Tests (second tests) 2.2.6.1. Introduction of New Samples Its data may be queried by selecting a contamination with a click or using the cursor keys. All the tests contaminated by the first contamination test appear selected on the contaminated tests list. If you wish to modify a contamination, select it with a double-click or pressing Enter. A contamination cannot be modified while it is being used in a work session. The list of contaminations can be ordered by dragging a contamination to the new position in the list or alphabetically by clicking on the list header. This screen contains the interface for introducing the data of each sample and the lists of New Samples and Sent Samples. Interface for introducing sample data The user can select the sample class (normal patient, urgent patient, blank, calibrator or control) and the sample type (serum, urine, cerebrospinal liquid, plasma or supernatant). A tree diagram shows all the tests and profiles programmed in the analyser. The user can select or introduce the patient code (alphanumeric). If the patient code introduced does not exist in the current work session, the new patient is added together with his or her sample. If the patient already exists, the sample of the patient in question is selected and, on the tests tree, the tests previously allocated are selected for possible edition. If the user does not introduce the patient code, the programme adds the patient sample with a correlative numeric identifier. If several normal or urgent samples are to be introduced with the same tests to be carried out, the desired number must be introduced in the Buttons Various buttons let the user perform the following actions: New: Enables the creation of a new contamination. You must select the names of the tests, respectively, from the lists of contaminating and contaminated tests. Print: Prints out the data of the selected contaminations. Delete: Deletes the contaminations selected on the list. Save: Clicking this button after modifications have been made provisionally stores the contamination. 21 User manual Number of Patient Samples field and the programme automatically adds all the samples, allocating them a correlative patient code. By default, the Number of Patient Samples is 1. The maximum value is 120.If the user has got a code bar reader, he can use such reader to insert the patient code. Place the cursor in the box of the patient code and read the code to be inserted with the reader. Lists of samples The list of New Samples shows all the samples introduced, grouped together by classes, which the user can then send to the analyser. The list of Sent Samples shows those the user has sent to the analyser, also grouped together by classes. To introduce a new sample into the list of new samples, proceed as follows: The grids of New Samples enable the modification of the information they contain. The grids of blanks and calibrators and controls are completed automatically as patients are added. If the user wishes, he or she can also introduce blanks, calibrators or controls manually. From the corresponding grids, it is possible to activate or deactivate the performance of blanks, calibrators and controls, changing the value of the fields New or In Use, respectively (as long as there are results stored from a previous session). If the blanks and calibrators are deactivated, the analyser will use the data of the last work session. If the user wishes to send certain samples for positioning on the racks and analysis, they must be selected and the Position button pressed. It is also possible to send certain tests of a sample only. The associated and activated blanks, calibrators and controls are sent automatically. By clicking on the Position button, with no previous selection, all the introduced and activated samples of the corresponding grid are sent. Clicking the Delete button deletes the samples or the tests of a sample that have been selected. The lists of New Samples and Sent Samples show the information grouped together by sample class. Each one contains a patient grid, one of blanks and calibrators and one of controls. By default, the patient grid of the list of new samples is displayed. 1. Select the sample class 2. Select the sample type 3. If desired, introduce the patient code. 4. Select the profiles and tests to be performed. 5. Add the sample to the list of samples by clicking on the Add (Arrow >) button. If you wish to introduce a certain number of samples n with the same set of tests to be performed, proceed as follows: 1. Select the sample class 2. Select the sample type 3. Select the profiles and tests to be performed. The Sent Samples grids enable the query of the samples sent to the analyser and the tests to be performed on each sample, but they do not allow modifications or the resending of samples to the analyser. 4. Introduce the number of samples n 5. Add the sample to the list of samples by clicking on the Add (Arrow >) button. The code of a patient can be changed on the list itself by clicking the right button of the mouse on the existing code. Once you have made the desired changes, press Enter. It is possible to add tests or profiles to a patient sample that has already been introduced. Different sample types can be introduced fro the same patient and the programme groups them together automatically. It is also possible to add, in one go, tests or profiles to several samples of the same type for different patients. The Reset Session button on the horizontal bar restarts the work session and deletes all the sample lists. When you reuse a Calibrator, you can modify the memorized factor from the New Samples screen, within the Blanks and Calibrators folder in order to recalculate the results with the new inserted value. - In order to edit the factor: double click its cell, insert a new value and accept by pressing Enter. This action recalculates all the affected Concentration results. 22 associated and activated blanks are also automatically sent. Patient data: This enables access to the screen for introducing the data of each patient. This data is not necessary for the performance of analyses and can be introduced once the analyser is running. 2.2.6.2. Positioning of samples and reagents This screen contains a tree diagram showing all the elements to be positioned, an image of the analyser tray indicating the current programmed distribution of the racks and an enlarged image of the racks showing the details of all the elements in the selected rack. Tree diagram of elements to be positioned - In order to recover the previous factor value: click any crossed cell. This action recalculates all the affected Concentration results. This tree contains all the reagents and samples to be positioned on the racks to execute the work session. For each of the reagents, the tree shows the name, the volume required and the minimum number of bottles required for each type (20 or 50 ml). The samples are grouped together by class: calibrators, controls and patients. For the calibrators, the tree indicates the name, the number of calibrators if it is multipoint and, if the test or tests allocated have pre-dilutions programmed, the pre-dilution tubes required, together with the corresponding factor of each one. For the controls, the tree indicates the name and, if the test or tests allocated have pre-dilutions programmed, the pre-dilution tubes required, together with the corresponding factor of each one. For the patients, normal or urgent, it indicates the patient code, the sample type and, if the test or tests allocated have pre-dilutions programmed, the pre-dilution tubes required, together with the corresponding factor of each one. Buttons Various buttons, some of which have already been mentioned, let the user perform different actions. The following is a brief description of the functionality of each one. Add sample (Arrow >): This dumps the information of the interface to introduce sample data in the corresponding new samples grid. Edit patient (Arrow <): This enables the edition of a patient sample or of several of the same type, of the new samples grids. The edition enables the addition of tests or profiles to the group of samples selected. It is also possible to change the priority of the edited samples, i.e. change from urgent to normal or vice versa. The patient code of a sample is changed during the edition, the programme adds a new patient, which is a copy of the pervious one. If you wish to change the patient code only without adding another new patient, make the change directly on the samples grid with the right button of the mouse. The colour blue indicates which reagents and samples are completely positioned in the racks tray. The colour black indicates the reagents and/or samples that are not positioned completely or whose volume has finished during the work session. Delete: This deletes the patient sample or control data selected. It is possible to delete tests, test or sample profiles of a patient or patients that have been completed. This is active for the new samples grids only. Position: This sends a selection or a complete list of samples to be positioned in the analyser for later analysis. This is active for all the new samples grids. It enables: - Sending of groups of patient samples. In this case, the associated and activated blanks, calibrators and controls are also automatically sent. - Sending of control groups. In this case, the associated and activated blanks and calibrators are also automatically sent. - Sending of groups of blanks and calibrators for making lists for calibration only. In this case, the 23 User manual Rack tray and extended rack Buttons The image of the rack tray shows the current rack distribution in the analyser. In each of the 6 rack positions, there may be a reagent rack or a sample rack or the position may be empty. In the reagent racks, the image shows which positions are occupied by 20 and 50 ml bottles. In the same way, in the sample racks the image shows the positions occupied by sample tubes. The 3 central positions, preferably used for bottles of distilled water, saline solution and washing solution, are also shown. Various buttons, some of which have already been mentioned, let the user perform different actions. The following is a brief description of the functionality of each one. Position Reagents Automatically: The programme places the reagents from the tree that are not yet positioned (black colour) in the free positions on the reagent racks on the tray. If required, it allocates new reagent racks to the free positions on the tray and fills the positions. A maximum of 5 reagent racks is permitted. If there are elements on the racks that are not required for the current work session, the programme alerts the user to remove them. If there is no room for all the reagents, the user is also alerted. The user can choose the rack type at each position on the tray. The limit configurations are 5 racks of reagents and 1 of samples (50 reagents / 24 samples) and 1 rack of reagents and 5 of samples (10 reagents / 120 samples). In the analyser options, the user can choose which type of samples rack he or she wishes to use for all the samples in the current session (13 mm diameter sample tube, 15 mm diameter sample tube or 13 mm diameter well). If he or she wishes to use racks of samples of different types in the same session, the user must deactivate the rack detection on the analyser configuration screen. It must also be taken into account that the analyser will not check that the physical disposition of the racks on the tray is the same as the programmed disposition. Besides empty racks, it is also possible to position reagent racks programmed on the rack programming screen or racks previously saved from the positioning screen itself. Position Samples Automatically: The programme places the samples from the tree that are not yet positioned (black colour) in the free positions on the samples racks on the tray. If required, it allocates new samples racks to the free positions on the tray and fills the positions. A maximum of 5 samples racks is permitted. If there are elements on the racks that are not required for the current work session, the programme alerts the user to remove them. If there is no room for all the samples, the user is also alerted. If different types of sample racks are used in one session, the user must manually reposition each sample on the corresponding rack in accord with the tube type used, since the analyser does not have information about the tube type used for each sample. The screen displays an enlarged view of the rack selected on the tray, enabling easy manipulation of its content. The selected elements can be unloaded from the rack or the rack can be completely emptied. It is possible to change the position of any element by dragging it to a free position on the enlarged image of the rack. The volume of a bottle of reagents can also be changed by double-clicking on it. When any change is made, the programme checks if all the required volume of said reagent is in position and alerts the user if it is not. Remove: This removes the selected elements from the enlarged rack. If no selection has been made, all the elements are removed from the rack. It is also possible to remove the selected elements using the delete button. Save Rack: This saves the enlarged rack (reagents or samples) for later use. Summary of positions: This enables easy verification of all the allocated positions. The user accesses a screen showing the current distribution of the racks tray in text mode, indicating the content of each position rack by rack. This information may be printed out. The positioning of the reagents and the samples on the racks can be carried out automatically or manually. Two buttons make it possible to automatically position the reagents or the samples, respectively. With automatic positioning, the programme allocates the rack types that are required. If the user wishes to position the elements manually, he or she must choose the required rack types and place the elements by dragging them with the mouse from the tree to a free position in the corresponding enlarged rack. It is possible to position individual bottles of reagent or all the required reagent in one bottle. If a sample is dragged and it has programmed pre-dilutions, the pre-dilution tubes required are also dragged. If you wish to use different sample rack types in one session, the user must manually position each sample in the corresponding rack in accord with the type of tube used. OK: By clicking OK, the programme checks that all the required elements are in position and requests confirmation from the user to save the information as definitive. When all the elements have not been positioned, an auxiliary alerts screen opens. If the analyser is ready for work, the Start button of the vertical buttons bar is enabled and the user can press it for the analyser to start the analyses. The programme automatically changes to the Monitor screen, from which the execution of the work session can be supervised. When the analyser is carrying out the analyses, the user can press the Sampling Stop button on the vertical button bar to introduce new elements into the analyser physically. Once the positions have been programmed on the Positions screen, by clicking OK, the programme checks that all the new required elements are in position Once all the elements have been positioned on the screen and physically in the analyser, the user can begin the analyses. 24 and requests confirmation from the user to save the information as definitive. The Continue button on the vertical bar is enabled and when the user presses it, the programme changes to the Monitor screen and the analyser continues the pending analyses and the new ones that have been sent. 2.2.8.2. Repetitions The User can make repetitions of blanks, calibrators, controls and samples. Repetitions can be manual or automatic. Manual Repetitions: In order to make manual repetitions, the own user has to select the samples that he wants to repeat. Once the sample measurement is finished and the result is in the Current results screen, select the results to be repeated in the Rep column and then press the Repeat Selected Samples button. The program will automatically insert the sample to be repeated in the working list. It will be added (rep) to the end of the sample name to distinguish it from the initial sample. In the Current results screen, the result of the repetition will appear under the initial sample. So the user will be able to choose, by means of the OK column, which of both results will comprise the patients’ report and become historical. The repetition result will be selected by default. If repeating blanks and calibrators, all the associated values will be recalculated. Cancel: This exits the screen without updating any of the changes made and keeps the previous distribution. Alerts: This button appears when there are elements not positioned in the prepared work session and it informs the user of everything that cannot be analysed. When nothing is in position, the Start button is not enabled. 2.2.7 Memorising sessions When Memorizing a working session, the assigned samples and tests are saved, but the positions are not. If you wish to memorize the current session, you should save it before starting its execution. When loading a memorized session, the tests are loaded such as they are programmed at that moment, and the tests that have been deleted from the test file are eliminated. Automatic repetitions: In the test programming, some limits or intervals of reference can be programmed to carry out automatic repetitions if the sample result is outside these intervals. In order to carry out the repetitions automatically, the automatic repetition tick must also be selected in the test programming: In order to Load a memorized session, it is necessary to carry out a RESET one previously. Once it is loaded, the session can be freely modified (modify identifiers, eliminate tests, add samples or tests...) - If the patient concentration is higher than the linearity limit, the sample is repeated with the decreased Factor of postdilution. The memorized sessions can be also Eliminated. 2.2.8. Current results - If the patient concentration is lower than the detection limit, the sample is repeated with the increased Factor of postdilution. The results can be consulted as they are obtained on the Current results screen, grouped together by patients or by tests. The results are updated automatically in real time as information is received from the analyser. For each analysis, the results of the replicates performed are displayed together with the corresponding average. Once the analyses have finalised, the user can discard the replicates of samples (blanks, calibrators, patients or controls) he considers aberrant and the programme automatically recalculates and displays the new results. The results can be printed in reports ordered by patients or by tests. - If the patient concentration is within the Rank of repetition, the sample is repeated with the same relation of sample-reagent. - If the absorbances of the kinetic in blanks, calibrators, controls and samples are not linear, it is repeated with the same relation of sample-reagent volumes. 2.2.8.1. Calculated factor modification The calculated Factor can be experimentally modified by the user in the Current Results screen, once the present session is finished. - In order to edit the factor: double click its cell, insert a new value and accept by pressing Enter. This action recalculates all the affected Concentration results. It also changes the test programming and becomes programmed with factor - In order to recover the factor experimental value: click any cell crossed at the average or replicate level. This action recalculates all the affected Concentration results. 25 User manual 2.2.9. Current and past alarms out reports with said results. The results can be organised by patients or by tests. It is also possible to make reports of patients per session or with all sessions. Reports by tests can be made only by previous selection of a specific session. The Delete button deletes all the data of the selected work session. The Monitor also displays information about the alarms or alerts that may appear throughout the work session in the shape of identifying icons, together with a brief informative text. By clicking on the corresponding button, the user can access the Current alarms screen, which offers more detailed information about the problems and their possible solution. The alarms and alerts occur when the certain detectors or sensors are triggered in the analyser or when the analyser detects anomalous functioning. When necessary, the analyser acts to avoid continuing working in unsafe conditions and notifies the computer. The alarms screen displays a list with all the alarms and alerts generated by the analyser in the current session. It is also possible to access the Past alarms and alerts, which contains a list with the alarms and alerts generated during previous work sessions. For each alarm or alert, the following can be displayed: The screen contains: - List of completed session dates - List of elements: patients or tests - Interface of patient or test data selected on the list - Interface of patient or test results selected on the list List of elements This list contains all the elements of the selected sessions. In the past results by patient, the list shows the patient code and the patient names introduced, corresponding to - Type of alarm or alert - Date of alarm - Brief definition of the alarm (name) - Detailed description - Proposed solution - Observations (lets the user introduce information: applied solution, date of solution, implicated personnel…) the selected session or to all the sessions. In the past results by test, the list contains the name of the tests performed in the specific selected session. This list enables the selection of elements for query, deletion or printing out the associated data by means of the corresponding buttons. The list can be ordered alphabetically by clicking on the title. In the past results by patient, the Allocate button enables the allocation to the selected patient previously introduced patient data. The Delete button enables the deletion of the elements selected on the list. The Print button enables the printing or exportation to file of a report with the data and results of the selected elements. The programme always displays a preview of the report. The lists are updated automatically in real time as information is received from the analyser. The alarms pending correction can be edited for text introduction indicating the implemented solution, the date of the solution and the personnel implicated. If so desired, the corrected alarms can be eliminated. The lists can be ordered according to the field type, date or name. Problem solution reports can be printed with the selected alarms. The Alarms and alerts section of this manual lists the main alarms and alerts the analyser can display and which require user intervention. Data Interface In the past results by patient, the data interface contains the following patient information: name of the selected patient, sex, date of birth, person who has requested the analysis and a field for comments. A button enables access to the Patient Data screen, where the data can be introduced or modified. In the past records by test, the data interface contains the absorbance of the blank and 2.2.10. Past results The Past results screen displays the results obtained in all the work sessions prior to the current session and prints 26 the calibrator or calibrators used in the selected session, the date the blanks and calibrators were performed and the reference range of the test. 2.2.11. Patient data This screen enables the introduction and modification of the data of patients who are analysed frequently. This data is not necessary for the performance of analyses and can be introduced once the analyser is running. This screen can be accessed directly from the Introduction of New Samples or Past Results screen by patients using the Patient Data button or from the Past results menu. It also enables the allocation of previously introduced data to a patient. This screen contains a list of patients and a patient data interface. Results Interface This interface shows the results of the element selected on the list, whether it is a patient or a test. Each grid record of results by patient contains: name of the test and sample type on which it has been carried out, value of the result, units, reference range programmed in the test (optional), date and time of the result and observation about the result obtained. Each grid record of results by test contains: patient code, result value, units, date and time of the result and observations. By clicking on the corresponding column, the results can be ordered by session date, by test or by patient name. List of patients This list contains the code and the name and surnames of all the patients with allocated data. To query patient data, the user must select it on the list. The list can be ordered alphabetically by title. To edit the data of a patient, double click on the patient on the list. The New button enables the introduction of new patient data. The Delete button deletes the data of the selected patient. The Print button prints out the data of the selected patient. General buttons The past results screen contains two general buttons: Delete: This deletes completed past sessions. OK: This saves the changes made to patient data and to the results and exits the screen. Cancel: This exits the screen without saving the changes made. 27 User manual Patient data interface The data interface shows the code of the selected patient, his or her name and surnames, sex, date of birth, the person who has requested the analysis and a field for introducing comments. The user can consult current data, modify them or introduce new data. General buttons The patient data screen contains two general buttons: Save: Saves all the changes made to the data. Cancel: Recovers all previous data without saving any change. 2.2.12. Configuration shutdown process. For each one, you may select whether it is performed with system liquid only or with washing solution. In the case of the latter, besides using washing solution, the analyser then performs a rinse with system liquid. The wash consumption can also be chosen (economical, normal or exhaustive). It is highly recommendable to always use washing solution to keep the fluid system in optimum condition, avoiding the accumulation of both residues and air bubbles. In this case, the user must place the washing solution container, supplied with the analyser, marked in green, in the system liquid container position when so requested by the analyser. These screens enable the user to configure the running mode of the analyser and the user programme. The different parameters can be configures from four dedicated screens: - A25 analyser - Languages - Configuration of the serial port - Header of results reports 2.2.12.1. A25 analyser When the analyser cannot avoid contamination between incompatible tests by reordering the tests of each patient, it automatically performs and intermediary special washing cycle. The user can choose to perform these special washes with system liquid or with washing solution. If the second option is chosen, a 50 ml bottle of washing solution must be placed in the analyser. Clicking on the A25 button on the horizontal button bar directly accesses the analyser configuration screen. The different options are separated in three tabs: Washes, Session and Analyser Washes - Initial, final and special washes between incompatible tests Carrying out of repetitions - Carrying out of automatic repetitions This option allows to activate or to deactivate all the automatic repetitions. - Calibrators and blanks in paediatric racks Separate Calibrators and Controls in Paediatric Racks - Automatic printing of patient reports In the A25 Configuration–Session screen, you can select the option: “Calibrators and Controls with paediatric racks”. Session - Used sample tube This option is intended for the Automatic positioning of samples. When pressing the button Place Samples Automatically of the “Positioning of Samples and Reagents” screen, the samples of Calibrator and Control type are placed in paediatric racks and the patient samples in the type of rack selected in the A25- Configuration-Session screen. Analyser - Container level control scales - Rack detection - Cover detection - Configuration of the filter drum Automatic printing of patient information Initial, final and special washes between incompatible tests This option allows activating and deactivating the automatic printing by patient during a current session without waiting for the list to finish. In this tab, it is possible to configure the initial washing of the fluid system, which is performed by the analyser during warm-up and the final washing that is performed during the 28 alarms appears: lack of reagent, lack of sample, waste bottles full, system liquid bottles empty, etc., together with the corresponding icon. Said acoustic signal sounds until the user stops it by pressing the end alarm button or any of the star, sampling&stop, continue, new rotor buttons. Configuration of the filter wheel This screen enables the modification of the analyser filter wheel. To access this screen, the work session must be restarted. The wheel has 10 positions. Position 0 must always contain a covered filter so that the analyser can perform the darkness adjustment. Positions 1 to 9 can be used for optical filters. All the positions of the wheel must be occupied for it to work correctly. The positions that do not contain an optical filter must be occupied by a covered filter. The analyser includes as standard 8 optical filters in positions 1 to 8 and two covered filters in positions 0 to 9. If one of the filters is to be changed, select the desired position of the wheel and press the Change Filter button. The analyser automatically positions the wheel filter appropriately so that the user can change the filter through the window of the optical system. Next, if it is different, introduce the wavelength of the new filter that has been installed. If the filter is covered, the value 0 must be introduced. The programme requests confirmation to know if the filter in the analyser has been physically changed. If it has, the programme resets certain reference values used to issue alerts and alarms from the optical system. Used sample tube This enables the selection from a dropdown list of the type of sample tube to be used in the work session. To access this list, the work session must be restarted. The possible types are: 15 mm diameter tube with a maximum height of 100 mm, 13 mm diameter tube with a maximum height of 100 mm and a 13 mm diameter well. If he or she wishes to use racks of samples of different types in the same session, the user must deactivate rack detection. It must also be taken into account that the analyser will not check that the physical disposition of the racks on the tray is the same as the programmed disposition. Container level control scales An alert is issued to the user if any of the tests has programmed filters that do not physically exist in the wheel. It enables the deactivation of the functioning of the scales the analyser uses to control the level of the waste and system liquid containers. In this way, the user can continue working with the analyser in case of breakdown of any of the scales, until the technical assistance service arrives to repair it. In this case, the user must ensure that the system liquid does not run out and that the waste container does not fill while the analyser is running. 2.2.12.2. Languages The user can change the language of the user programme on a dropdown list that offers all the languages available. When the language has been selected and OK clicked, the programme updates all the texts to the selected language. Rack detection 2.2.12.3. Serial port This enables the deactivation of the rack tray that identifies the rack in each position. In this way, the user can continue working with the analyser in case of breakdown of any of the detectors, until the technical assistance service arrives to repair it. If he or she wishes to use racks of samples of different types in the same session, the user must deactivate rack detection. It must also be taken into account that the analyser will not check that the physical disposition of the racks on the tray is the same as the programmed disposition. This screen enables the configuration of the computer serial port used by the programme. The user can choose for the configuration to be performed automatically or manually. If manual, he or she can choose the computer serial port and the transmission speed of the communications. 2.2.12.4. Header of results reports From this screen, the user can customise the header of the results reports. It is possible to introduce the name of the laboratory, the address, telephone number and a bitmap (.bmp) image. The format of the texts introduced can be varied. Configuring the acoustic alarm. This option configures the enabling or disabling of the acoustic alarm. If this option is enabled, an acoustic alarm sounds when the analyser is running and one of the following 29 User manual All the utilities require the analyser to change to specific mode, called Test mode, and for this reason it is not possible to access this screen when a work session is not being prepared or performed. When running test utilities, the rest of the programme’s functionality is blocked until the test ends and the utilities screen is closed. 2.2.13. About This screen displays information about the User Programme version being executed. The Firmware version also appears (program executed directly by the analyser) and the serial number of the analyser. In order to see the Firmware and serial number, the program must be connected to the analyser. 2.2.14.1. PC-Analyser communications channel test On pressing the test button, the computer attempts to establish communication with the analyser. The programme tells the user if communication with the analyser has been possible or not. 2.2.14.2. Reactions rotor check The user can use this test to check the optical status of a reactions rotor. he or she can choose the optical filter with which the test is to be performed. The rotor must be placed in the analyser, the rotor cover replaced and the analyser cover closed, then press the Test button. The analyser fills the 120 wells of the rotor with system liquid and then performs a base line in each well with the selected filter. The analyser presents a graph of the absorbances relative to the average of the light intensity of the wells together with the standard deviation of said standards. In accord with these results, the user can decide whether or not the rotor can be reused or if it should be replaced by a new one. It is important to point out that the test checks the optical quality of the wells but not the status of chemical cleansing. Depending on the analysis made with the rotor, the chemical residues that may be left in the wells can have a noticeable effect on the following analyses performed with the rotor. In case of doubt, or when very sensitive tests are to be performed, it is always recommendable to use a new rotor. After the test, the user must remove the rotor of the analyser, empty it and dry it completely before using it for analyses. 2.2.14. Utilities Clicking on the utilities button on the horizontal button bar directly accesses the main utilities screen. This screen lets the user access the different test, preparation and maintenance utilities of the analyser, by clicking the corresponding button. For some of the utilities, the programme displays a corresponding screen. The available utilities are: - PC-Analyser communications channel test - Reactions rotor check - Disassembly of the dispensing needle - Fluid system supply - Cleaning of the dispensing system - Changing the lamp 30 2.2.14.3. Disassembly of the dispensing needle analyser, marked in green, in the system liquid position. Once the wash has been performed, the analyser asks him or her to replace the system liquid container and performs a rinse with the system liquid. On clicking on the Disassemble Needle button, the operating arm positions itself over the rack tray. The programme alerts the user to remove any object positioned under the arm. On clicking OK, the needle descends and the user can remove it to work with it or change it. To remove the needle, unscrew it by holding the top fitting. If, while handling the needle, the carriage rises due to the pressure made by the user, press the Lower Needle button for the needle to descend once again. Once the needle has been reassembled on the analyser, press the OK button for the needle to rise. It performs the self-centring test and the arm finally returns to its parked position. These operations must be done with utmost care since they are carried out with the analyser cover open and the needle may be contaminated. Laboratory gloves must always be used. 2.2.14.6. Changing the lamp When the user fits a new lamp, this utility must be used to notify the analyser that the lamp has been changed and optimise the luminosity of the photometric system. The programme requests confirmation to know whether or not the lamp of the analyser has been physically changed. If it has, the programme resets certain reference values used to issue alerts and alarms from the optical system. To access this utility, the work session must be restarted. The lamp must be changed with the analyser in sleeping mode. If the analyser is on standby mode, the programme shuts it down automatically. The lamp must never be touched with fingers. Once the new lamp has been installed and the covers of the optics and the rotor have been closed, the instructions given by the programme must be followed. The programme starts up the analyser, checks the light intensity of the optical system, shuts down the analyser and then requests the user to remove the lamp holder again and replace it again turning it 180º on the axis of the lamp. The programme forces waiting periods to prevent the lamp holder from getting too hot. If the temperature of the lamp holder is still high, handle it with pincers. The programme starts up the analyser again, measures the light intensity of the optical system again, compares the light intensity in both possible positions and chooses the greatest luminosity. If it is the current position, it tells the user that the test is complete. If the best position were the previous one, the programme shuts down the analyser and asks the user to remove the lamp holder and replace it, turning it 180º on the axis of the lamp, returning the lamp to its initial position. 2.2.14.4. Fluid system supply On clicking the Supply button, with the main cover closed, the analyser fills the fluid system conduits with system liquid. It is possible to supply the dispensing system, the washing system or both at the same time. To supply the dispensing system, the operating arm moves to the washing station. It is possible to choose the number of supply cycles to be performed. When the system liquid container is filled during a work session, the fluid system can be supplied by clicking directly on the New System Liquid Container button on the vertical button bar. 2.2.14.5. Cleaning of the dispensing system By clicking on the Wash button, with the main cover closed, the analyser washes the dispensing system internally and externally. To perform this operation, the operating arm is moved to the washing station. The user can choose to perform the wash with system liquid or with washing solution. In the case of the latter, the analyser asks the user to position the washing solution container, supplied with the 31 User manual 2.2.15. Internal quality control (Cmin) and Maximum (Cmax) Concentration, respectively. These values are programmed by the user on the test programming screen, for the specific controls, or on the multiple controls programming, for multiple controls. The average value and the standard deviation are calculated, respectively, as Xm = (Cmin+Cmax) / 2 and s = (Cmax-Cmin) / (2k). Internal quality control enables the verification of the correct functioning of each measurement procedure and the validation or rejection of the analytical series. An analytical series is an interval of time or results in which it is reasonable to suppose that the metrological characteristics of the measurement procedure are maintained stable. Each laboratory must establish its own internal quality control programme and the correction procedures to be followed if the controls do not meet acceptable tolerances. The basic idea of internal quality control is very simple: one or more control materials, the controls, are placed between the patient samples and they are measured together. The result from the control material is compared with an expected value. In this way, it is possible to detect the occasional existence of anomalies in the measurement procedure. The use of controls is programmed independently for each measurement procedure from the Test Programming screen. The analyser automatically proposes the carrying out of controls whenever the work session is reset, in accord with the tests programmed, and the user simply has to activate them. The user can also launch additional controls manually. The use of BioSystems valuated control materials and calibrators is recommended. The Quality Control screen of the user programme enables access to the quality control results of the analyser. The programme memorises all the control results for each test and for each sample type. The user can select a test and a sample type and the screen indicates, for each control, the name, batch, average value (Xm), standard deviation (s), variation quotient CV = 100 s / Xm, and the rejection limits programmed. Whenever a new batch is introduced for one of the controls, the programme automatically creates a new data sheet and the statistical calculations are reset for this new sheet. All the sheets created can be accessed through a dropdown list. A grid displays, for each series performed, the date, concentration, absolute error and relative error, for each control, and an alert for the rejected series. Absolute error is defined as Eabs = C - Xm, where C is the measured control concentration, and the relative error as Erel = Eabs / s. The programme displays the alert for rejecting a series when the result of one of the controls is out of the programmed rejection limits. From the test programming screen, the user can programme the number of controls (0, 1 or 2), the rejection criteria (between 0.1 and 3 standard deviations), the number of replicates (1, 2 or 3), the control type (multiple or specific) and the calculation mode (manual or statistical). The calculation mode indicates the method used for deciding if a series of results is accepted or rejected. With the memorised data, the programme displays the corresponding Levey-Jennings graphs. When any of the controls of a series exceeds the interval limits Xm ± 2s, the programme automatically executes the Westgard algorithm and shows the results on the Levey-Jennings graph. This algorithm is a set of control rules that are examined sequentially. The result of this algorithm is not used by the programme to accept or reject a series. It is presented as graphic information only and the user is who must decide to accept or reject the series. The programme only displays the rejection alert based on the rejection interval chosen by the user. The Westgard rules examined are: · In statistical mode, the user must introduce the number of series. This parameter is the number of data used to perform the statistical analysis, i.e. to calculate the measurement (Xm) and the standard deviation (s). It is recommended that it is not above 20. A series of results is accepted if the values of the controls are within the interval Xm ± ks, where k is the rejection criteria. · 13s: The result obtained on one of the controls exceeds the limits of the interval Xm ± 3s. · In manual mode, the series of results is accepted if the results of the controls are between the values of Minimum 32 · 22s: The results obtained on two controls exceed, in the same way, the limits of the interval Xm ± 2s. This can be the two controls of one series or one single control on two consecutive series. with the alarms and alerts generated during previous work sessions. The following is a description of the main alarms and alerts issued by the analyser, requiring user intervention, together with their possible cause and solution. The alarms that require contact with the technical Assistance Service are indicated. If any of the alarms persists, it is also necessary to contact the TAS (Technical Assistance Service). · R4s: The difference between the results of two controls of one series or of one control on two consecutive series is higher than 4s. · 41s: Four consecutive results have been obtained, exceeding, in the same way, the limits of the interval Xm ± 1s. This may occur with two controls on two consecutive series or with one single control on four consecutive series. Machine alarms and alerts General · 10Xm: Ten consecutive results have been obtained, all greater or all less than the average. This may occur with two controls on five consecutive series or with one single control on ten consecutive series. - Incorrect rack type. Check the configuration of the rack tray. If the error persists once the racks have been correctly positioned, deactivate the sensor of the rack tray from the corresponding configuration screen and contact the TAS. Buttons - Analyser cover open. Close the analyser cover. If the error persists, deactivate the cover sensors from the corresponding configuration screen and contact the TAS. Danger: the main cover of the analyser must always be closed when it is running. The Quality Control screen has different buttons that let the user perform different actions: Graphs: This enables the display of the Levey-Jennings graphs of the test selected for each control. The squares represent the values obtained in the accepted series. When a Westgard algorithm rule is activated, the values involved are represented in circles. In the rejected series, the values are represented by a triangle. The axis of ordinates indicates the concentration, at standard deviation s. The horizontal line indicates the number of the series. The horizontal lines indicate the multiples of the standard deviation and the continual lines the programmed rejection limits. - Electronics start-up fail. Shut down the analyser and start it up again. If the problem persists, contact the TAS. - Error in the Firmware version. Contact the TAS. Operating arm - The operating arm cannot be started. Check that the arm is not blocked and that there is no object obstructing its movement. Delete: Deletes the series selected on the grid. - Loss of steps during the functioning of the Z axis. The arm has collided vertically or is broken. Check that there is no object obstructing the movement of the arm. Delete Sheet: Deletes the selected results sheet. Print: Prints a Quality Control report with the data of the selected test and sample type. It is also possible to print out the Levey-Jennings graph. - Self-elevation safety device broken. Contact the TAS. Dispensing system Edit: Modifies the rejection criteria and the calculation mode. The changes affect the selected sheet only. • Needle Introduce Series: Enables manual introduction of series up to a maximum of 30 series per sheet. - No needle detected. Check that the needle is correctly installed. New sheet: Enables the creation of a new sheet when the 30 series of the current sheet are exceeded. If a new sheet is not created, the following series overwrite the oldest series. A new sheet is automatically created when a test parameter is changed. - Needle is too bent. The needle has been detected to be outside its safety margins. Check the straightness of the needle. If necessary, replace it with a new needle. - Needle level detection error. Contact the TAS. • Needle thermostatisation system - Needle thermostatisation error. Contact the TAS. The alarm gives supplementary information to be used by the TAS to diagnose the breakdown. 2.2. Alarms and alerts By clicking on the corresponding button on the horizontal bar menu, the user can access the Current alarms screen, which displays the alarms and alerts generated during the current session. Through the main menu, it is also possible to access the Past alarms and alerts, which contains a list • Dispensing pump - The dispensing pump cannot be started. Contact the TAS. 33 User manual • Containers Results - There is no system liquid container. Place the container correctly. - Absorbance > 2.5 A. reading with absorbance above 2.5 A. Repeat the analysis with the sample pre-dilution. - There is no waste container. Place the container correctly. - Absorbance OUT. It has not been possible to measure the absorbance. Repeat the analysis. - Waste container full. Empty the waste container. - Blank absorbance limit exceeded. Reagent in bad condition. Replace it with a new one. - System liquid container empty. Fill the system liquid container. - Kinetic blank absorbance limit exceeded. Reagent in bad condition. Replace it with a new one. - Error in the container level control system. Deactivate the level control scales from the corresponding configuration screen and contact the TAS. - Test linearity limit exceeded. Repeat the analysis with sample pre-dilution. - Test detection limit exceeded. As a check, the analysis can be repeated. If the alert persists, we may consider the concentration sample null and void. Reactions rotor and readings - The rotor cannot be started. Check that the reactions rotor is not blocked. - Test reference values exceeded. The patient has pathological results. As a check, the analysis can be repeated. - No rotor. Place a rotor in the analyser. - End of rotor. 120 wells of the current rotor have been used. Place a new empty rotor in the analyser. - Lack of linearity in kinetic reaction. Check the status of the reagent. Repeat the analysis. If the alert persists, the sample concentration probably exceeds the linearity limit of the kinetic test. - No rotor cover. Position the cover correctly. If the error persists, deactivate the cover sensors from the corresponding configuration screen and contact the TAS. Danger: the main cover of the analyser must always be closed when it is running. - Calibrator sensitivity error (factor limits exceeded). Check the status of the calibrator and the reagent. Repeat the analysis. • Rotor thermostatisation system - Calibration curve error. Check the status of the multipoint calibrator and the reagent. Repeat calibration. - Rotor thermostatisation error. Contact the TAS. The alarm gives supplementary information to be used by the TAS to diagnose the breakdown. - Internal quality control alert. Access the Quality Control screen. Optical system - Base line error: reduced light intensity. Place a new rotor. If the alert persists, replace the lamp. - Lamp’s life. Information referring to the insufficient luminosity of the lamp. This message will appear during the Warming up or during the change of rotor. Replace the lamp. - Reduced light intensity in x filter. Replace x filter recommended / necessary. Replace corresponding filter. - Filter drum cannot be started. Contact the TAS. - Error in photometric system. Contact the TAS. - Lamp lifetime exceeded. Replace the lamp. Work session alarms and alerts Preparations - Sample volume run out. Add more sample and indicate it to the analyser from the Positions screen for it to perform the analyses. Check the sample tube is correctly in position. - Reagent volume run out. Add more reagent and indicate it to the analyser from the Positions screen for it to perform the analyses. Check the reagent bottle is correctly in position. 34 3. Calculation and measurement procedures This chapter describes the different analysis modes of the analyser and the calculations made to obtain the analytical results, i.e. the concentration values of the different analytes of the samples. In each case, the different formulas used are indicated. The analysis modes are the same for blanks, calibrators, controls and samples of patients. The controls are treated in the same way as the patient samples in all the calculations. Symbols used in the formulas Asample Sample absorbance (patient or control) Acalibrator Calibrator absorbance Ablank Blank absorbance [...] λmain Absorbance value at main wavelength [...]λreference Absorbance value at reference wavelength TR Factor that depends on the type of reaction programmed. Its value is +1 for increasing reactions and -1 for decreasing reactions. F Calibration factor Csample Sample concentration (patient or control) Ccalibrator Programmed calibrator concentration Func[...] Calibration curve or function (with multipoint calibrators) nsample Number of sample replicates (patient or control) ncalibrator Number of calibrator replicates nblank Number of blank replicates i Replicate index [...]R1 Absorbance value with the first reagent in a bireagent differential method. [...] Absorbance value after adding the second reagent in a bireagent differential method. R1+R2 [...]T1 Absorbance value in the first reading in a fixed time method. [...] ∆A ∆t Absorbance value in the second reading in a fixed time method. T2 Variation of absorbance of a sample per unit of time (patient or control) sample ∆A ∆t Variation of absorbance of a calibrator per unit of time calibrator ∆A ∆t Variation of absorbance of a blank per unit of time blank 35 User manual 3.1. End point Csample= 3.1.1. Absorbance The absorbance of the reaction is measured once only on a base line of distilled water. In this procedure, one or two reagents may be used and the absorbance may be measured at one or two wavelengths. The calibration can be based on the use of multiple or specific calibrators (one or several), or on a programmed factor. For each test, a blank is prepared using distilled water instead of the sample or with reagent only. The absorbance of the blank is also measured on the base line of distilled water. Asample-Ablank Ccalibrator Acalibrator-Ablank Considering that TR2=1, this formula is equivalent to the previous one with a factor F=TR· Ccalibrator Acalibrator-Ablank 3.1.2.3. Several calibrators If a multipoint calibrator is used, the concentration is calculated using a calibration function or curve. This curve is obtained from the programmed concentration values of the calibrators and the absorbance values measured for each one with regard to the base line Acalibrator, using an interpolation method (polygonal or spline) or a regression method (linear or quadratic) and linear or logarithmic axes, in accord with how it is programmed fro each test. With this curve, the analyser calculates the concentration of the sample in accord with its absorbance with regard to the base line 3.1.1.1. Monoreagent / Bireagent The procedure is different for the tests using one or two reagents. For the monoreagents, the analyser dispenses the reagent and the sample in cycle 1 and measures the absorbance of the reaction during a later cycle, in accord with how it is programmed in the test. For bireagents, the analyser dispenses reagent 1 and the sample in cycle 1. In a later cycle, it dispenses reagent 2 in the same well and then measures the absorbance of the reaction in another later cycle, in accord with how it is programmed in the test. Csample=Func[Asample] 3.1.1.2. Monochromatic / Bichromatic 3.1.3. Replicates The absorbance can be measures at one or two wavelengths. In the case of bichromatic readings, the difference between the absorbance at the main wavelength and the absorbance at the reference wavelength is taken as the absorbance value. Up to 50 replicates can be programmed for each sample and up to 3 for each blank, calibrator or control. 3.1.3.1. Blank The average of the absorbance values measured is taken as the absorbance of the blank. Amuestra=[Asample]λmain-[Asample]λrefefence Acalibrator=[Acalibrator]λmain-[Acalibrator]λreference Ablank= Ablank=[Ablank]λmain-[Ablank]λreference 1 nblank nblank ΣA i blank i=1 3.1.2. Concentration 3.1.3.2. Calibrator Based on the absorbance value obtained, the analytical concentration in the sample can be calculated. The average of the absorbance values measured is taken as the absorbance of the calibrator. 3.1.2.1. Factor Acalibrator= The concentration is calculated using a programmed factor with the formula 1 ncalibrador ncalibrator ΣA i calibrator i=1 3.1.3.3. Sample Csample=TR·F·(Asample-Ablank) The average values calculated for the absorbance of the blank and the calibrator or calibrators are used in the calculations set forth in the previous section to obtain the concentration of each replicate of the sample. The average value of the calculated concentrations is taken as the concentration of the sample. 3.1.2.2. Single calibrator If a single point calibrator is used, the concentration is calculated with the formula 36 Csample= 3.2.2.3. Several calibrators n sample Σ 1 nsample Cisample If a multipoint calibrator is used, the concentration is calculated using a calibration function or curve. This curve is obtained from the programmed concentration values of the calibrators and the absorbance values measured for each one with regard to the base line Acalibrator, using an interpolation method (polygonal or spline) or a regression method (linear or quadratic) and linear or logarithmic axes, in accord with how it is programmed fro each test. With this curve, the analyser calculates the concentration of the sample in accord with its absorbance with regard to the base line i=1 3.2. Bireagent differential 3.2.1. Absorbance The analyser dispenses reagent 1 and the sample in cycle 1. In a later cycle, it measures the absorbance of the mixture on a base line of distilled water. later, it dispenses reagent 2 in the same well and then measures the absorbance of the reaction in a later cycle, in accord with how it is programmed in the test. The absorbances are measured at one single wavelength. For each test, a blank is prepared using distilled water instead of the sample or with reagents only. The absorbances of said blank, with the first reagent and with both reagents, are also measured on the base line of distilled water. The calibration can be based on the use of multiple or specific calibrators (one or several), or on a programmed factor. The difference between the absorbance measured with the two reagents and the absorbance measured with the first reagent only is taken as the absorbance value. Csample=Func[Asample] 3.2.3. Replicates Up to 50 replicates can be programmed for each sample and up to 3 for each blank, calibrator or control. 3.2.3.1. Blank The average of the absorbance values measured is taken as the absorbance of the blank. Asample=[Asample]R1+R2-[Asample]R1 Acalibrator=[Acalibrator] R1+R2 Ablank=[Ablank] R1+R2 -[Acalibrator] Ablank= R1 1 nblank 3.2.3.2. Calibrator -[Ablank] R1 n blank ΣA i blank i=1 The average of the absorbance values measured is taken as the absorbance of the calibrator. 3.2.2. Concentration Based on the absorbance value obtained, the analytical concentration in the sample can be calculated. Acalibrator= 1 ncalibrator ncalibrator ΣA i calibrator i=1 3.2.2.1. Factor 3.2.3.3. Sample The concentration is calculated using a programmed factor with the formula The average values calculated for the absorbance of the blank and the calibrator or calibrators are used in the calculations set forth in the previous section to obtain the concentration of each replicate of the sample. The average value of the calculated concentrations is taken as the concentration of the sample. Csample=TR·F·(Asample-Ablank) 3.2.2.2. Single calibrator If a single point calibrator is used, the concentration is calculated with the formula Csample= Asample-Ablank Acalibrator-Ablank Csample= Ccalibrator nsample nsample ΣC i sample i=1 3.3. Fixed time Considering that TR2=1, this formula is equivalent to the previous one with a factor F=TR· 1 3.3.1. Absorbance The absorbance of the reaction is read at two particular times with regard to a base line of distilled water at one single wavelength. The calibration can be based on the Ccalibrator Acalibrator-Ablank 37 User manual is obtained from the programmed concentration values of the calibrators and the absorbance values measured for each one with regard to the base line Acalibrator, using an interpolation method (polygonal or spline) or a regression method (linear or quadratic) and linear or logarithmic axes, in accord with how it is programmed fro each test. With this curve, the analyser calculates the concentration of the sample in accord with its absorbance with regard to the base line use of multiple or specific calibrators (one or several), or on a programmed factor. For each test, a blank is prepared using distilled water instead of the sample or with reagent only. The absorbances of this blank at the two specific times are also measured on the base line of distilled water. 3.3.1.1. Monoreagent / Bireagent The procedure is different for the tests using one or two reagents. For the monoreagents, the analyser dispenses the reagent and the sample in cycle 1 and measures the absorbance of the reaction in two later cycles, at the moments in time T1 and T2, in accord with how it is programmed in the test. For bireagents, the analyser dispenses reagent 1 and the sample in cycle 1. In a later cycle, it dispenses reagent 2 in the same well and then measures the absorbances of the reaction at the moments in time T1 and T2, in accord with how it is programmed in the test. The difference between the absorbance measured at time T1 and the absorbance measured at time T2 is taken as the absorbance value. Asample=[Asample] -[Asample] T2 3.3.3. Replicates Csample=Func[Asample] Up to 50 replicates can be programmed for each sample and up to 3 for each blank, calibrator or control. 3.3.3.1. Blank The average of the absorbance values measured is taken as the absorbance of the blank. Ablank= T1 Acalibrator=[Acalibrator]T2-[Acalibrator]T1 1 nblank n blank ΣA i blank i=1 3.3.3.2. Calibrator Ablank=[Ablank]T2-[Ablank]T1 The average of the absorbance values measured is taken as the absorbance of the calibrator. 3.3.2. Concentration Based on the absorbance value obtained, the analytical concentration in the sample can be calculated. Acalibrator= 1 ncalibrator ncalibrator ΣA i calibrator i=1 3.3.2.1. Factor 3.3.3.3. Sample The concentration is calculated using a programmed factor with the formula The average values calculated for the absorbance of the blank and the calibrator or calibrators are used in the calculations set forth in the previous section to obtain the concentration of each replicate of the sample. The average value of the calculated concentrations is taken as the concentration of the sample. Csample=TR·F·(Asample-Ablank) 3.3.2.2. Single calibrator If a single point calibrator is used, the concentration is calculated with the formula Csample= Asample-Ablank Acalibrator-Ablank Csample= Ccalibrator nsample nsample ΣC i sample i=1 3.4. Kinetics Considering that TR2=1, this formula is equivalent to the previous one with a factor F=TR· 1 3.4.1. Variation of the absorbance per unit of time Ccalibrator The kinetic mode is used to measure the catalytic activity of an enzyme. The absorbance of the reaction on a base line of distilled water is measured periodically during several cycles, between the times Ti and Tf programmed in the test. The readings are taken at one single wavelength. Based on these absorbance measurements, the analyser calculates the variation of the absorbance of the reaction per unit of time. The calibration can be based on the use of Acalibrator-Ablank 3.3.2.3. Several calibrators If a multipoint calibrator is used, the concentration is calculated using a calibration function or curve. This curve 38 Considering that , this formula is equivalent to the previous one with a factor Ccalibrator Csample=TR multiple or specific calibrators (one or several), or on a programmed factor. For each test, a blank is prepared using distilled water instead of the sample or with reagent only. The absorbances of this blank are also measured on the base line of distilled water. ∆A ∆t 3.4.1.1. Monoreagent / Bireagent calibrator blank 3.4.2.3. Several calibrators The procedure is different for the tests using one or two reagents. For the monoreagents, the analyser dispenses the reagent and the sample in cycle 1 and measures the absorbance of the reaction in several later cycles, between the times Ti (start) and Tf (end), in accord with how it is programmed in the test. For bireagents, the analyser dispenses reagent 1 and the sample in cycle 1. In a later cycle, it dispenses reagent 2 in the same well and then measures the absorbances of the reaction at the moments in several later cycles, between the times Ti and Tf, in accord with how it is programmed in the test. If a multipoint calibrator is used, the concentration is calculated using a calibration function or curve. This curve is obtained from the programmed concentration values of the calibrators and the absorbance gradient values measured for each one with regard to the base line , ∆A ∆t using an interpolation method (polygonal or spline) or a regression method (linear or calibrator quadratic) and linear or logarithmic axes, in accord with how it is programmed fro each test. With this curve, the analyser calculates the concentration of the sample in accord with the absorbance gradient with regard to the base line ∆A Csample=Func ∆t 3.4.1.2. Checking linearity Catalytic activity is measured by the speed of the reaction, which is proportional to the gradient of the absorbancetime curve. This ∆A/∆t gradient is calculated using the linear method over the set of absorbances measured between the times Ti and Tf. The most common units for measuring the gradient are ∆A/min. Depending on the test, the period of measurements can be different. In general, for the more common tests, around 13 readings are taken at regular 15second intervals. The analyser automatically calculates the best line of regression by the squared minimums method and checks the linearity of the measurements base don the correlation quotient. If the linearity is low, the analyser issues the corresponding alert together with the result of the test. [ ] sample 3.4.3. Replicates Up to 50 replicates can be programmed for each sample and up to 3 for each blank, calibrator or control. 3.4.3.1. Blank The average of the absorbance gradient values measured is taken as the absorbance gradient of the blank. ∆A ∆t 3.4.2. Concentration = blank Based on the absorbance gradient obtained, the analytical concentration in the sample can be calculated. 1 nblank n blank Σ i=1 ∆A ∆t blank The average of the absorbance gradient values measured is taken as the absorbance gradient of the calibrator. The concentration is calculated using a programmed factor with the formula ( ∆A ∆t ∆A ∆t sample ∆A ∆t ) = calibrator blank 1 ncalibrator ncalibrator Σ i=1 ∆A ∆t 3.4.2.2. Single calibrator ∆A ∆t ∆A ∆t blank Ccalibrator ∆A ∆t calibrator calibrator The average values calculated for the absorbance gradient of the blank and the calibrator or calibrators are used in the calculations set forth in the previous section to obtain the concentration of each replicate of the sample. The average value of the calculated concentrations is taken as the concentration of the sample. ∆A ∆t sample i 3.4.3.3. Sample If a single point calibrator is used, the concentration is calculated with the formula Csample= i 3.4.3.2. Calibrator 3.4.2.1. Factor Csample=TR·F ∆A ∆t Csample= blank 39 1 nsample nsample ΣC i=1 i sample