Download - Point of Care (POC) Blood Glucose Monitoring
Point of Care (POC) Blood Glucose Monitoring
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Accu-Chek Inform II Operator Training
Presentation Objectives
• User certification
• Meter interferences
• Patient testing exclusion criteria
• Introduction to the Accu-Chek Inform II meter
• How to run QC
• Meter maintenance
• Patient testing
• Critical Values
• Results review
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Certification
• Certification of all personnel and yearly recertification (demonstrating on-going competency)
• Lab accreditation requirement
• treatment decisions are made based on these results
• Professional responsibility
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Dr. M.E.Lyon
Glucose Meter
User Error
Exogenous
Interferences
Endogenous
Interferences
Environmental
Factors
ie. hand washing,
expired strips
ie. Hematocrit, renal
failure
ie. Altitude, temperature,
humidity
ie. Galactose,
ascorbate, tylenol
Factors Affecting Glucose Meter Performance
Boston Biomedical Consultants, 2010
Glucose Meter
User Error
Exogenous
Interferences
Endogenous
Interferences
Environmental
Factors
ie. hand washing,
expired strips
ie. Hematocrit, renal
failure
ie. Altitude, temperature,
humidity
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The Enigma of Glucose Measurement
Glucose meter:
2.3 mmol/L
Blood Gas Analyzer:
2.9 mmol/L
Clinical Lab (plasma hexokinase):
1.5 mmol/L
Which one is right?
5 Dr. M. E. Lyon
Patient Specific Factors That Could Influence Glucose Meter Performance
The Patient
Medications/Treatments
Clinical Laboratory Parameters
Hematocrit?
Plasma Water Concentration?
RBC Water Concentration?
Ascorbate?
Peritoneal Dialysis?
Infant formula? Galactose
Patient Characteristics
Metabolic?
Ambulatory?
Intensive Care?
Burn Patient?
Renal Disease?
6 Dr. M. E. Lyon
Accu-Chek Inform II Operator Training 7
Highlights of the Inform II System
Sample size – 0.6 microliters and applied to FRONT EDGE TIP of strip
Testing time – 5 seconds
Linear range for meter is 0.6mmol/L-33.3mmol/L
Use of second blood drop for testing
Cleaning site with soap and water
Strip must be in meter BEFORE testing.
Accu-Chek Inform II Operator Training
Operator ID lockout – Will need to enter Operator ID to test
Operator ID will be given to certified users only
Your operator ID will be tied to the result for which you are then accountable
Meter must be docked for recharging-and remain in Base Unit when not in use.
More Highlights of the Inform II System
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Accu-Chek Inform II Operator Training 9
Accu-Chek Inform II Introduction
Tote Box -NOT for
storage of meter only
storage of strips, controls,
lancets, ref guide
Accu-Chek Inform II
(wireless available)
Base Unit for automatic data
transfer and charging battery
Blue light on when
communicating, green when
charging
Red is when you first plug in
Base Unit to power outlet until
meter gets put in it
Accu-Chek Inform II Operator Training 10
Accu-Chek Inform II Introduction
Barcode Scanner (Laser)
Test Strip Port
Touchscreen-
Main menu
with 3 options
On/Off Button
Accu-Chek Inform II Operator Training
Back of Meter
• Meter re-set button
(for meter freeze situation, only to be accessed upon
recommendation of key operator or vendor)
•Re-Chargeable Battery Pack
•Charging Contacts
(To Base Unit)
•Infra-red contact to upload lot information only to be accessed
by key operator or vendor
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Accu-Chek Inform II Operator Training 12
Accu-Chek Inform II Test Strips – 50/vial
(replace cap immediately!)
Strips are good until manufacturer expiry
date. Replace lid when strips are not in use.
Accu-Chek Performa Control Solutions
Control 1 and Control 2
Good for 3 months at Room Temp after
opening - write open date on vial.
Accu-Chek Inform II Introduction
Accu-Chek Inform II Operator Training
When To Run QC
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QC is to be run:
1)Every 24 hours
2)If the meter is dropped or potentially damaged
3)If you suspect that the result is incorrect
4)If a new lot # strips or QC
Accu-Chek Inform II Operator Training
Cleaning the Meter and Accessories
• Remove the meter from the docking station • Always clean meter between patient use • Wipe with Percept RTU wipe that has been wrung out so it is not
too damp.
• If visibly soiled-wipe to remove soil-wipe again for disinfection
• Gently wipe exposed areas, carefully avoiding the connectors
and openings on meter and docking station.
• meter has only one opening – strip port entry
• Always allow the meter and base unit to thoroughly air dry
before putting it back into use.
• Refer to cleaning procedure for more in depth cleaning
instruction
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Accu-Chek Inform II Operator Training
Cleaning Meter after testing when Patient is on Precautions:
1. Leave the meter in the room on a flat surface near the door
2. Remove PPE in the usual manner
3. Do Hand hygiene
4. Donn clean gloves and take an approved pre-moistened disinfectant wipe
5. Go back into room, get meter and wipe it down
6. Take the clean meter out of the room and place it on a clean surface
7. Remove gloves and do Hand Hygiene
8. Place meter into the base
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Accu-Chek Inform II Operator Training 16
Hands On with meter!
Remove meter from base unit.
1. Press and release the On/Off button
2. ‘Power Up’ screen appears after meter performs self-
checks
3. Note battery life symbol in bottom right corner will
be fully black if fully charged
4. Manually proceed to the next screen by touching
symbol (happens automatically after 5 seconds)
Accu-Chek Inform II Operator Training 17
Entering an Operator ID - Manual Entry – Hands On
• Touch the symbol to backspace and delete a
character entered incorrectly
• Touch symbol to confirm
Once entry is complete, the main menu appears
Picture
with
operator
ID
screen-
not QC
Accu-Chek Inform II Operator Training 18
Entering an Operator ID – Barcode Scanner Hands On
Operator ID may be scanned from the barcode reader:
1. Touch and release the ‘Scan’ symbol in top right corner of
screen (black background=scan mode)
2. Hold meter so window of scanner is 4-8 inches above
barcode you wish to read.
Meter beeps once the barcode has been read successfully
and info scanned appears on screen. Scanner turns off
after 5 seconds.
Accu-Chek Inform II Operator Training 19
Accu-Chek Inform II Perform Quality Control (QC) Hands On – Run 1 level QC
QC testing is required every 24 hours and if
not done, meter will be locked out until
QC testing is completed
1. Touch Control Test
2. Press barcode icon and scan the barcode on a
Quality Control Vial.
3. Choose or scan lot number of strips you will be
using
4. Press √ to continue
Both level 1 and 2 must be run every 24
hours
• NOTE: lot numbers cannot be manually entered
Accu-Chek Inform II Operator Training 20
Accu-Chek Inform II Perform a QC – Hands On
4. When “Flashing Arrow” symbol appears, insert test strip into test strip port at top of
meter. “Flashing Drop” symbol appears when meter is ready for QC sample
5. Mix the control vials by gently inverting 5 times
6. Remove cap and wipe vial with tissue
7. Discard first drop and apply 2nd drop to FRONT EDGE TIP of strip (not Top)
Result will appear within 5 seconds
Note: Test strip must ALWAYS be in meter BEFORE application of Quality Control
sample!!
Accu-Chek Inform II Operator Training
Accu-Chek Inform II Perform a QC – Hands On
1. Quality Control result will display as PASS or FAIL
2. If you see quality control has PASS then chose √ and move on the barcode scan of the other level of quality control
3. If the quality control FAILS the comment icon in the lower left of the screen will flash. Press on it and chose the appropriate comment from the drop down list and then press √ to confirm. Confirm once again on the FAIL screen and then repeat control. Once both QC levels have PASSED you can proceed with patient testing.
Comment is required if result is “Out Of Range” or an error.
Touch symbol in lower left corner of screen, pre-programmed comments will appear. (Up to 3 comments can be selected)
Touch in lower right to confirm selection.
Note: Once exited from QC result/comment screen, new comment cannot be added later.
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Accu-Chek Inform II Operator Training 22
Accu-Chek Inform II Perform a Patient Test – Hands On
1. Touch ‘Patient Test’.
2. Confirm selection by touching in
lower right corner of screen.
Accu-Chek Inform II Operator Training 23
Accu-Chek Inform II Perform a Patient Test- Hands On
confirm the test strip lot:
3. Touch barcode symbol top right corner of screen
4. Scan barcode on strip vial holding scanner 4-8 inches in front of
vial barcode
5. When “Flashing Arrow” symbol appears, insert test strip (close cap
asap)
Note: Test strip must ALWAYS
be in meter BEFORE
application of patient blood
sample!!
Accu-Chek Inform II Operator Training 24
Accu-Chek Inform II Perform a Patient Test – Hands On – Simulate with Level 2 Control
6. For actual patient testing - make sure site is cleaned with soap
and water and thoroughly air dried
*Scan the patient’s barcode or manually enter the patient PHN or
MRN*
7. When “Flashing Drop” symbol appears, pierce site
8. Wipe away first drop and apply second drop to front edge tip of
test strip (not top). You have up to 5 minutes to apply the sample.
(note: Can re-dose within 5 seconds, if needed)
Result appears after 5 seconds
Accu-Chek Inform II Operator Training
Accu-Chek Inform II Entering comment for Critical Result – Hands On
Required if result is a “Critical Value” or an error
10. Touch comment symbol in lower left corner of the screen
11. Touch up to three pre-programmed comments. A comment is required for all critical value results
12. Touch in lower right to confirm selection.
13. To confirm, touch again if satisfied with comment and to exit from screen.
Note: Once exited from result comment screen, new comment cannot be added later.
*If no comment was required, press in lower right corner of result screen.
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Accu-Chek Inform II Operator Training 26
Neonatal Heel Puncture Provide comfort measures (swaddling, suckling, sucrose)
Choose site avoiding calcaneum and plantar surfaces Squeezing heel increases pain and cell lysis and decreases blood yield Contraindications include edema, injuries or anomalies, poor perfusion, or infection. These could lead to erroneous results.
Accu-Chek Inform II Operator Training 27
Accu-Chek Inform II Results Review Patient or Quality Control – Hands On
From main menu screen touch ‘Review Results’. Stored test results are
displayed in a sequential list.
Touch or to scroll up or down in the list. Results are grouped by date.
Accu-Chek Inform II Operator Training 28
Accu-Chek Inform II Results Review- Hands On
•Touch an entry in list to display related details.
• When the details are displayed touching the ‘Patient’ symbol to display all results
remaining in the meter for that specific patient only.
Accu-Chek Inform II Operator Training 29
Accu-Chek Inform II Operator Training 30
Accu-Chek Inform II Operator Training
a) Observed testing/certification is needed
Software Overview and Features OTS (1/2)*
Roche Diagnostics, ACI II Softw are Overview and Features 6_8.ppt March-2017
b) Operator performs a test under observation:
* Example screenshots, not necessarily an exact match when instrument is connected to cobas IT 1000
Accu-Chek Inform II Operator Training
Software Overview and Features OTS (2/2)* in mg/dl
c) Observer rates and comments the observed test execution:
Roche Diagnostics, ACI II Softw are Overview and Features 6_8.ppt March-2017
* Example screenshots, not necessarily an exact match when instrument is connected to cobas IT 1000
Accu-Chek Inform II Operator Training 33
Accu-Chek Inform II Ranges
Action Values:
Result on meter less than 4.0 mmol/L follow hypoglycemia protocol.
Results greater than 22.0 mmol/L follow protocol & call MD
Critical Action Values:
Less than 2.8 mmol/L follow hypoglycemia protocol
Linearity Range of Meter 0.6 – 33.3 mmol/L
Hematocrit operating range: 23%-58% for neonates, and 10%-65% for adults
Sample Types- results may vary depending on the source of the blood sample
Venous
Arterial
Capillary