Need your feedback ASAP

[Brenda K Hutson]

I know we are not supposed to double post but I really need feedback on this and I have not gotten much putting it in the Equipment section. We are expecting CAP any day now so I am frantically trying to revise some procedures that I have changed in the past year. I expect that most of us use cellwashers so there must be more input out there??

Thanks in advance; here is the Thread posted in equipment:

In places I have worked, the only Daily QC Maintenance we have performed on cellwashers is:

1. Tube Fill Level (Daily)

2. Fill Volume (Weekly)

Method 8-6 in the 16th Edition of the Technical Manual, also describes a process for checking the cell button. It does not state the frequency, but seems to me it implies "regularly." Briefly, it is adding potentiator, human serum and 1 drop of IgG-coated cells to 12 tubes; washing them; checking fill level;checking that red cells are resuspended, and then a dry cell button; add AHG and examine for agglutination. This sounds more like extensive calibration than Daily QC "to me."

So just interested in knowing:

1. Do any of you follow this procedure? If YES, how frequently?

2. What "do" you all do on a Daily and/or Weekly basis for cellwasher Maintenance/QC?

I have to admit, though I have worked in many different places and been the charge person at several of those, equipment has never been my strong point (or interest). It is for me, a necessary evil... :tongue:

Thanks

Brenda Hutson, CLS(ASCP)SBB

[LShirley]

We do the "long" procedure each quarter. Our only daily QC is fill volume. Haven't had any problems with CAP or AABB on this.

[pmata]

We do Method 8-6 quarterly to determine appropriate "spin time" for each cellwasher.

[Lcsmrz]

Some cell washers add AHG for you. These cells washers need more extensive function checking.

We used ours for washing only, so we did the daily fill check and the weekly dispense voiume verification -- that is, until it started smoking and it was taken out of service.

If check cells worked after washing, we said it was working well ...

[Mary**]

It is best to follow the manufacturer's recommendations.

[Eagle Eye]

we calibrate every year(long procedure). we check fill volume, cell loss, cell button etc every week. DO not have any daily QC on it.

[GilTphoto]

Fill volume daily, spin time calibration yearly.

[Brenda K Hutson]

It is best to follow the manufacturer's recommendations.

I agree, but unfortunately, I have not been able to locate a manual in my dept. (I have only been there a couple of years; they have had the cellwashers many years).

But that is a good idea; I will contact the Manufacturer on this question.

I just also wanted to cover myself from a regulatory standpoint in that their requirements can at times, be more strict than the Manufacturer's Manuals.

Thanks

Brenda

[Sheila]

I only do the long procedure annually. Daily QC checks include size of cell button, using check cells on the negative tubes to insure adequate washing, etc. when we run our regular daily reagent QC.

Weekly, the cellwashers are rinsed through with bleach, per the recommendation of the manufacturer. This is documented on a checklist posted at each work station.

[Malcolm Needs ☆]

We test all our washers, using a known weak anti-D and D+ red cells weekly.

This is probably over-kill, because, as someone else said above, if the check cells work, the washer is working (but we have to follow the national SOP).

[Brenda K Hutson]

Right; but I guess my concern then has more to do with looking at the "appearance" of the button, is how it is written in the Method: checking that red cells are resuspended, and then a dry cell button.

So Malcom, when you say you check D+ cells and weak anti-D weakly, what precisely is your testing procedure, and what all are you looking for?

It seems there are so many different responses here that I am still unsure how to proceed. I think I will start though by getting hold of the Cellwasher's Manufacturer's Manual to see what they recommend.

Thanks,

Brenda

[Malcolm Needs ☆]

Right; but I guess my concern then has more to do with looking at the "appearance" of the button, is how it is written in the Method: checking that red cells are resuspended, and then a dry cell button.

So Malcom, when you say you check D+ cells and weak anti-D weakly, what precisely is your testing procedure, and what all are you looking for?

It seems there are so many different responses here that I am still unsure how to proceed. I think I will start though by getting hold of the Cellwasher's Manufacturer's Manual to see what they recommend.

Thanks,

Brenda

I may have got the wrong end of the stick here Brenda, but, from my point of view, it doesn't matter what the cell button looks like, nor, to a certain extent, whether or not the red cells are fully suspended, but whether the washer actually works.

To do this, once a week we will set up as many tubes as we have places in our washers, that contain a known weak anti-D (not a strong anti-D that we have diluted, as this will have different reaction constants) and R1r red cells. These are incubated at 37oC, as normal, and then washed in the washers being tested. At the end of the washing, we add AHG, centrifuge gentle, and record not only the results as positive or negative, but also the strength of the positive results, and record these as normal.

In addition, once every 6 months, or when we have a new batch, we would also test the strength of the AHG by adding a dilution of human plasma to the washed red cells, to ensure that the AHG we then add is inhibited.

I'm still not sure that I have answered your point, or, come to that, have now grasped the correct end of the stick (my body is back in Surrey, but I'm afraid that my mind mind may still be in Cornwall)!!!

:confused:

[Brenda K Hutson]

I may have got the wrong end of the stick here Brenda, but, from my point of view, it doesn't matter what the cell button looks like, nor, to a certain extent, whether or not the red cells are fully suspended, but whether the washer actually works.

To do this, once a week we will set up as many tubes as we have places in our washers, that contain a known weak anti-D (not a strong anti-D that we have diluted, as this will have different reaction constants) and R1r red cells. These are incubated at 37oC, as normal, and then washed in the washers being tested. At the end of the washing, we add AHG, centrifuge gentle, and record not only the results as positive or negative, but also the strength of the positive results, and record these as normal.

In addition, once every 6 months, or when we have a new batch, we would also test the strength of the AHG by adding a dilution of human plasma to the washed red cells, to ensure that the AHG we then add is inhibited.

I'm still not sure that I have answered your point, or, come to that, have now grasped the correct end of the stick (my body is back in Surrey, but I'm afraid that my mind mind may still be in Cornwall)!!!

:confused:

No, I do hear what you are saying (and do agree).

The "only" thing I am trying to assess is the part of the Method for "Testing Automatic Cell Washers" in that I do routinely perform "part" of that (tube fill level; fill volume) but I do not on any frequent basis, look to see that all of the red cells have been completely resuspended and/or observe the tubes at completion for a "dry cell button." If the Coombs Control Cells work, that is good enough for me.

In fact, we do our Daily Fill Level with 12 empty tubes and perform the Fill Volume weekly. The issues of "complete resuspension of cells" and a "dry cell button" are something we only assess when performing calibration of the cellwashers. And currently, we are only performing the calibration annually. Looking at Appendix 1-4 in the 16th Edition of the Technical Manual, it states to check the "Function" yearly. We have an outside company that does the Speed and Timer checks quarterly; we do the Tube fill level daily (with empty tubes) and the Saline fill volume weekly; for us, the volume of AHG dispensed is N/A.

So, bottom line: I am trying to make sure that we are doing "enough," and that we are doing it "frequently enough."

And there seem to be a lot of time variables in the responses to this question above.

Thanks for your input and patience...

Brenda Hutson, CLS(ASCP)SBB

[Malcolm Needs ☆]

Right, now (I think) I understand and, from what you say, I cannot see that you are doing anything wrong.

[Brenda K Hutson]

I only do the long procedure annually. Daily QC checks include size of cell button, using check cells on the negative tubes to insure adequate washing, etc. when we run our regular daily reagent QC.

Weekly, the cellwashers are rinsed through with bleach, per the recommendation of the manufacturer. This is documented on a checklist posted at each work station.

Actually, what I see in the Manufacturer's Operating Instructions is: Due to the corrosive effects of Clorox bleach the following procedure should not be done more than once per week. That does seem like a lot to me, but certainly you are within the Instructions as far as frequency (but could do it less and still be acceptable). Just FYI in case you hate the smell of bleach as much as I do....

Brenda Hutson, MT(ASCP)CLS, SBB

[Kathyang]

We do fill tube daily, check the saline weekly, and clean the cellwasher monthly and check the cells after cleaning. I worked in a busier Blood Bank for many years and the monthly cleaning seemed to be enough. We don't use the cellwasher much since all our testing is completed in gel.

[jlmoses]

Our Daily Maintenance: Inspect Interior Bowl - wipe with damp sponge.

Inspect tubings and connections.

Weekly maintenance: Saline Volume dispense check (list the ml amt ) Reference the section/page in

OP Manual

System Flush Reference OP manual section and page

Semi-annual checks are done by BIOMED

Comments and corrective actions

Have you tried to call the Manufacturer? You might get help from your supplier.

[Townsend]

Years ago, we made the change to do fill-volume check daily and cleaning every two weeks. We now only performing cell button calibration upon receipt (prior to use) and after major repairs by Biomed. Biomed also does the tach and timer on a quarterly basis. It does seem like there is a lot of variation in practice, but as long as you have a defined system in place (SOP), I would be surprised to see any problems from AABB or CAP inspections - hopefully I did not speak too soon!

[bevdu]

1. daily vol.dispensed chk

2. daily clean/visual inspect. of tubing

3. daily qc (mostly for rgts) with known pos/neg expected rxn.

4. wkly fill check

5. annual tube & tube holder replacement

i agree, if i had wanted to do instruments, i would've been a chemist:))

[Brenda K Hutson]

Our Daily Maintenance: Inspect Interior Bowl - wipe with damp sponge.

Inspect tubings and connections.

Weekly maintenance: Saline Volume dispense check (list the ml amt ) Reference the section/page in

OP Manual

System Flush Reference OP manual section and page

Semi-annual checks are done by BIOMED

Comments and corrective actions

Have you tried to call the Manufacturer? You might get help from your supplier.

I have obtained the Manufacturer's Users Manual. It doesn't go into a lot of detail for maintenance, and gives even less guidelines than the Technical Manual.

Brenda