COBE
COBE Spectra Apheresis System
COBE Spectra Apheresis System Ver 4.7, 5.1-5.9, 6.0-6.9, 7.0-7.9 Cell Therapy Guide Nov 2003
Cell Therapy Guide
110 Pages
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12/4/03, 8:24 AM
Apheresis System Cell Therapy Guide For use with Spectra system versions 4.7, 5.1–5.9, 6.0–6.9, 7.0–7.9
Part No. 777093-188 Reorder No. 701225-000 11/2003
© 2003, 1999 by Gambro BCT, Inc.
Contents Introduction... 1-1 Maintaining Hemodynamic Stability in Pediatric Apheresis Patients... 1-2 Viewing AC Data... 1-5 Alarms and Troubleshooting... 1-5
Mononuclear Cell (MNC) Collection Procedure... 2-1 Equipment and Supplies... 2-2 Before You Start... 2-2 Setting Up the Spectra System... 2-5 Loading the Disposable Tubing Set... 2-6 Priming the Disposable Tubing Set... 2-8 Entering Donor/Patient Data... 2-11 Connecting the Donor/Patient... 2-13 Starting the Run... 2-13 Starting Rinseback... 2-17 Disconnecting the Donor/Patient... 2-18 Removing the Disposable Tubing Set... 2-18 Helpful Hints and Recovery Procedures... 2-19 Alarms and Troubleshooting... 2-20
Polymorphonuclear (PMN) Cell Collection Procedure 3-1 Equipment and Supplies... 3-2 Before You Start... 3-2 Setting Up the Spectra System... 3-4 Loading the Disposable Tubing Set... 3-5 Priming the Disposable Tubing Set... 3-5 Entering Donor Data... 3-8 Connecting the Donor... 3-9 Starting the Run... 3-9 Starting Rinseback... 3-9 Disconnecting the Donor... 3-9 Removing the Disposable Tubing Set... 3-9 COBE Spectra Apheresis System • Cell Therapy Guide
Helpful Hints and Recovery Procedures...3-10 Alarms and Troubleshooting...3-10
Spectra AutoPBSC® Procedure...4-1 Equipment and Supplies...4-2 Before You Start...4-2 Setting Up the Spectra System...4-7 Loading the Disposable Tubing Set...4-7 Priming the Disposable Tubing Set...4-10 Entering Donor/Patient Data...4-12 Connecting the Donor/Patient...4-15 Starting the Run...4-16 Starting Rinseback...4-20 Disconnecting the Donor/Patient...4-21 Removing the Disposable Tubing Set...4-21 Helpful Hints and Recovery Procedures...4-22 Alarms and Troubleshooting...4-28
Bone Marrow Processing (BMP) Procedure...5-1 Equipment and Supplies...5-2 Before You Start...5-2 Setting Up the Spectra System...5-4 Loading the Disposable Tubing Set...5-4 Priming the Disposable Tubing Set...5-5 Transferring Bone Marrow to the BMP Set...5-8 Entering Bone Marrow Data...5-9 Connecting the BMP Set to the WBC Disposable Tubing Set. . .5-10 Starting the Run...5-11 Starting Rinseback and Completing the Procedure...5-14 Removing the Disposable Tubing Set...5-16 Helpful Hints and Recovery Procedures...5-16 Alarms and Troubleshooting...5-17
Index...I-1 iii
Contents
iv
COBE Spectra Apheresis System • Cell Therapy Guide
1 Introduction The Cell Therapy Guide is part of the COBE Spectra™ Apheresis System Operator’s Manual. This guide contains instructions for performing cell therapy collection procedures on the COBE Spectra Apheresis System. This chapter contains information common to every procedure in the guide. Other chapters contain instructions for performing specific procedures. Some of the products the COBE Spectra Apheresis System collects are mononuclear cells. The United States Food and Drug Administration continues to develop its regulatory approach for mononuclear cells. You should have the COBE Spectra Apheresis System Essentials Guide on hand to perform these procedures, since it contains necessary reference information.
COBE Spectra Apheresis System • Cell Therapy Guide
1-1
Introduction
Maintaining Hemodynamic Stability in Pediatric Apheresis Patients Follow these instructions to add a "Blood Prime" step to a procedure. In a "Blood Prime," you use a patient-compatible red blood cell (RBC) unit to fill the extracoporeal circuit after the Prime mode and before the patient is connected.
Performing a “Blood Prime” Note: Use aseptic technique throughout all procedures.
1
Obtain one patient-compatible RBC unit.
2
Determine the hematocrit (Hct) and volume of the RBC unit, and the patient’s current Hct.
The procedure may include a "Blood Prime" step because
•
The physician orders it.
•
The system’s extracorporeal blood volume exceeds 10% to 15% of the patient’s total blood volume (TBV). Table 1-1 describes conditions when adding a "Blood Prime" step may be appropriate.
Dilute the RBC unit with enough 0.9% NaCl, albumin, or fresh frozen plasma (FFP) (according to physician’s orders) to create a unit with the same Hct as the patient, or the Hct ordered by the physician. Use the formula, “Calculation for RBC Dilution,” at the end of this section to calculate the appropriate volume to add to the RBC unit.
Table 1-1: Adding a “Blood Prime” At 15% of TBV, “Blood Prime” May Be Ordered If Patient’s TBV Is Equal to or Less Than:
At 10% of TBV, “Blood Prime” May Be Ordered If Patient’s TBV Is Equal to or Less Than:
WBC (285 mL)
1,893 mL
2,840 mL
AutoPBSC (165 mL)
1,100 mL
1,650 mL
Spectra Disposable Tubing Set (Equivalent Whole Blood Volume)
Note: For a patient with a low Hct and TBV, you may want to avoid the effects of dilution and increase the patient’s Hct after a “Blood Prime.” To do this, use an undiluted RBC unit with an Hct of 50% to 65%. For RBCX procedures, dilute the RBC unit to the patient’s Hct. (More information about “Blood Prime” is available on the Gambro BCT website, www.gambrobct.com, or from a Gambro BCT representative.)
3
1-2
Set up and prime the Spectra system with 0.9% NaCl. (For priming instructions, see the chapter for the procedure you are performing.)
COBE Spectra Apheresis System • Cell Therapy Guide
Introduction
4
When prompted, enter the patient data. Enter the Hct of the RBC unit if it is different from the patient’s Hct.
10 Press CONTINUE. The Spectra system draws blood from the RBC unit into the extracorporeal circuit. The following screen appears:
When you finish entering the patient data, the following screen appears: Connect access and return lines. Close access saline. Press CONTINUE to Run.
5
Connect a blood administration set to the RBC unit. The blood administration set should have a filter for removing clots from the unit. The filter prevents any clots from blocking the inlet air detector.
6
Prime the blood administration set according to manufacturer’s instructions and standard transfusion practice.
7
Connect the blood administration set to the access line.
8
Attach the return line to an empty transfer bag that holds at least 300 mL. Note: You can use 3-way stopcocks to connect the blood to the access line and the transfer bag to the return line.
9
Close the roller clamps on the access and return saline lines. Open the pinch clamps on the access and return lines. Open the roller clamp(s) on the blood administration set. Note: A saline drip on the return line is not necessary during “Blood Prime,” since the patient is not connected at this time.
COBE Spectra Apheresis System • Cell Therapy Guide
__.__ ___.__ ___.__ ___.__ ___.__ ____ Diverting prime saline.
11 To decrease the processing time for the RBC unit, record the current inlet:AC ratio, then increase the ratio to 50:1. This increases the inlet flow rate.
12 After the prime saline divert and a valve position check, the following screen appears: __.__ ___.__ ___.__ ___.__ ___.__ ____ Close return saline. Press CLEAR.
Press CLEAR.
13 Process the RBC unit: •
If you are using an undiluted RBC unit, process the entire unit.
•
If you are using a diluted RBC unit, process between 300ml to 500 ml. As the volume processed increases, the effect of dilution from the “Blood Prime” decreases.
14 When you finish processing the RBC unit, press PAUSE. 15 Close the pinch clamps on the access and return lines. 16 Disconnect the RBC unit and transfer bag from the disposable tubing set.
17 Record the volumes processed by the AC, inlet, plasma, and collect/replace pumps, if applicable, that appear on the run screen.
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Introduction
18 Add the inlet volume processed during "Blood Prime" to the target inlet volume. During "Blood Prime," the Spectra system counts the inlet volume processed as part of the target value. To adjust your target value to account for this volume, perform steps a and b: a
Press TARGET VALUES.
b
Press INLET VOLUME. Use the keypad to select the desired value.
19 If you changed the inlet:AC ratio in Step 11, change it back to the desired inlet:AC ratio for the procedure. If the Hct you entered is different from the patient’s, change the Hct to that of the patient.
20 Connect the access and return lines to the patient. 21 Open the access and return lines.
Calculation for RBC Dilution Use this formula to calculate the amount of saline or albumin needed to dilute the RBC unit to the appropriate Hct. In the formula below, RBC is the red blood cell unit obtained from the blood bank to perform the "Blood Prime." Hct is expressed as a decimal. (RBC Hct) × (RBC Volume) ---------------------------------------------------------------------- = Volume of RBC Unit after Dilution Desired Hct for Unit Volume of RBC Unit after Dilution – RBC Volume = Volume of Diluent
Example: RBC Hct = 70% RBC Volume = 220 mL Desired Hct for Unit = 30%
22 Press CONTINUE. The system begins processing the patient’s blood. Complete the procedure. When the Run is complete, DO NOT perform Rinseback. Skipping the Rinseback mode keeps the patient in an isovolemic state and maintains cellular equilibrium.
23 Disconnect the patient. 24 To determine the actual run results, subtract the values recorded in
(0.70) x (220 mL) -------------------------------------------- = 513 mL 0.30 513 mL – 220 mL = 293 mL
To achieve a 30% Hct for the unit, add 293 mL of fluid to the original unit of blood. Then verify the Hct of the unit to ensure you achieved the desired Hct.
Step 17 from the target run results.
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COBE Spectra Apheresis System • Cell Therapy Guide
Introduction
Viewing AC Data To view the current AC infusion rate or the amount of AC in the final product, perform the following during Run mode. Also, perform this to monitor the effect that increasing the inlet pump flow rate has on the AC infusion rate, and to ensure the AC infusion rate does not exceed the prescribed limit for the donor/patient:
1
Press MENU ON/OFF.
2
Press 1 to select “Data Entry.”
3
Press 4 to display the AC data.
4
Press MENU ON/OFF again.
Alarms and Troubleshooting For general information about alarms, see Chapter 12, “General Alarms and Troubleshooting,” in the Essentials Guide.
COBE Spectra Apheresis System • Cell Therapy Guide
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Introduction
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COBE Spectra Apheresis System • Cell Therapy Guide
2 Mononuclear Cell (MNC) Collection Procedure The MNC procedure collects mononuclear cells (MNCs), including peripheral blood stem cells (PBSCs), from a donor/patient. The United States Food and Drug Administration (FDA) continues to develop its regulatory approach to mononuclear cells. During the procedure, anticoagulated whole blood enters the inlet chamber through the inlet tube. As the blood flows through the channel, the system separates it into three layers: Red blood cells (RBCs) on the outside, buffy coat containing white blood cells (WBCs) in the center, and platelet-rich plasma on the inside. The system establishes the RBC/plasma interface during Quick Start. After Quick Start, the operator adjusts the plasma pump flow rate to hold the interface in a constant position. The system draws the MNCs from the channel through the WBC collect tube, while the platelet-rich plasma exits through the plasma tube. The RBCs exit through the RBC tube.
COBE Spectra Apheresis System • Cell Therapy Guide
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Mononuclear Cell (MNC) Collection Procedure
Equipment and Supplies •
COBE Spectra Apheresis System
•
Single-stage filler
•
Collect flow path overlay
•
WBC disposable tubing set or Functionally Closed WBC disposable tubing set
•
COBE Spectra WBC Colorgram™
•
ACD-A anticoagulant. (Each 100 mL contains 2.2 g sodium citrate hydrous, 730 mg citric acid anhydrous, and 2.45 g dextrose hydrous.)
•
If using a vascular access device:
•
Materials to disinfect, aspirate from, and connect to the device according to your standard operating procedures.
Before You Start Read this section before performing a mononuclear cell (MNC) collection procedure.
Configuration Options Configuration settings remain in effect for all MNC collection procedures until you change them. For more information about configurable parameters, see “Spectra System Configuration,” in Chapter 5 of the Essentials Guide.
1,000 mL 0.9% sodium chloride (NaCl) for injection. If using a single-port saline container, and/or need to avoid hypersensitivity reactions associated with ethylene oxide sterilization, see “Using an Alternative Single-Pass Prime Procedure” in Chapter 11 of the Essentials Guide.
Configuration selection screens vary slightly depending on the Spectra system software you use. Version 6.1 screens appear below.
•
Forceps or hemostats
1
Press MENU ON/OFF.
•
One 600-mL transfer bag for plasma collection (if plasma will be collected)
2
The menu appears: 1=Data Entry, 2=Pressure Display, 3=CCM, 4=Air Remove, 5=Strobe, 6=Configuration.
If using peripheral access:
•
If using a Functionally Closed WBC disposable tubing set, one needle of sufficient gauge to accomodate procedure flow rates – or – If using a WBC disposable tubing set, two needles of sufficient gauge to accomodate procedure flow rates
•
Venipuncture site preparation materials
•
Blood pressure cuff
2-2
Press 6.
3
The first configuration selection screen appears: Configuration: 1=Height/weight units, 2=Decimal point, 3=AC rate, ENTER=more.
Press ENTER.
COBE Spectra Apheresis System • Cell Therapy Guide
Mononuclear Cell (MNC) Collection Procedure
4
The second configuration selection screen appears:
3
Configuration: 1=plasma collect, 2=end points, 3=ratio, 4=AutoPBSC, ENTER=more
5
The following screen appears: MNC end point: Run time ={ 0} Inlet Volume = 0 or 2.0 X TBV
Press ENTER.
Enter a procedure end point.
The third configuration screen appears:
To move to the next field, press ENTER. To return to the previous field, press CLEAR. If you enter a number in any field, the other two fields return to zero.
Configuration: 1=high flow, 2=step down 3=Single Needle, 4=yield cal.
Configuring the MNC Inlet:AC Ratio To accept the default value displayed on a screen, press ENTER.
The default inlet:AC ratio for MNC procedures is 12:1.
To return to the previous screen without making a change, press CLEAR.
1
Go to the second configuration selection screen. Press 3.
2
The following screen appears:
Configuring the MNC End Point
Select Inlet/AC ratio configuration: 1=PLT, 2=TPE, 3=MNC, 4=PMN,5=AutoPBSC
The default end point for MNC procedures is 2.0 x TBV. You can configure this end point to be a:
•
Specific run time.
•
Specific volume of blood (inlet volume) to process.
•
Multiple of the donor’s/patient’s total blood volume.
1
Go to the second configuration selection screen. Press 2.
2
The following screen appears: Configure end point for: 1=PLT, 2=TPE, 3=MNC,4=AutoPBSC
Press 3 again.
3
The following screen appears: Enter MNC Inlet/AC ratio default value
{12.0}
To accept the default, press ENTER, or enter a new value and press ENTER.
Press 3.
COBE Spectra Apheresis System • Cell Therapy Guide
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Mononuclear Cell (MNC) Collection Procedure
Configuring the AC Infusion Rate
“Blood Prime” for Pediatric Donors/Patients
The default AC infusion rate is 0.8 mL/min/L of TBV. This rate reduces the risk of hypocalcemic reactions in the donor. You can configure the AC infusion rate up to a maximum of 1.1 mL/min/L of TBV.
See “Maintaining Hemodynamic Stability in Pediatric Apheresis Patients” on page 1-2.
If you increase the AC infusion rate, you process more blood and increase the yield for the equivalent process time. The risk of hypocalcemic reactions in the donor may increase. Set the rate based on your guidelines for managing donor reactions.
Collect Pump Flow Rate
1
Go to the first configuration selection screen and press 3.
2
A caution message appears:
You cannot change the CFR during Quick Start. Change the CFR after Quick Start, then establish the optimum interface (see page 2-19).
CAUTION: Higher AC infusion rate may increase donor reaction.
More information about the CFR is available on the Gambro BCT website, www.gambrobct.com, or from a Gambro BCT representative.
To remove the caution message, press CLEAR.
3
The default collect pump flow rate (CFR) varies according to the WBC procedure. For MNC procedures, the CFR defaults to 1.0 mL/min. Use a CFR between 0.8 and 1.5 mL/min. You may need to use a higher CFR for an exceptionally mobilized donor with an elevated WBC count.
Net Additional Saline Returned to Donor/Patient
The following screen appears:
Table 2-1 shows the net amount of additional saline returned to a donor/patient at the end of the Rinseback mode.
Enter ELP/WBC default AC infusion rate, in ml/min per liter of TBV: {0.8}
Table 2-1: Net additional saline returned to patient after Rinseback
Enter a new value between 0.8 and 1.1 mL/min/L of TBV. The Spectra system uses this value to calculate the starting AC pump flow rate for all platelet and WBC procedures. Note: If you changed the configured AC infusion rate during the last Run, this message appears at the start of the next Run: AC infusion rate configuration was changed last run. Please review.
Total Volume of Saline Processed During Rinseback
+413 mL
Amount of Saline Diverted to Waste Bag During Prime Divert
–150 mL
Net Additional Saline Returned to Donor/Patient
+263 mL
CLEAR
To remove the message, press CLEAR.
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COBE Spectra Apheresis System • Cell Therapy Guide
Mononuclear Cell (MNC) Collection Procedure
Setting Up the Spectra System
MNC Collection Fluid Volumes For a complete explanation of fluid volumes, see Chapter 9, “Fluid Volumes,” in the Essentials Guide.
Turn on the Spectra system. For more information, see “Setting up the Spectra System” in Chapter 4 of the Essentials Guide.
Table 2-2 shows the fluid volumes for the WBC disposable tubing set.
Installing the Filler
Table 2-2: WBC disposable tubing set fluid volumes Disposable Tubing Set Volume
285 mL
Install the single-stage filler (Figure 2-1). For instructions, see “Removing and Installing the Filler” in Chapter 4 of the Essentials Guide.
Total Equivalent Whole Blood Volume
285 mL
Continue with “Loading the Disposable Tubing Set.”
Total RBC Volume
114 mL
Residual RBC Volume
24 mL
Volumes Processed During Rinseback Table 2-3 shows the volume of blood and saline returned to the donor/patient at each stage of the Rinseback mode:. Table 2-3: Volumes processed during Rinseback Collect
60 mL
Returning RBCs
120 mL
Evacuating Channel
125 mL
Rinsing Channel
108 mL
TOTAL
413 mL
COBE Spectra Apheresis System • Cell Therapy Guide
Figure 2-1: Single-stage filler
2-5
Mononuclear Cell (MNC) Collection Procedure
Loading the Disposable Tubing Set
8
• AC
Note: You may load the WBC disposable tubing set with the pumps left in the unload position up to 24 hours before the procedure. If you have primed the set, use it as soon as possible. Note: You may load the Functionally Closed WBC disposable tubing set with the pumps left in the unload position up to 24 hours before the procedure. If you have primed the set, use it on the same working day. Once you prime the donor connections, use the set as soon as possible.
Hang the bags on the IV pole in the order shown below: • • Saline Waste
• • Plasma Collection (if used)
Note: The plasma bag is used for collecting concurrent plasma. If you do not attach a plasma bag, close the slide clamp on the plasma line.
9
Snap the pump cartridges into the cartridge clamps.
10 Press CONTINUE. 11 The system loads the tubing into the pumps:
Placing Tubing on the Front Panel The instructions below are a condensed version of the detailed instructions in Chapter 4 of the Essentials Guide. If you are unfamiliar with loading the disposable tubing set, follow the instructions in the Essentials Guide. Experienced operators may use the following as a guideline:
1
Install the collect flow path overlay on the front panel.
2
Remove the inlet line coil and paper tapes.
3
Hang the access connection on the hook on the left side of the IV pole. (The three lines attached to this connection are taped together.)
Loading pumps Load
Ensure that all pump headers have been properly loaded before beginning a procedure. Inspect each pump and carefully guide your finger around the edge of each pump. After pumps are loaded, the valves automatically open to the load position. You cannot load the tubing until the valves open.
12 Install the lines, sensors, and chambers in the following order: a
Lines in the collect/replace and plasma valves
b
Return pressure sensor in its housing
4
Place the access saline line over the top of the system.
c
RBC line in the RBC valve and detector
5
Remove the return line coil and paper tapes.
d
Return and inlet air chambers in the air detectors
6
Hang the return connection on the hook on the left side of the IV pole. (The two lines attached to this connection are taped together.)
e
Waste divert lines in the waste divert valve assembly
f
Line in the centrifuge pressure sensor housing
7
Place the return saline line over the top of the system.
g
Access pressure sensor in its housing
h
Return line in the return valve
2-6
COBE Spectra Apheresis System • Cell Therapy Guide
Mononuclear Cell (MNC) Collection Procedure
The WBC Channel Inlet chamber
Channel
Control tube (clear plastic with stripe, smaller diameter): Helps maintain the interface in the channel. The RBC and control tubes join to form one tube near the centrifuge collar. Plasma tube (yellow plastic): Allows platelet-rich plasma to exit the channel.
Control tube Inlet tube Plasma tube RBC tube
Installing the Channel in the Filler Refer to Figure 2-3.
WBC collect tube Collection chamber RBC out WBC out (collect tube)
Control tube Plasma tube Blood in (inlet tube)
1
Press UNLOCK COVER. Slide back the centrifuge cover and lower the centrifuge door.
2
Rotate the centrifuge so the loading port is to the front. Ensure the centrifuge collar holder rests on the outer rim of the filler.
3
Fold the channel in half, insert it through the loading port, and pull it out the top. Inlet chamber
Centrifuge collar
Upper collar
Collection chamber
Figure 2-2: WBC channel Upper bearing
Inlet tube (red plastic): Allows the anticoagulated whole blood to enter the inlet chamber. Multi-lumen tubing
Inlet chamber: Allows the anticoagulated whole blood to enter the channel.
Lower bearing
Channel: Facilitates the separation of whole blood into its components. Collection chamber: Holds the exit tubes. WBC collect tube: Allows white blood cells to exit the channel to the collection bag. RBC tube (clear plastic, larger diameter): Allows red blood cells to exit the channel for return to the donor/patient. COBE Spectra Apheresis System • Cell Therapy Guide
Figure 2-3: WBC channel with multi-lumen tubing
4
Load the centrifuge collar into the centrifuge collar holder and snap the cover over the collar. Push the filler latch down into the locked position.
2-7
Mononuclear Cell (MNC) Collection Procedure
5
Press the channel into position, and press the tubes into the appropriate filler slots, as shown in Table 2-4. Figure 2-4 shows the WBC channel correctly installed in the filler.
9
Rotate the centrifuge clockwise several times to ensure the tubing does not twist and the upper bearing remains in place. Close the centrifuge door and cover.
Continue with “Priming the Disposable Tubing Set.”
Table 2-4: Filler slots for channel tubing Far Left Slot
Left Slot
Right Slot
Far Right Slot
Clear tube (WBC collect tube)
Clear tube (RBC tube)
Clear tube with stripe on top (control tube) Yellow tube on bottom (plasma tube)
Red tube (inlet tube)
Priming the Disposable Tubing Set If you use single-port saline containers, and/or need to avoid hypersensitivity reactions associated with ethylene oxide sterilization, see “Using an Alternative Single-Pass Prime Procedure” in Chapter 11 of the Essentials Guide. .
Caution: Before you begin Prime, inspect all tubing especially in the centrifuge and on the front panel to ensure it is not kinked. Tubing that is partially or completely occluded can lead to malfunction or fluid imbalance. Tubing performs without difficulty as long as the interior diameter of the tubing is larger than the interior diameter of the needle. Note: Use aseptic technique throughout all procedures.
Tip: You usually enter donor /patient data after the Prime mode is complete, but you can also enter it during Prime. After selecting the procedure press MENU ON/OFF, then press 1. See “Entering Donor/Patient Data” on page 2-11 for specific instructions.
Figure 2-4: Correctly installed WBC channel
6
Place the lower bearing in the lower bearing holder and the upper bearing in the upper bearing holder.
7
Place the upper collar in the upper collar holder.
8
Press the multi-lumen tubing into the exit slot on the right side of the centrifuge compartment.
1
The set selection screen appears: Select set: 1=ELP, 2=TPE, 3=WBC, 4=RBCX
Press 3.
2-8
COBE Spectra Apheresis System • Cell Therapy Guide
Mononuclear Cell (MNC) Collection Procedure
2
The WBC procedure selection screen appears:
6
Caution: Ensure fluid is flowing into the drip chambers.
Select WBC procedure: 1=MNC, 2=PMN, 3=BMP, 4=AutoPBSC
Press 1.
3
7
Close the pinch clamps near the luer connections on the access and return lines. Close the roller clamps on the access and return saline lines: Clamp access and return lines. Close both saline lines. Press CONTINUE
Press CONTINUE.
4
Connect the AC line (orange spike) to the AC container. Place the AC line in the AC level detector: Connect WBC tubing set to fluid containers. Press CONTINUE.
.
Note: Ensure the AC line is not kinked. To remove any kinks, adjust the position of the AC level detector on the IV pole.
5
Connect the access and return saline lines to the 0.9% NaCl container. Remove the cap, and place the plastic spike in the spike port. Clean the injection port with alcohol before inserting the metal spike.
Fill the drip chambers half full. Press CONTINUE.
Open the access and return saline roller clamps: Open access and return saline lines. Press CONTINUE to prime.
Press CONTINUE. Caution: Once fluid enters the disposable tubing set, DO NOT disturb sensors in pressure sensor housings, or the centrifuge pressure sensor. This prevents transducers from accurately monitoring pressures. For more information, see the following sections in Chapter 11 of the Essentials Guide:
• “Repositioning the Access Pressure Sensor Diaphragm” • “Repositioning the Return Pressure Sensor Diaphragm” If the Spectra system was not turned off after the last procedure, it performs a short self-check: Power up tests in progress.
Caution: Ensure lines are attached to correct fluids:
• AC line (orange spike) to the ACD-A container. • The spike on the access saline line and the needle on the return saline line to the 0.9% NaCl container.
COBE Spectra Apheresis System • Cell Therapy Guide
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