Sonoclot SCP2 and SCP4 Operators Manual Rev 2.1

Copyright © 1999-2009 Sienco®, Inc. All Rights Reserved. Manufactured For: Sienco®, Inc. 7985 Vance Drive, Suite 104 Arvada, CO 80003 USA 303/ 420-1148 303/ 379-4403 (FAX) • [email protected] (e-mail) http://www.sienco.com Sonoclot is a registered trademark of Sienco®, Inc. Sonoclot Analyzers are protected under U.S. and foreign patents.

QNET BV Hommerterweg 286 6436 AM Amstenrade The Netherlands

Table of Contents Chapter 1: Installation and Setup 1-1 Principle of Operation and Intended Use 1-1 Head Assembly- Models SCP2 and SCP4 All Channels 1-1 Model SCP2- Front View 1-2 Model SCP2 - Back View 1-2 Model SCP4- Front View 1-3 Model SCP4 - Back View 1-3 Package Contents 1-4 Installation1-4 Good Operating Procedures (applicable for all tests) 1-6 Warnings, Cautions, and Hazards 1-7 Quality Control 1-7 Chapter 2: Running a Whole Blood Sample Analyzer Preparation Cuvette and Probe Setup Obtaining the Blood Sample Running the Analyzer

2-1 2-1 2-2 2-3 2-3

Chapter 3: Maintenance and Troubleshooting 3-1 Maintenance3-1 Troubleshooting3-2 Warning and Error Messages 3-2 Factory Service or Repair 3-3 AppendixA-1 ReferencesA-1 WarrantyA-2 Technical Specifications A-2 Environmental Conditions for Transportation and Storage A-2 Environmental Conditions for Use A-3 Electrical Classification A-3 Disposal Instructions A-3 Glossary of International Symbols A-4 Decontamination Form A-5

Chapter 1: Installation and Setup Principle of Operation and Intended Use The Sonoclot® Coagulation & Platelet Function Analyzer calculates onset of clot formation, clot rate, and platelet function for in vitro coagulation studies by monitoring mechanical changes that occur in blood samples during hemostasis. The mechanism is a tubular probe that moves up and down within a blood sample. As the sample progresses through various stages of clotting, the electronic circuitry (the transducer) detects increasing resistance. This produces a series of electronic signals that are processed by a microcomputer. Results are reported on the LCD display panel and in Signature Viewer Data Collection Software.

Head Assembly- Models SCP2 and SCP4 All Channels

analyzer head probe mount hub

convenience wells cuvette holder platen head alignment pin

1-1

Model SCP2- Front View Channel 1

Channel 2 analyzer head

platen

convenience wells

Channel 1 Select Test button

Channel 2 Select Test button

Channel 1 Start/Stop button

Channel 2 Start/Stop button

LCD display

Model SCP2 - Back View

serial number label

USB port

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Chapter 1: Installation and Setup

power cord receptacle

Model SCP4- Front View Channel 1

Channel 2

Channel 3

Channel 4

convenience wells

analyzer head

platen

Channel 1 and 2 LCD display Channel 1 Start/Stop button Channel 1 Channel 2 Select Test Select Test button button

Channel 2 Start/Stop button

Channel 3 and 4 LCD display

Channel 3 Start/Stop Channel 3 button Select Test button

Channel 4 Start/Stop button

Channel 4 Select Test button

Model SCP4 - Back View

serial number label

USB port

power cord receptacle

Chapter 1: Installation and Setup

1-3

Package Contents • Sonoclot Coagulation & Platelet Function Analyzer (Model SCP2 or SCP4) • power adaptor and cord • probe extractor • operator’s manual • USB cord • Signature Viewer installation CD

Installation 1) Unpack the contents of the shipping container and check you have all the above items. NOTE: Sienco recommends that you retain the original shipping box in case you need to return your instrument for service. 2) Pull the ribbon to remove the packing foam from the top of the instrument. Then pull the ribbon to lift the instrument out of the packing foam in the bottom of the box. 3) Remove the analyzer from the plastic bag. 4) Carefully remove the tape from the top and back of the instrument. 5) Remove the spacer tabs from between the analyzer case and the head assembly platen. Keep these tabs with the original packaging. 6) Plug the power cord into the analyzer and an easily accessible grounded wall outlet. Do not use an ungrounded extension cord or adaptor. Do not obstruct access to the outlet. 7) The analyzer will automatically turn on. First, the LCD display will illuminate. Next, the analyzer will display the version number, product name, and copyright. Before proceeding, you will need to install Signature Viewer and connect the analyzer to the computer. Installing & Using Signature Viewer Data Collection Software (Signature Viewer) The analyzer collects and manages data through Signature Viewer Data Collection Software. In order to run a test, you must first connect the analyzer to the computer and start the Signature Viewer application (see following instructions). If the analyzer is not connected or the Signature Viewer application is not running, the analyzer display will read “Host Inactive!”

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Chapter 1: Installation and Setup

To install Signature Viewer on your computer: 1) Read the installation instructions and hardware specifications on the CD sleeve. Instructions are also located in PDF format on the CD. 2) Plug a USB cord into the back of the analyzer and a USB port on your computer. NOTE: The analyzer requires a 1.1 USB Port or higher. 3) Open Signature Viewer on your computer. For software instructions, please see the Signature Viewer operator’s manual PDF file on the installation disk. Analyzer Warming 1) Once plugged in and connected to a computer, the analyzer will begin warming. While warming, the display reads: 2) When the analyzer has reached 37.0°C, the display indicates the name of the default test for each channel. The analyzer is now ready to run a test.

CHANNEL 1

Test CS/Time ACT CR/PF

g bAC T+ H eati n g 34.2

˚

CHANNEL 1

Test CS/Time ACT CR/PF

g bAC T+

CHANNEL 2

g bAC T+ Test H eati n g CS/Time 3 4 . 2 ACT

˚ CR/PF

CHANNEL 2

g bAC T+ Test

CS/Time ACT

CR/PF

3) Review the remainder of this chapter.

Chapter 1: Installation and Setup

1-5

Good Operating Procedures (applicable for all tests) The quality of test results depends on proper technique. Carefully follow these precautions: 1) Operator should read this operator’s manual in its entirety before attempting to operate the analyzer. 2) Only properly trained lab personnel and healthcare professionals should operate the analyzer. 3) Diagnosis should be based on test results in combination with clinical observations. 4) Handle materials with care: • When taking a blood sample, avoid heparin contamination from catheters. • Never user the first sample from a new line to avoid sample contamination with tissue thromboplastin. • Keep blood, dirt, and other substances away from the probe mount hub to avoid contaminating the electromechanical transducer. • Never reuse a probe or cuvette to prevent thrombin contamination. 5) For consistent results, the cuvettes should be warmed prior to analysis. To warm, place the cuvette in its holder at least 30 seconds prior to running a test. 6) Always insert and remove the probe by moving it vertically over the probe mount hub. Never move the hub horizontally. Make sure the probe is fully seated to avoid interference with the stir-bar. 7) Always remove the cap from the cuvette prior to placing it into the cuvette holder. Failure to do so can damage the transducer. 8) The cuvette must be fully seated in the cuvette holder to avoid interference between the probe and stir-bar. 9) Do not overfill the cuvette. The proper fill level is slightly below the inner rim of the cuvette. 10) Native whole blood must be analyzed within 2 minutes or less of collection. 11) Perform QC testing to verify proper operation of the analyzer and activation cuvettes. See page 1-7. 12) Use proper biohazard handling techniques to dispose of probes and cuvettes. 13) On rare occasions, mechanical disturbances may cause incorrect results. Always inspect results to ensure that they are consistent. 14) High viscosity blood samples (immersion response > 25 clot signal units as displayed on the instrument) can stratify. Use an external device to mix the blood sample before placing it in the cuvette.

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Chapter 1: Installation and Setup

Warnings, Cautions, and Hazards 1) WARNING: As with any laboratory test result, diagnosis should not be based solely on the analyzer test results. The attending physician is responsible for interpreting the analyzer test result in conjunction with the patient’s condition, other test results, and clinical observations. 2) WARNING: To safeguard against electrical shock, only use a grounded electrical outlet. 3) WARNING: Use only as specified by Sienco, Inc. Otherwise, equipment protection may be impaired. 4) CAUTION: Only properly trained laboratory personnel and/or other appropriate health care professionals should use the analyzer. 5) CAUTION: A biomedical engineering department should check the analyzer at least once a year for compliance with leakage standards. 6) HAZARD: Human blood is a biohazardous material. The operator should wear appropriate protective gear when handling blood and/or test cuvettes containing blood samples. Biocontaminated materials should be handled and disposed of properly in accordance with hospital, local, state, and federal regulations. 7) CAUTION: Do not place the analyzer on counter tops where other vibrating instruments, such as centrifuges, are located. Mechanical vibration may cause erratic results.

Quality Control Proper performance requires regular quality control (QC) tests: 1) Daily, run a reference viscosity test for each channel on the analyzer. This requires QC kit #900-1323 (for Model SCP2) or #900-1343 (for Model SCP4). 2) Monthly, and prior to the use of a new shipment, validate the activated cuvettes. This requires QC kit #900-1318. Complete instructions for running each QC test are included in the kits. The kits also include forms for recording QC results. To order quality control kits, contact Sienco at 800-432-1624 or contact your distributor.

Chapter 1: Installation and Setup

1-7

Chapter 2: Running a Whole Blood Sample The analyzer monitors mechanical changes that occur during hemostasis. This section describes how to prepare and run a test with native whole blood samples. Use only test kits available from Sienco, Inc. Sienco offers different tests for different applications. Choose the test best suited for your application. The SCP2 and SCP4 analyzers are intended to run multiple tests at once. Prepare all channels with cuvettes and probes prior to starting the first test. Start tests quickly and sequentially to reduce mechanical disturbance introduced by operating the other channels. Starting a channel while another channel is processing data can introduce mechanical disturbance which can compromise results. NOTE: Displays are only shown throughout this manual for Model SCP2 and Channels 1 and 2 for Model SCP4. Display readings for channels 3 and 4 on Model SCP4 are identical to Channels 1 and 2. Instructions below apply to all channels.

Analyzer Preparation 1) Cuvettes should be placed in the convenience wells so they will be ready when the blood is drawn. Place probes into the lids of the cuvettes.

probe cuvette

2) If the analyzer has just been recently turned on, allow it to warm, with head assembly in the down position, until the analyzer reaches 37° C. If the analyzer is not at the desired temperature it will display an error message and not run the test.

2-1

3) When the analyzer is ready the display reads: NOTE: Results from the previous test may be displayed on the LCD display.

CHANNEL 1

Test CS/Time ACT CR/PF

g bAC T+

CHANNEL 2

g bAC T+ Test

CS/Time ACT

CR/PF

4) Press the “Select Test” button on the front panel for the appropriate channel until the desired test is displayed on the LCD.

Cuvette and Probe Setup 1) For the appropriate channel, open the head by tilting it backwards. The display will read “Open.”

2) Sharply tap the cuvette on a hard surface to dislodge activation powder from the sides and lid. 3) With a slight twisting motion, use the cuvette to seat the probe on the mount hub. This motion should result in the probe sliding straight over the probe mount hub. The hub should not move sideways. The probe must be fully seated for proper operation.

4) Remove the cuvette, leaving the probe on the hub.

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Chapter 2: Running a Whole Blood Sample

5) Remove the lid from the cuvette by placing it in a convenience well and popping the lid off with your thumb.

6) Insert the cuvette into the cuvette holder. Make sure it is fully seated. Close the head. Allow the cuvette to warm in the cuvette holder for at least 30 seconds. DO NOT close the head on a lidded cuvette. It will damage the instrument. Different tests have different set-up requirements. Please refer to the product insert for detailed instructions.

Obtaining the Blood Sample Native whole blood must be analyzed within 2 minutes of collection. When drawing blood, observe the following precautions: 1) Carefully decide where to draw the sample. Contamination (from a heparinized line, a heparin-impregnated catheter, or a surgery prep line) will cause inaccurate results. 2) Withdraw blood in a smooth, slow, and non-traumatic manner. Do not use force. 3) When drawing from an anesthesia or pump port, use a 2-syringe technique. Discard the first syringe of 2 to 3 ml. Use the second syringe for the sample. You MUST use plastic syringes to avoid uncontrolled glass activation.

Chapter 2: Running a Whole Blood Sample

2-3

Running the Analyzer 1) Transfer the whole blood sample from the syringe into the warmed cuvette. Use a blunt cannula tip for a clean and controlled fill. Fill the warmed cuvette with the blood sample until the fluid level is slightly below the inner rim of the cuvette. This volume is approximately 330 to 360 µl. Fill slightly below here

2) Leaving the head open, immediately press the START/STOP button for the channel being run. 3) The magnetic stirrer will rotate and the display will read:

CHANNEL 1

Test CS/Time ACT

g bAC T+ Mixing

CHANNEL 2

k AC T Test M i x i n g CS/Time ACT

CR/PF

CR/PF

4) When mixing is completed, the analyzer will beep and the display will read: “Close Head.”

CHANNEL 1

Test CS/Time ACT CR/PF

g bAC T+ Cl o s e H ea d

CHANNEL 2

k AC T Test

CS/Time ACT CR/PF

5) Close the analyzer head. Make sure it is fully seated over the head alignment pin.

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Chapter 2: Running a Whole Blood Sample

6) During data collection, the LCD display will show the test being run, the clot signal reading (CS), the time in seconds, and “???” for each result. Some tests only provide ACT and CR results. For these tests, the PF field is filled in with”---” throughout the test. When the analyzer is calculating a result, the display will flash the number the result is greater than.

CHANNEL 1

Test CS/Time ACT CR/PF

CS/Time ACT

k AC T Test

g bAC T+ ???? ??? ???

CHANNEL 1

Test

CHANNEL 2

g bAC T+

???

>10 0

CS/Time ACT

- - - CR/PF

CHANNEL 2

k AC T Test

CS/Time

>10 0 ACT >140 CR/PF ??? ??? ??? - - - CR/PF

7) The sample is initially a liquid. After several minutes the sample begins to evolve into a clot. The analyzer detects this initial clot formation and calculates the time the sample remained a liquid (ACT). During the next several minutes of analysis, the fibrinogen converts into a fibrin gel. The analyzer calculates the rate of change in the clot signal (Clot Rate). CHANNEL 1 CHANNEL 2 8) When a result has been calculated, the analyzer will beep and display Test g bAC T+ k AC T Test the time that the sample remained a CS/Time CS/Time liquid (ACT), the Clot Rate (CR), and ACT ACT 177 120 the platelet function (PF) result for CR/PF 19 3.0 >14 - - - CR/PF the appropriate channel. Times for results vary from 2 to 20 minutes depending on heparin levels and clinical conditions. The numeric result is displayed next to the corresponding text for the appropriate channel. “NR” is displayed if no results were found for the test sample.

9) The analyzer will automatically stop data collection when results for ACT, Clot Rate, and platelet function have been calculated or after 30 minutes (unless a different automatic stop time has been set in Signature Viewer). 10) Open the head and remove the probe from the hub with a probe extractor. Avoid moving the hub sideways. Properly discard the probe and the cuvette. Lower the head to maintain temperature control of the instrument.

Chapter 2: Running a Whole Blood Sample

2-5

Chapter 3: Maintenance and Troubleshooting Maintenance Cleaning Clean after use to reduce biohazard risks. The analyzer can be sprayed or wiped with a disinfectant approved by your institution. Close the heads when spraying to avoid contaminating the transducers. Avoid excess wetting. Place a clean probe on the probe adaptor to protect the sensing mechanism while cleaning. Gently wipe around the cuvette holders or inside the heads. Do not clean the probe mount hubs, unless absolutely necessary. The transducers attached to the probe mount hubs can easily be damaged by debris or liquids. NOTE: Do not use isopropyl alcohol or other solvents on the front panel or LCD cover. Calibration & Service The user cannot calibrate or service the analyzer. Running a reference viscosity QC test (PN 900-1323 or 900-1343) will verify if each channel of the analyzer is operating within calibration standards. Sienco recommends performing the reference viscosity QC test on each channel daily, prior to use of the analyzer. If the analyzer requires calibration or service, contact Sienco, Inc. or your distributor.

3-1

Troubleshooting If you have a problem with the analyzer, follow these steps: 1) Review “Warnings, Cautions, and Hazards” on page 1-7. 2) Review “Good Operating Procedures” on page 1-7. 3) Review the operating instructions that come with the test you are running. 4) If problems persist, contact the Sienco service department: Phone: Toll Free: Fax: E-mail: Mail:

303-420-1148 800-432-1624 303-379-4403 [email protected] Sienco Service Department 7985 Vance Drive, Suite 104 Arvada, CO 80003 USA

Warning and Error Messages The Sonoclot Analyzer will occasionally display messages that may not be familiar. Below are some examples of these messages and procedures to follow, if necessary. “NOISE” indicates that the clot signal is being disturbed by either mechanical noise, such as bumping the analyzer, or by interference between the probe and the cuvette. Check to ensure that the probe is tight against the mount hub and the cuvette is in contact with the bottom of the cuvette holder. The message should disappear within a few seconds. “HOST INACTIVE” indicates that the analyzer is either not connected to the computer or the Signature Viewer application is not running. Check that the analyzer is connected to the computer with a USB cord and that Signature Viewer is running. “ERROR” indicates that the self test routine has detected a problem. Normally, the message will disappear after several seconds. You can resume testing then. If the error message remains, make a note of the error number and call Sienco’s service department. “TEST NOT RUN, NOT AT TEMP” indicates that the analyzer is not to temperature and the test was not run. The analyzer must be at 37° C to run a test. “NR” indicates that no results were found for the last test analysis. This can occur due to operator error (i.e. failure to close instrument head within 60 seconds of “Close Head” message), instrument error, or an unusual clot that cannot be analyzed.) NUMBERED ERROR CODES: The analyzer is programed to display various numbered error codes. Should your analyzer display a numbered error code, record the number displayed and contact your distributor or Sienco’s service department. If you have any questions in regards to a display message, call Sienco’s service department at 800-432-1624 or 303-420-1148.

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Chapter 3: Maintenance and Troubleshooting

Factory Service or Repair Contact Sienco prior to shipping your analyzer for repairs. The analyzer should be shipped in its original packing materials, if possible. If you do not have the original packing materials please contact Sienco. We will ship you packing materials or you may use the packaging materials from your loaner. We charge a minimum fee for testing the instruments, even if you decide not to have it repaired. Damages caused by poor packaging are your responsibility. To ship, follow these steps: 1) Remove cuvettes, probes, power cord, and other supplies. 2) Photocopy the decontamination form at the end of this manual. 3) Clean and decontaminate the analyzer according to your institutional guidelines and fill out the decontamination form. Failure to fill out form and include with the analyzer will result in a $150 decontamination fee. 4) Carefully slide the spacer tabs between the instrument case and platen. For model SCP4, also slide a spacer tab in the center of the two platens on the front and back of the instrument. Tape the back of the platen and the top of the instrument case as shown. Tape each head down as shown. Place the analyzer in a large, clean plastic bag and fold the open end under the instrument. 5) Place the instrument in the molded foam in the bottom of the box, with the ribbon running underneath the analyzer as shown. If you are also returning your power adaptor and cord, fold the power cords, secure each with a rubber band, and place in the spaces on either side of the analyzer. 6) Place the top of the molded foam over the analyzer. Make sure the foam is securely packed around the analyzer heads. 7) Make sure the decontamination form is complete. Be sure to include a brief description of the problem along with a contact name, phone number, and purchase order. 8) Place the completed form on top of the molded foam. 9) Tape the box shut and ship the package to: Sienco, Inc. Service Department 7985 Vance Drive, Suite 104 Arvada, CO 80003 USA

Chapter 3: Maintenance and Troubleshooting

3-3

Appendix References Sonoclot Analysis is used in many clinical and research applications and consequently is referenced in numerous studies and articles. For a complete list of references, please visit our web site at www.sienco.com. 1) Nilsson CU and Engström. Monitoring fondaprinux with the Sonoclot. Blood Coagulation and Fibrinolysis. 2007; 18: 619-622. 2) Ganter MT, Monn A, Tavakoli R, et al. Monitoring activated clotting time for combined heparin and aprotinin application: in vivo evaluation of a new aprotinin-insensitive test using Sonoclot. Eur J Cardiothorac Surg. 2006; 30(2): 278-84. 3) Shibata T, Sasaki Y, Hattori K, et al. Sonoclot analysis in cardiac surgery in dialysis dependent patients. Ann Thorac Surg. 2004; 77(1): 220-05. 4) Liszka-Hackzell JJ and Ekback G. Analysis of the information content in Sonoclot data and reconstruction of coagulation test variables. Journal of Medical Systems. 2002; 26(1): 1-8. 5) Pivalizza EG, Pivalizza PJ, Kee S, Gottschalk LI, Szmuk P, Abramson DC. Sonoclot analysis in healthy children. Anesth Analg. 2001; 92(4): 904-6. 6) Santucci RA, Erlich J, Labriola J, et al. Measurement of tissue factor activity in whole blood. Thromb Haemost. 2000; 83(3): 445-54. 7) Ekback G, Carlsson O, Schott U. Sonoclot coagulation analysis: a study of test variability. J Cardiothorac Vasc Anesth. 1999; 13(4): 393-7. 8) Hett DA, Walker D, Pilkington SN, Smith DC. Sonoclot analysis. Br J Anaesth. 1995; 75(6): 771-6. 9) Steer PL, Krantz HB. Thromboelastography and Sonoclot analysis in the healthy patient. J. Clin Anesth. 1993; 5(5): 419-24. 10) Shenaq SA, Saleem A. Viscoelastic measurement of clot formation: the Sonoclot. In: Ellison N, Jobes DR, eds. Effective Hemostasis in Cardiac Surgery. Philadelphia, PA: Harcourt Brace Jovanovich, Inc.; 1988: 183-93. 11) Newland MC, Chapin JW, Hurlbert BJ, Kennedy EM, Newland JR. Thrombelastograph and Sonoclot Signature monitoring of changes in blood coagulation following cardiopulmonary bypass. Anesthesiology. 1987; 67(3A); A199. 12) Newlin, F., Ens, G., Leppke, L. and Hamstra, R.: “Heparin Control with the SONOCLOT”. American Journal of Medical Technology, 44: 508, 1978.

A-1

Warranty The Sonoclot® Coagulation & Platelet Function Analyzer has a 2 year warranty that it conforms to specifications and is free of defects in material and workmanship. The warranty is limited to the replacement or repair of defective parts and components. The warranty shall be voided if the product is: 1) Used in any manner or subjected to any condition that is inconsistent with its intended purpose or accepted industry practice; or 2) Modified in any way without prior written approval by Sienco; or 3) Repaired in any manner so as to adversely affect its operation or reliability by persons other than Sienco or its agents. Warranty claims shall be submitted in writing to Sienco during the 2 year warranty period. The claim shall state the nature and details of the analyzer defect and the serial number of the analyzer. The claim must accompany any defective product submitted for repair or replacement. Purchasers must decontaminate and package the analyzer per instructions on pages 3-1 and 3-3. Such products shall, at Sienco’s election, be either repaired, replaced or returned.

Technical Specifications Model SCP2

Model SCP4

Width

6.75”

17.2 cm

13.25”

33.7 cm

Depth

6”

15.2 cm

6”

15.5 cm

Height

5”

12.7 cm

5”

12.7 cm

Weight

3.5 lbs

1.59 kg

6.5 lbs

2.95 kg

Electrical voltage requirement Electrical power requirement

100 to 240V 9V

, 2A

9V

Frequency

50 to 60 Hz

Temperature regulation of platen

37°C ± 0.5°C

Viscosity range for test sample

<80 cP

, 3A

Environmental Conditions for Transportation and Storage 70°C

-25°C

Transport and store within the ambient temperature range of -25°C and 70°C.

95%

Transport and store to a maximum relative ambient humidity of 95%.

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Appendix