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What This Guide Helps With
Repeated clot, bubble, or sample-volume errors caused by specimen quality, tube fill, mixing, positioning, aspiration, or external fluid-path conditions.
Step-by-Step Troubleshooting
1. Protect Patient Testing and Confirm the Pattern
Redirect urgent testing if repeated sample errors are delaying results. Determine whether the problem affects one specimen, one tube type, several specimens, or nearly all samples.
Expected outcome: The failure pattern is defined and unreliable samples are not repeatedly processed.
2. Inspect the Specimen
Check the affected sample for visible clots, fibrin, bubbles, foam, inadequate volume, overfill, leakage, or other abnormal appearance. Follow laboratory policy for unsuitable specimens.
Expected outcome: The sample is confirmed suitable or is removed from testing and replaced according to laboratory procedure.
3. Verify Proper Sample Mixing
Confirm the specimen was mixed according to approved laboratory practice before analysis. Do not use excessive agitation that may create bubbles or foam.
Expected outcome: The specimen is adequately mixed without introducing additional bubbles.
4. Check Tube Fill and Presentation
Verify the sample volume is sufficient for the analyzer workflow and that the tube is correctly positioned. Inspect tube geometry, cap, adapter, and rack seating for obvious interference.
Expected outcome: The sample is presented consistently and can be aspirated without volume-related interference.
5. Compare With a Known-Good Sample
Run an appropriate known-good sample or QC material to determine whether the error follows the specimen or is reproducible across unrelated material.
Expected outcome: Known-good material processes normally. If so, the original specimen is the likely source of the error.
6. Inspect Accessible Aspiration Areas
With the analyzer safely stopped when required, inspect accessible sample and aspiration areas for dried material, debris, labels, or contamination that could interfere with aspiration.
Expected outcome: The external aspiration path is clear of visible contamination or obstruction.
7. Check Accessible Fluid Connections
Look for visible air in accessible lines, loose connections, kinks, leaks, or empty associated fluid containers that could contribute to repeated bubble or volume errors.
Expected outcome: Accessible fluid connections are secure and free of obvious abnormal conditions.
8. Compare Multiple Samples
Process several appropriate known-good samples or controls after correcting external issues. Determine whether the failure remains sample-specific or affects the analyzer broadly.
Expected outcome: Samples process without repeat clot, bubble, or volume errors.
9. Perform Final Quality Verification
Run appropriate QC or analyzer checks after correction and confirm acceptable performance.
Expected outcome: QC is acceptable and no repeat errors occur. Troubleshooting can stop.
10. Escalate System-Wide Repeat Errors
If properly prepared known-good samples repeatedly generate clot, bubble, or volume errors, stop external troubleshooting.
Expected outcome: The analyzer is removed from affected service and qualified service evaluation is initiated.
If the Problem Persists
Common specimen-quality, fill-volume, mixing, tube-positioning, contamination, and accessible fluid-path causes have been ruled out. The remaining issue may involve internal aspiration sensing, pressure monitoring, pumps, valves, tubing, or other service-level fluidics components.
Remove the analyzer from service, label it Out of Service, and arrange repair or bench/service evaluation using Sysmex documentation and approved test equipment. Internal fluidics repair or sensor adjustment should be completed only by qualified personnel.
Before return to service, verify reliable aspiration with appropriate material and confirm acceptable QC. Knowing when to stop external troubleshooting is proper troubleshooting.
Clinical Use Tip
Do not repeatedly rerun a visibly clotted or inadequate specimen; doing so can delay care and introduce contamination into the analyzer.
Work Order Documentation (CCR Method)
CCR = Complaint, Cause, Resolution
Complaint
What was reported by the clinical staff.
Example:
"Laboratory staff reported repeated sample-volume errors on several tubes from the same rack."
Cause
What was observed during troubleshooting.
Example:
"Clinical Engineering found the affected tubes were not fully seated in the rack and were presented at inconsistent heights."
Resolution
What action was taken.
Example:
"Correctly seated the tubes, reran appropriate verification samples successfully, and confirmed acceptable QC with no repeat volume errors."
Helpful Details to Include (If Known)
- Exact error wording
- Number and type of specimens affected
- Visible clots, bubbles, or foam
- Sample fill condition
- Mixing status
- Tube and rack positioning
- Accessible fluid-line condition
- Known-good sample comparison
- QC result
- Final analyzer status
Final Thought
Repeated clot, bubble, and volume errors should first be treated as specimen and presentation problems, then narrowed toward analyzer fluidics only when known-good material behaves the same way. Verify performance before return to clinical testing.
That is successful troubleshooting.