ABL800 FLEX
Device Facts
| Record ID | K041874 |
|---|---|
| Device Name | ABL800 FLEX |
| Applicant | Radiometer Medical Aps |
| Product Code | CHL · Clinical Chemistry |
| Decision Date | Oct 8, 2004 |
| Decision | SESE |
| Submission Type | Traditional |
| Regulation | 21 CFR 862.1120 |
| Device Class | Class 2 |
Indications for Use
The ABL800 FLEX is intended for in vitro testing of samples of whole blood for the parameters pH, pO2, pCO2, potassium, sodium, calcium, chloride, glucose, lactate, total bilirubin, and co-oximetry parameters (total hemoglobin, oxygen saturation, and the hemoglobin fractions FO2Hb, FCOHb, FMetHb, FHHb, FHbF). In addition the ABL800 FLEX is intended for in vitro testing of samples of expired air for the parameters pO2 and pCO2. The ABL800 FLEX includes an AutoCheck Module to perform automated analysis of quality control fluids.
Device Story
The ABL800 FLEX is a multi-parameter analyzer for whole blood and expired air. It uses electrochemical sensors for pH, blood gases, electrolytes, and metabolites, and a 128-wavelength spectrophotometer for co-oximetry and bilirubin. The device features 'FLEXMODE,' an adaptive sample handling system that adjusts parameter reporting based on available sample volume (35-195μL). It includes an integrated AutoCheck module for automated quality control. Operated via touchscreen in clinical settings, it provides quantitative results to clinicians for assessing acid-base status, electrolyte balance, and oxygenation. The device is a platform-based system where specific models report different parameter subsets. It replaces the ABL700 series, maintaining identical sensor technology and analytical performance while introducing hardware updates like a CD-R/RW drive and extended inlet probe.
Clinical Evidence
Bench testing only. Performance was established through a large comparative in-house study using 11 ABL8xx FLEX analyzers and 5 ABL735 reference analyzers. Precision (%CV) and bias were evaluated across the entire reportable range for all parameters. Linearity was confirmed by comparing bias against primary reference methods (NIST-traceable standards, spectrophotometry, tonometry). No clinical studies were submitted.
Technological Characteristics
Electrochemical sensors (potentiometric for pH, pCO2, electrolytes; amperometric for pO2, glucose, lactate). Optical system: 128-wavelength spectrophotometer (478-672nm). Connectivity: Serial/Ethernet TCP/IP to LIS/HIS. Power: New power supply. Form factor: Touchscreen interface, CD-R/RW drive, extended inlet probe. Software: In-house and commercial components. Sterilization: Not applicable (in vitro diagnostic).
Indications for Use
Indicated for in vitro testing of whole blood and expired air samples to measure pH, blood gases (pO2, pCO2), electrolytes (K+, Na+, Ca2+, Cl-), metabolites (glucose, lactate), total bilirubin, and co-oximetry parameters (total hemoglobin, oxygen saturation, hemoglobin fractions) for monitoring metabolic processes, electrolyte balance, oxygenation, and tissue oxygen supply/demand.
Regulatory Classification
Identification
A blood gases (PCO2 , PO2 ) and blood pH test system is a device intended to measure certain gases in blood, serum, plasma or pH of blood, serum, and plasma. Measurements of blood gases (PCO2 , PO2 ) and blood pH are used in the diagnosis and treatment of life-threatening acid-base disturbances.
Predicate Devices
Related Devices
- K043218 — ABL800 FLEX WITH FLEXQ MODULE, MODEL ABL8XX · Radiometer Medical Aps · May 10, 2005
- K130144 — ABL90 FLEX · Radiometer Medical Aps · Jul 31, 2013
- K123748 — ABL90 FLEX · Radiometer Medical Aps · May 7, 2013
Submission Summary (Full Text)
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# 510(k) SUBSTANTIAL EQUIVALENCE DETERMINATION DECISION SUMMARY DEVICE ONLY TEMPLATE
A. 510(k) Number: k041874
B. Purpose For Submission:
Notification from Radiometer Medical Aps of their intent to manufacture and market the new Radiometer ABL800 FLEX Blood gas, Cooximetry, Electrolyte and Metabolite Analyzer.
C. Analyte:
The ABL800 FLEX is designed for use on undiluted whole human blood and expired air. The following parameters can be measured: pH(acidity), pCO₂(carbon dioxide tension), pO₂ (oxygen tension), ctHb(total hemoglobin concentration), sO₂(oxygen saturation), FO₂Hb(fraction of oxyhemoglobin in total hemoglobin), FCOHb(fraction of carboxyhemoglobin in total hemoglobin), FHHb, fraction of deoxyhemoglobin in total hemoglobin, FMetHb, (fraction of methemoglobin in total hemoglobin), FHbF(fraction of fetal hemoblobin), cK⁺(potassium ion concentration, cNa⁺(sodium ion concentration), cCa²⁺(calcium ion concentration), cCl⁻(chloride ion concentration), ctBil(concentration of total bilirubin in plasma)
The following samples can be measured on expired air samples:
pCO₂(carbon dioxide tension) and pO₂ (oxygen tension)
D. Type of Test:
With respect to sensor technology, the ABL800 FLEX is substantially equivalent to the predicate device ABL700 Series upgrade
| | ABL800 FLEX Sensor Technology | ABL700 Series Upgrade Sensor Technology |
| --- | --- | --- |
| Blood gases and pH | Electrochemical | Electrochemical |
| Sodium | Electrochemical | Electrochemical |
| Potassium | Electrochemical | Electrochemical |
| Calcium | Electrochemical | Electrochemical |
| Glucose | Electrochemical | Electrochemical |
| Lactate | Electrochemical | Electrochemical |
| Co-oximetry parameters | Optical | Optical |
| Bilirubin | Optical | Optical |
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E. Applicant: Radiometer Medical ApS
# F. Proprietary and Established Names:
ABL800 FLEX blood gas, oximetry, electrolyte and metabolite analyzer.
Common Name: The analyzer is called ABL800 FLEX. There are several models of the device, all with 8xx number.
# G. Regulatory Information:
Regulation section:
| | CFR Section | Device Class | Product Code |
| --- | --- | --- | --- |
| Blood gases and blood pH | 862.1120 | II | CHL |
| Sodium test system | 862.1665 | II | JGS |
| Potassium test system | 862.1600 | II | CEM |
| Calcium test system | 862.1145 | II | JFP |
| Chloride test system | 862.1170 | II | CGZ |
| Glucose test system | 862.1345 | II | CGA |
| Lactic acid test system | 862.1450 | I | KHP |
| Bilirubin (total or direct test system | 862.1110 | II | CIG |
| Bilirubin in the neonate test system | 862.1113 | I (reserved) | MQM |
| Carboxyhemoglobin assay | 864.7425 | II | GHS |
| Automated hemoglobin system | 864.5620 | II | GKR |
| Fetal hemoglobin assay | 864.7455 | II | KQI |
# H. Intended use(s):
# 1. Intended use(s)
The ABL800 FLEX is intended for in vitro testing of samples of whole blood for the parameters pH, $\mathrm{pO}_2$ , $\mathrm{pCO}_2$ , potassium, sodium, calcium, chloride, glucose, lactate, total bilirubin, and co-oximetry parameters (total hemoglobin, oxygen saturation, and the hemoglobin fractions $\mathrm{FO}_2\mathrm{Hb}$ , FCOHb, FMetHb, FHHb, FHbF). In addition the ABL800 FLEX is intended for in vitro testing of samples of expired air for the parameters $\mathrm{pO}_2$ and $\mathrm{pCO}_2$ . The ABL800 FLEX includes an AutoCheck Module to perform automated analysis of quality control fluids.
# 2. Indication(s) for use:
The ABL800 FLEX is intended for in vitro testing of samples of whole blood for the parameters pH, $\mathrm{pO}_2$ , $\mathrm{pCO}_2$ , potassium, sodium, calcium, chloride, glucose, lactate, total bilirubin, and co-oximetry parameters (total hemoglobin, oxygen saturation, and the hemoglobin fractions $\mathrm{FO}_2\mathrm{Hb}$ , FCOHb, FMetHb, FHHb, FHbF). In addition the ABL800 FLEX is intended for in vitro testing of samples of expired air for the parameters $\mathrm{pO}_2$ and
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pCO₂. The ABL800 FLEX includes an AutoChek Module to perform automated analysis of quality control fluids.
Indication for use information for the analytes measured by the ABL800 FLEX:
pH: pH is the indispensable measure of acidemia or alkalemia and is therefore an essential part of the pH/blood gas measurement. The normal function of many metabolic processes requires a pH to be within a relatively narrow range.
pO₂: The arterial oxygen tension is an indicator of the oxygen uptake in the lungs.
pCO₂: pCO₂ is a direct reflection of the adequacy of alveolar ventilation in relation to the metabolic rate.
Potassium (cK⁺): The measurements of the concentration of potassium ions in plasma are used to monitor the electrolyte balance.
Sodium (cNa⁺): The measurements of the concentration of sodium ions in plasma are used to monitor the electrolyte balance.
Calcium (cCa²⁺): The measurements of the concentration of calcium ions in plasma are used to monitor the electrolyte balance.
Chloride (cCl⁻): The measurements of the concentration of chloride ions in plasma are used to monitor the electrolyte balance.
Glucose (cGlu): The glucose measurements measure the concentration of glucose in plasma. The glucose measurements are used to screen for, diagnose and monitor diabetes, pre-diabetes, and hyper- and hypoglycemia.
Lactate (cLac): The lactate measurements measure the concentration of lactate in plasma. Lactate measurements serve as a marker of critical imbalance between tissue oxygen demand and oxygen supply.
Bilirubin (ctBil): The bilirubin measurements measure the total concentration of bilirubin in plasma. ctBil is used to assess the risk of hyperbilirubinemia.
Total Hemoglobin (ctHb): ctHb is a measure of the potential oxygen-carrying capacity of the blood.
Oxygen Saturation (sO₂): sO₂ is the percentage of oxygenated hemoglobin in relation to the amount of hemoglobin capable of carrying oxygen. sO₂ allows evaluation of oxygenation.
Fraction of Oxyhemoglobin (FO₂Hb): FO₂Hb is a measure of the utilization of the potential oxygen transport capacity; that is the fraction of oxyhemoglobin in relation to all hemoglobins present (tHb) including dyshemoglobins.
Fraction of Carboxyhemoglobin (FCOHb): FCOHb is the fraction of carboxyhemoglobin. It is incapable of transporting oxygen.
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Fraction of Methemoglobin (FMetHb): FMetHb is the fraction of methemoglobin. It is incapable of transporting oxygen.
Fraction of Deoxyhemoglobin in Total Hemoglobin (FHHb): FHHb is the fraction of deoxyhemoglobin in total hemoglobin. It can bind oxygen then forming oxyhemoglobin.
Fraction of Fetal Hemoglobin (FHbF): Fetal hemoglobin consists of two $\alpha$-chains and two $\beta$-chains, and has a higher oxygen affinity than adult Hb.
3. Special condition for use statement(s): For Prescription Use.
4. Special instrument Requirements: Radiometer ABL800 FLEX
I. Device Description:
The ABL800 FLEX will, as the predicate device ABL700 Series Upgrade, consists of several models of the same analyzer for the measurement of blood gas, electrolyte, metabolite and co-oximetry. The operator may choose a model wherein only pH and blood gases will be reported; or a model wherein only pH/blood gases. tHb and oxygen saturation will be reported; or a model wherein only pH/blood gases, electrolytes and metabolites will be reported; or a model wherein all the ABL800 FLEX parameters except the hemoglobin fractions will be reported; or a model wherein all the ABL 800 FLEX parameters except the electrolytes and metabolites parameters will be reported, etc. Each model may consist of a different model part number. The ABL 835 FLEX model includes all the possible parameter options, and is the platform on which all the other reduced parameters models are based.
J. Substantial Equivalence Information:
1. Predicate device name(s):
The ABL800 FLEX is substantially equivalent in features and characteristics to the predicate ABL700 Series Upgrade (k002290) manufactured by Radiometer Medical ApS. The ABL800 FLEX includes an AutoCheck module (a module for automatically performing quality control), which is identical to the ABL700 Analyzers AutoCheck Module (k992859).
2. Predicate K number(s): (k002290) ABL700 Series Upgrade (k992859) ABL700 Analyzers AutoCheck Module
3. Comparison with Predicate:
Technology
With respect to sensor technology, the ABL800 FLEX is substantially equivalent to the predicate device ABL700 Series upgrade
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| | ABL800 FLEX Sensor Technology | ABL700 Series Upgrade Sensor Technology |
| --- | --- | --- |
| Blood gases and pH | Electrochemical | Electrochemical |
| Sodium | Electrochemical | Electrochemical |
| Potassium | Electrochemical | Electrochemical |
| Calcium | Electrochemical | Electrochemical |
| Glucose | Electrochemical | Electrochemical |
| Lactate | Electrochemical | Electrochemical |
| Co-oximetry parameters | Optical | Optical |
| Bilirubin | Optical | Optical |
The sensors for pH, blood gases, electrolytes, metabolites and co-oximetry parameters are the same as in the ABL700 Series Upgrade.
# Performance
With respect to performance, the ABL800 FLEX is substantially equivalent to the ABL700 Series Upgrade.
The measuring ranges for the two devices are as stated below:
Whole Blood
| Parameter | ABL7800 Series low | ABL700 Series high | ABL800 FLEX low | ABL800 FLEX high | Unit |
| --- | --- | --- | --- | --- | --- |
| pH | 6.300 | 8.000 | 6.300 | 8.000 | |
| pO2 | 0.0 | 800.0 | 0.0 | 800.0 | mmHg |
| pCO2 | 5.0 | 250.0 | 5.0 | 250.0 | mmHg |
| cK+ | 0.5 | 25.0 | 0.5 | 25.0 | mmol/L |
| cNA+ | 7 | 350 | 7 | 350 | mmol/L |
| cCa++ | 0.20 | 9.99 | 0.20 | 9.99 | mmol/L |
| cCl- | 7 | 350 | 7 | 350 | mmol/L |
| cGlucose | 0.0 | 60.0 | 0.0 | 60.0 | mmol/L |
| cLactate | 0.0 | 30.0 | 0.0 | 30.0 | mmol/L |
| ctHb | 0.0 | 27.7 | 0.0 | 27.7 | g/dL |
| ctBil | 0.0 | 600 | 0.0 | 600 | mg/L |
| sO2 | 0.0 | 100.0 | 0.0 | 100.0 | % |
| FO2Hb | 0.0 | 100.0 | 0.0 | 100.0 | % |
| FCOHb | 0.0 | 100.0 | 0.0 | 100.0 | % |
| FMetHb | 0.0 | 100.0 | 0.0 | 100.0 | % |
| FHHb | 0.0 | 100 | 0.0 | 100 | % |
| FHbF | 0.0 | 100 | 0.0 | 100 | % |
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Gas
| Parameter | ABL700 Series low | ABL700 Series high | ABL800 FLEX low | ABL800 FLEX high | Unit |
| --- | --- | --- | --- | --- | --- |
| pO₂ | 0.0 | 800 | 0.0 | 800 | mmHg |
| pCO₂ | 5.0 | 250.0 | 5.0 | 250.0 | mmHg |
The test ranges for the two devices are as stated below:
Whole Blood
| Parameter | ABL7800 Series low | ABL700 Series high | ABL800 FLEX low | ABL800 FLEX high | Unit |
| --- | --- | --- | --- | --- | --- |
| pH | 7.0 | 7.7 | 7.0 | 7.7 | |
| pO₂ | 15 | 530 | 15 | 530 | mmHg |
| pCO₂ | 15 | 150 | 15 | 150 | mmHg |
| cK⁺ | 2 | 8 | 2 | 8 | mmol/L |
| cNA⁺ | 120 | 180 | 120 | 180 | mmol/L |
| cCa++ | 0.50 | 2.5 | 0.50 | 2.5 | mmol/L |
| cCl⁻ | 85 | 140 | 85 | 140 | mmol/L |
| cGlucose | 2 | 15 | 2 | 15 | mmol/L |
| cLactate | 0.3 | 10 | 0.3 | 10 | mmol/L |
| ctHb | 7 | 25 | 7 | 25 | g/dL |
| ctBil | 0 | 235 | 0 | 235 | mg/L |
| sO₂ | 0 | 100 | 0 | 100 | % |
| FO₂Hb | 0 | 100 | 0 | 100 | % |
| FCOHb | 0 | 20 | 0 | 20 | % |
| FMetHb | 0 | 20 | 0 | 20 | % |
| FHHb | 0 | 20 | 0 | 20 | % |
| FHbF | 0 | 80 | 0 | 80 | % |
Gas
| Parameter | ABL700 Series low | ABL700 Series high | ABL800 FLEX low | ABL800 FLEX high | Unit |
| --- | --- | --- | --- | --- | --- |
| pO₂ | 15 | 530 | 15 | 530 | mmHg |
| pCO₂ | 15 | 150 | 15 | 150 | mmHg |
## Measuring modes and sample volumes
As the ABL700 Series Upgrade, the ABL800 FLEX Analyzer comprises several different measuring modes. For each analyzer, the number of parameters reported depends on the model of the analyzer, and the number of parameters to be reported depends on the amount of sample available as well.
Generally for the ABL800 FLEX, the following parameters may be reported:
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| | Available sample volume | Measured parameters |
| --- | --- | --- |
| Whole Blood | 195μL and more | pH/BG/Oxi/Met/Lyte/Bil |
| | 95-195μL | pH/BG/Met/Lyte (possibly Oxi/ctBil) |
| | 55-95μL | pH/BG (possibly Oxi/Met/ctBil) |
| | 35-55μL | pH (possibly Oxi/ctBil) |
| Gas | 15 mL | pO₂/ pCO₂ |
In addition the ABL800 FLEX comprises an adaptive sample handling called FLEXMODE, which is described below:
The software now allows for a new adaptive sample handling called FLEXMODE. In case a too small sample volume has been introduced in the measuring mode with the largest volume, the sample will not be rejected. A measurement will be performed in FLEXMODE. Depending on the available sample volume, FLEXMODE provides the highest number of parameters as reliably possible.
## Derived Parameters
For derived parameters, the ABL700 Series Upgrade and the ABL800 FLEX are identical.
## Solutions and gases
The two calibration solutions, the rinse solution, the cleaning solution, the tHb calibrator and the calibration gases for the pO₂ and the pCO₂ sensors are of the same formulations as in the ABL700 Series Upgrade.
## Software
The software is partly based on commercially available standard software and partly on software developed in-house, the software interfaces via serial channel or Ethernet with TCP/IP to LIS HIS systems.
## User interface
Operation of the ABL800 FLEX analyzer is as the ABL700 Series Upgrade analyzer performed via a touch screen. Sample introduction is performed by aspirating the sample from the sample collection device. Both analyzers contain a hard drive and a printer. The ABL700 Series Upgrade includes also a disk drive, which in the ABL800 FLEX is substituted by a CD-R/WR ROM drive.
## Hardware
The ABL800 FLEX comprises a new power supply, new computer and minor modifications to the inlet section including a further liquid sensor to be used with the new feature FLEXMODE. Due to the inclusion of the further liquid sensor, the measuring conduit of the ABL800 FLEX is a bit longer than the measuring conduit of the ABL700 Series Upgrade. Further, the ABL800 FLEX is provided with an extended inlet probe for more easy aspiration of samples from test tubes.
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All models of the ABL800 FLEX are provided with an AutoCheck module for automatically performing quality control. The module is identical to the AutoCheck module (k992059) for the ABL700 Series Analyzer.
## K. Standard/Guidance Document Referenced (if applicable):
Electrical Safety and EMC
Approvals: UL, CSA. In compliance with IEC 61010-1. Installation category II
EMC Emission: the equipment complies with the emission requirements for Class B equipment in EN 61326-1: Electrical equipment for measurement, control and laboratory use – EMC requirements part 1: General requirements.
EMC Immunity: The equipment complies with immunity requirements in EN 61326-1: Electrical equipment for measurement, control and laboratory use – EMC requirements part 1: General requirements.
## L. Test Principle:
### Potentiometric measuring principle
The potential of an electrode chain is recorded using a voltmeter, and related to the concentration of the sample (the Nernst equation).
An electrode chain describes an electrical circuit consisting of a sample, electrode, reference electrode, voltmeter, membranes, and electrolyte solutions. Every element in the electrode chain contributes a voltage to the total potential drop through the chain. Thus:
- When immersed in the appropriate electrolyte solution, both electrodes have separate potentials.
- The membrane junctions between the sample and electrolyte solutions also have separate potentials.
The potentiometric measuring principle is applied to pH, pCO₂, and electrolyte electrodes.
### Amperometric measuring principle
The magnitude of an electrical current flowing through an electrode chain, which is in turn proportional to the concentration of the substance being oxidized or reduced at an electrode in the chain.
The electrode chain in amperometric measurements consists of the sample, the two electrodes (anode and cathode), an amperometer, a voltage source, the membrane, and the electrolyte solution.
To simplify the description of the measuring process in an amperometric electrode, we make the following assumptions:
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- There is a species $\mathbf{A}$ in the sample which is reduced at the cathode to $\mathbf{A}^{-}$ .
- There is a species $\mathbf{X}$ in the electrolyte which is oxidized at the anode to $\mathbf{X}^{+}$ . The membrane is selective to the species $\mathbf{A}$ , allowing no other species but it to pass through from the sample into the electrolyte solution.
As appropriate potential is applied across the electrodes, the species $\mathbf{A}$ is reduced as the cathode according to the following reaction:
$$
\mathrm {A} + \mathrm {e} ^ {-} \rightarrow \mathrm {A} ^ {-}
$$
The reduction of $\mathbf{A}$ produces a flow of electrons, i.e. an electrical current.
To complete the electrical circuit an oxidation reaction where electrons are released is necessary. Therefore species $\mathbf{X}$ is oxidized according to the following reaction:
$$
\mathrm {X} \rightarrow \mathrm {X} ^ {+} + \mathrm {e} ^ {-}
$$
The magnitude of the current flowing through the circuit is proportional to the concentration of the species being reduced, in this case species A. The analyzer thereby automatically calculates the concentration on A in the sample.
The amperometric measuring principle is applied in the $\mathrm{pO}_2$ , glucose, and lactate electrodes.
## Optical measuring principles
The optical system of the ABL800 FLEX analyzer is designed to measure the following parameters:
| Parameter | Description |
| --- | --- |
| ctHb | concentration of total hemoglobin |
| sO_{2} | oxygen saturation |
| FO_{2}Hb | fraction of oxyhemoglobin |
| FCOHb | fractionation of carboxyhemoglobin |
| FHHb | fractionation of deoxyhemoglobin |
| FMetHb | fraction of methemoglobin |
| FHbF | fraction of fetal hemoglobin |
| ctBil | concentration of total bilirubin (the sum of conjugated and conjugated bilirubin) in plasma |
Note: ctBil can be measured on a whole blood or plasma sample. Plasma samples provide the optimal measurement performance. To obtain optimal accuracy when following a patient trend in ctBil, use the same aspiration mode and same analyzer.
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Hematocrit (Hct) is also available as a derived parameter.
The optical system is based on a 128-wavelength spectrophotometer with a measuring range of $478 - 672\mathrm{nm}$ . The spectrophotometer is connected via an optical fiber to a combined hemolyzer and measuring chamber.
# M. Performance Characteristics (if/when applicable):
# 1. Analytical performance:
a. Precision/Reproducibility:
The precision (i.e. repeatability or within-run imprecision) and reproducibility (i.e. total imprecision) results for the parameters as well as the linearity/assay reportable ranges were established from a single large-sized study.
The variation parameters of the study appears from the table below
| Parameter | (n) |
| --- | --- |
| Observations | 2 |
| Days | 11 |
| Instruments | 11 |
| Operators | 3 |
| Sites | 1 |
| Runs | 16 |
The study was performed as a large comparative in-house study using 11 ABL8xx FLEX analyzers and 5 ABL735 analyzers. The study used the average of the 5 ABL735 analyzers (adjusted for drift of the parameters in the sample) as reference values. The study was designed to comprise all measuring modes of all the configurations of the ABL8xx FLEX analyzer on all parameters. All measurements on the ABL8xx FLEX analyzers were made as doubles. Three in-house operators located at one site performed the measurements during 11 working days - from March 22, 2004 to April 6, 2004.
Below are listed tables showing the $\% \mathrm{CV}$ for the parameters of the ABL800 FLEX analyzer:
| pH | %CV-Micromode | %CV-Macromode |
| --- | --- | --- |
| 6.80 | 0.12 | 0.09 |
| 6.90 | 0.11 | 0.08 |
| 7.00 | 0.11 | 0.08 |
| 7.10 | 0.11 | 0.08 |
| 7.20 | 0.11 | 0.08 |
| 7.25 | 0.11 | 0.08 |
| 7.30 | 0.11 | 0.08 |
| 7.40 | 0.11 | 0.09 |
| 7.50 | 0.12 | 0.10 |
| 7.60 | 0.13 | 0.11 |
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| pCO2(mmHg) | %CV-Micromode | %CV-Macromode |
| --- | --- | --- |
| 14 | 1.9 | 4.0 |
| 15 | 1.8 | 4.0 |
| 20 | 1.8 | 4.0 |
| 25 | 1.8 | 3.9 |
| 35 | 1.7 | 3.9 |
| 45 | 1.7 | 3.9 |
| 50 | 1.7 | 3.9 |
| 65 | 1.7 | 4.0 |
| 75 | 1.7 | 4.0 |
| 80 | 1.7 | 4.1 |
| 85 | 1.4 | 3.4 |
| 120 | 1.4 | 3.3 |
| 150 | 1.4 | 3.3 |
| 180 | 1.4 | 3.3 |
| 210 | 1.4 | 3.3 |
| 250 | 1.4 | 3.3 |
| 280 | 1.4 | 3.3 |
| 310 | 1.4 | 3.4 |
| 340 | 1.4 | 3.4 |
| 390 | 1.4 | 3.5 |
| 410 | 1.9 | 4.8 |
| 420 | 1.8 | 4.6 |
| 430 | 1.8 | 4.5 |
| 440 | 1.8 | 4.4 |
| 450 | 1.8 | 4.3 |
| 460 | 1.7 | 4.3 |
| 480 | 1.7 | 4.2 |
| 510 | 1.7 | 4.1 |
| 530 | 1.7 | 4.1 |
| 550 | 1.7 | 4.1 |
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| cK+(mmol/L) | %CV-Micromode | %CV-Macromode |
| --- | --- | --- |
| 119.1 | 1.2 | 0.9 |
| 127.7 | 1.2 | 0.9 |
| 134.3 | 1.2 | 0.9 |
| 141.2 | 1.2 | 0.9 |
| 148.4 | 1.2 | 0.9 |
| 156.0 | 1.2 | 0.9 |
| 164.0 | 1.2 | 0.9 |
| 172.4 | 1.2 | 0.9 |
| 181.3 | 1.2 | 0.9 |
| 200.3 | 1.2 | 0.9 |
| cNa++(mmol/L) | %CV-Micromode | %CV-Macromode |
| --- | --- | --- |
| 0.50 | 8.8 | 3.8 |
| 0.75 | 5.9 | 2.5 |
| 0.95 | 4.6 | 2.0 |
| 1.15 | 3.8 | 1.7 |
| 1.35 | 3.3 | 1.5 |
| 1.55 | 2.9 | 1.3 |
| 1.75 | 2.6 | 1.2 |
| 1.95 | 2.3 | 1.1 |
| 2.10 | 2.1 | 1.0 |
| 2.21 | 2.0 | 1.0 |
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| cCl (mmol/L) | %CV-Micromode | %CV-Macromode |
| --- | --- | --- |
| 85.63 | 0.3 | 1.3 |
| 94.63 | 0.2 | 1.3 |
| 99.48 | 0.2 | 1.4 |
| 104.58 | 0.2 | 1.4 |
| 109.95 | 0.2 | 1.4 |
| 115.58 | 0.2 | 1.4 |
| 121.51 | 0.2 | 1.4 |
| 127.74 | 0.3 | 1.4 |
| 134.29 | 0.3 | 1.4 |
| 149.90 | 0.3 | 1.5 |
| cGlu (mmol/L) | %CV-Micromode | %CV-Macromode |
| --- | --- | --- |
| 0.49 | 23.172 | 21.768 |
| 1.00 | 13.610 | 12.469 |
| 2.25 | 8.042 | 7.203 |
| 4.00 | 5.806 | 5.161 |
| 6.25 | 4.624 | 4.113 |
| 7.84 | 4.153 | 3.706 |
| 9.00 | 3.902 | 3.490 |
| 10.24 | 3.689 | 3.309 |
| 12.25 | 3.422 | 3.085 |
| 15.21 | 3.143 | 2.854 |
| cLac (mmol/L) | %CV-Micromode | %CV-Macromode |
| --- | --- | --- |
| 0.15 | 36 | 35 |
| 0.37 | 18 | 15 |
| 1.00 | 13.1 | 9.2 |
| 2.72 | 12.9 | 8.3 |
| 4.48 | 13.1 | 8.4 |
| 5.75 | 13.3 | 8.6 |
| 7.39 | 13.5 | 8.7 |
| 9.49 | 13.6 | 8.8 |
| 12.18 | 13.8 | 9.0 |
| 15.64 | 14.0 | 9.2 |
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| ctHb(mmol/L) | %CV-Micromode | %CV-Macromode |
| --- | --- | --- |
| 2.00 | 3.3 | 2.2 |
| 4.00 | 3.3 | 2.2 |
| 6.00 | 3.3 | 2.2 |
| 8.00 | 3.3 | 2.2 |
| 10.00 | 3.3 | 2.2 |
| 12.00 | 3.3 | 2.2 |
| 14.00 | 3.3 | 2.2 |
| 17.00 | 3.3 | 2.2 |
| 20.00 | 3.3 | 2.2 |
| 24.00 | 3.3 | 2.2 |
# b. Linearity/assay reportable range:
The protocol used for the test of linearity is an integrated part of the experimental design for performance testing. The experimental design is basically a randomized experiment, where the measurements in the different modes of the analyzer are performed in a randomized sequence for each of the blood preparations.
Bias is defined as:
$$
\operatorname {B i a s} _ {\text {R e f}} = \mathrm {X} _ {\text {A B L 8 0 0 F l e x}} - \mathrm {X} _ {\text {P r i m a r y R e f e r e n c e m e t h o d}}
$$
$$
\operatorname {B i a s} _ {\mathrm {A B L}} = \mathrm {X} _ {\mathrm {A B L 8 0 0 F l e x}} - \mathrm {X} _ {\mathrm {A B L 7 3 5}}
$$
where
$\mathrm{X_{ABL800Flex}}$ is the mean value of the measured value for a group of ABL800Flex analyzer.
$\mathrm{X}_{\text {Primary Reference method }}$ is the mean value of the measured value obtained with the Primary Reference method.
$\mathrm{X_{ABL735}}$ is the mean value of the measured value for the ABL735 analyzers used as reference analyzers.
The acceptance criteria for linearity are the maximum bias values, specified at different values of the particular parameter. These values are chosen to cover the entire test range.
The maximum bias values were specified in the design specifications for the analyzer. Requirements for the maximum bias values assure that the linearity is within acceptance criteria. The maximum bias values specified in the design specifications for the ABL800 series analyzers are given in Tables 1 and 2. The actual measured bias values from the data of the verification test are also presented in Tables 1 and 2.
{14}
From the Tables 1 and 2 it is seen that all acceptance criteria for bias, and thereby also for linearity, are met.
The concept of using bias requirements for test of linearity is illustrated in Figure 1 below.
Fig. 1
Micromode
| Parameter | Level | Unit | 95% Confidence Intervals (in specified units) | | | Accepted/ not accepted |
| --- | --- | --- | --- | --- | --- | --- |
| | | | Lower Limit | Upper Limit | Acceptance criteria | |
| pH | 7.0 | | -0.009 | 0.006 | ±0.01 | accepted |
| pH | 7.4 | | 0.003 | 0.005 | ±0.005 | accepted |
| pH | 7.6 | | -0.008 | 0.006 | ±0.01 | accepted |
| pO2 | 15 | mmHg | -0.81 | 0.04 | ±2 | accepted |
| pO2 | 50 | mmHg | -0.39 | 1.71 | ±2 | accepted |
| pO2 | 150 | mmHg | -2.17 | 3.38 | ±4 | accepted |
| pO2 | 250 | mmHg | -5.32 | 2.68 | ±6 | accepted |
| pO2 | 530 | mmHg | -39.09 | 17.09 | ±40 | accepted |
| pCO2 | 15 | mmHg | -0.79 | 0.38 | ±0.8 | accepted |
| pCO2 | 40 | mmHg | -0.87 | 0.61 | ±1 | accepted |
| pCO2 | 60 | mmHg | -0.42 | 2.28 | ±3 | accepted |
| pCO2 | 80 | mmHg | -1.25 | 2.99 | ±3 | accepted |
| pCO2 | 150 | mmHg | -3.15 | 9.90 | ±10 | accepted |
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Page 16 of 28
| Parameter | Level | Unit | 95% Confidence Intervals (in specified units) | | | Accepted/ not accepted |
| --- | --- | --- | --- | --- | --- | --- |
| | | | Lower Limit | Upper Limit | Acceptance criteria | |
| Cl | 85 | mmol/L | 0.15 | 1.00 | ±3.5 | accepted |
| Cl | 105 | mmol/L | 1.66 | 2.50 | ±3.0 | accepted |
| Cl | 140 | mmol/L | 2.81 | 1.83 | ±3.0 | accepted |
| Ca | 0.5 | mmol/L | 0.03 | 0.08 | ±0.08 | accepted |
| Ca | 1.25 | mmol/L | 0.03 | 0.06 | ±0.06 | accepted |
| K | 2 | mmol/L | -0.07 | -0.02 | ±0.08 | accepted |
| K | 4 | mmol/L | 0.20 | 0.24 | ±0.25 | accepted |
| K | 8 | mmol/L | 0.28 | 0.43 | ±0.45 | accepted |
| Na | 120 | mmol/L | 0.24 | 1.44 | ±1.5 | accepted |
| Na | 140 | mmol/L | 1.10 | 0.12 | ±1.5 | accepted |
| Na | 180 | mmol/L | 1.12 | 0.22 | ±1.5 | accepted |
| Glu | 2 | mmol/L | -0.07 | 0.04 | ±0.1 | accepted |
| Glu | 5 | mmol/L | -0.09 | 0.15 | ±0.2 | accepted |
| Glu | 15 | mmol/L | -0.26 | 0.49 | ±0.6 | accepted |
| Lac | 0.3 | mmol/L | -0.02 | 0.08 | ±0.1 | accepted |
| Lac | 2 | mmol/L | 0.06 | 0.27 | ±0.3 | accepted |
| Lac | 10 | mmol/L | -0.30 | -1.05 | ±1.1 | accepted |
| tHb | 7 | g/dL | 0.28 | -0.12 | ±0.3 | accepted |
| tHb | 15 | g/dL | 0.54 | 0.12 | ±0.6 | accepted |
| tHb | 25 | g/dL | 1.40 | 0.05 | ±1.5 | accepted |
Table 1
Macromode
| Parameter | Level | Unit | 95% Confidence Intervals (in specified units) | | | Accepted/ not accepted |
| --- | --- | --- | --- | --- | --- | --- |
| | | | Lower limit | Upper limit | Acceptance criteria | |
| pH | 7.0 | | -0.005 | -0.002 | ±0.005 | accepted |
| pH | 7.4 | | -0.003 | -0.001 | ±0.005 | accepted |
| pH | 7.6 | | -0.005 | 0.000 | ±0.005 | accepted |
| pO2 | 15 | mmHg | -0.03 | 0.12 | ±1.5 | accepted |
| pO2 | 50 | mmHg | 0.34 | 0.61 | ±1.5 | accepted |
| pO2 | 150 | mmHg | -1.87 | -0.97 | ±2 | accepted |
| pO2 | 250 | mmHg | -2.57 | -0.57 | ±3 | accepted |
| pO2 | 530 | mmHg | -12.59 | -6.23 | ±15 | accepted |
| pCO2 | 15 | mmHg | -0.49 | -0.30 | ±0.5 | accepted |
| pCO2 | 40 | mmHg | -0.59 | -0.03 | ±0.6 | accepted |
| pCO2 | 60 | mmHg | -0.12 | 1.02 | ±1.1 | accepted |
| pCO2 | 80 | mmHg | -1.05 | 0.83 | ±1.5 | accepted |
| pCO2 | 150 | mmHg | -0.75 | 4.28 | ±6 | accepted |
| Cl | 85 | mmol/L | 0.15 | 1.34 | ±3.5 | accepted |
| Cl | 105 | mmol/L | 1.66 | 2.81 | ±3 | accepted |
| Cl | 140 | mmol/L | 1.41 | 2.95 | ±3 | accepted |
| Ca | 0.5 | mmol/L | 0.03 | 0.05 | ±0.05 | accepted |
| Ca | 1.25 | mmol/L | 0.01 | 0.03 | ±0.03 | accepted |
{16}
| Parameter | Level | Unit | 95% Confidence Intervals (in specified units) | | | Accepted/ not accepted |
| --- | --- | --- | --- | --- | --- | --- |
| | | | Lower limit | Upper limit | Acceptance criteria | |
| K | 2 | mmol/L | -0.04 | -0.01 | ±0.07 | accepted |
| K | 4 | mmol/L | 0.19 | 0.23 | ±0.25 | accepted |
| K | 8 | mmol/L | 0.18 | 0.32 | ±0.4 | accepted |
| Na | 120 | mmol/L | -0.36 | 1.08 | ±1.1 | accepted |
| Na | 140 | mmol/L | -0.44 | 0.75 | ±0.8 | accepted |
| Na | 180 | mmol/L | -0.05 | 0.58 | ±1 | accepted |
| Glu | 2 | mmol/L | -0.04 | 0.00 | ±0.1 | accepted |
| Glu | 5 | mmol/L | 0.00 | 0.10 | ±0.12 | accepted |
| Glu | 15 | mmol/L | 0.07 | 0.43 | ±0.5 | accepted |
| Lac | 0.3 | mmol/L | -0.03 | 0.01 | ±0.1 | accepted |
| Lac | 2 | mmol/L | -0.07 | 0.11 | ±0.12 | accepted |
| Lac | 10 | mmol/L | -0.80 | 0.20 | ±0.9 | accepted |
| tHb | 7 | g/dL | -0.01 | 0.11 | ±0.3 | accepted |
| tHb | 15 | g/dL | 0.29 | 0.44 | ±0.5 | accepted |
| tHb | 25 | g/dL | 0.90 | 1.23 | ±1.3 | accepted |
# Table 2
# c. Traceability (controls, calibrators, or method):
# pH
Capillary-type glass pH electrode with a saturated calomel reference electrode and a liquid junction saturated with KCL (BMS™ Mk2) [1, 2].
# pCO2
Tonometry [3].
The gas used for tonometry are traceable to NIST certified Standard Reference Materials.
# pO2
Tonometry [3].
The gas used for tonometry are traceable to NIST certified Standard Reference Materials.
# $\mathbf{K}^{+}$
NIST certified Standard Reference Material SRM 909b (human serum).
# Na+
NIST certified Standard Reference Material SRM 909b (human serum) and Radiometer specified standard serum material (specified using flame photometry).
# CT
NIST certified Standard Reference Material SRM 909b (human serum)
# Ca2+
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Page 18 of 28
The calcium transfer standards were used. These are traceable to NIST SRM915 and have an ionic strength of 160.0 mmol per kg of water and pH 7.40 at 37 °C, using 1 mmol/L (37 °C) HEPES buffer. The standards were produced as indicated in [4].
## Glu
Spectrophotometry, using the hexokinase (HK) method recommended by NCCLS [5], measured on serum.
## Lac
Spectrophotometry using lactate dehydrogenase (LDH) method, measured on serum [10].
## Hb
HiCN method recommended by NCCLS [6].
## Oximetry
The optical system is unchanged in the ABL800 FLEX analyzers compared to the ABL700 Series. Tests of ctHb on the ABL800 FLEX analyzer have been conducted. As the other oximetry parameters (sO₂, FO₂Hb, FCOHb, FMetHb, FHHB, FHbF) are derived from ctHb, these parameters have not been retested; the information and results below are from the ABL700 Series.
The reference method established for the oximetry parameters used modified ABL520 analyzers as the reference instruments. The ABL520 analyzers have been validated and their performance specifications determined according to primary reference methods.
The modified ABL520 analyzers are used in accordance with IFCC's recommendations for traceability of reference methods.
## References
List of references
1. Kristensen HB, Salomon A, Kokholm G. International pH scales and certification of pH.
2. Definition of pH scales, standard reference values, measurement of pH and related terminology (Recommendations 1994). Pure and Appl Chem 1985; 57, 3: 531 - 42.
3. Burnett RW, Covington AK, Maas AHJ, Müller-Plathe O et al. J Clin Chem Clin Biochem 1989; 27: 403 - 08.
4. IFCC reference methods and materials for measurement pH, gases and electrolytes in blood. Scand J Clin Lab Invest 1993; 53, Suppl 214: 84 - 94.
5. Glucose. NCCLS Publication RS1-A. Villanova, Pa: NCCLS, 1989.
6. Reference and selected procedures for the quantitative determination of hemoglobin in blood. Approved Standard (3rd edition), NCCLS Publication H15-2A. Villanova, Pa: NCCLS, 2000.
7. Evelyn K, Malloy H. Microdetermination of oxyhemoglobin, methemoglobin and sulfhemoglobin in a single sample of blood. Biological Chem 1938; 126: 655 - 62.
8. Kristoffersen K. An improved method for the estimation of small
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Page 19 of 28
quantities of alkali-resistant hemoglobin in blood. Scand J Clin Lab Invest 1961; 13: 402.
9. Quantitative measurement of fetal hemoglobin using the alkali denaturation method. Approved Guideline. NCCLS Publication H13-A 1989; 9, 18.
10. Begmeyer. Methods of enzymatic analysis. 3rd ed., Verlag Chemie Deerfield Beach 1984; 6: 582-88.
d. Detection limit:
16 different mixtures of heparinized whole blood samples were used in the test. The mixtures were prepared to have the parameter levels indicated in the table below:
Target Concentrations of Test Sample Mixtures
| Mix No. | K+ mMol/L | Na+ mMol/L | Cl- mMol/L | Ca2+ mMol/L | Glu mMol/L | Lac mMol/L | tHb g/dL | pH pH | pO2 mmHg | pCO2 mmHg | Sat % | Bili μMol/L |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1 | 8 | 120 | 98 | 1.99 | 3.15 | 5.04 | 15.598 | 7.538 | 493 | 10 | | 5 |
| 2 | | | | | | | 15 | 7.58 | 545 | 10 | 100 | |
| 3 | 3.44 | 187.5 | 138 | 0.56 | 1.01 | 6.24 | 9.656 | 7.061 | 31.8 | 80 | | 20 |
| 4 | 7 | | | | | | 15 | 7.13 | 130 | 80 | 98 | |
| 5 | 2.26 | 191.7 | 144 | 0.57 | 2.61 | 2.97 | 15.503 | 6.892 | 22.5 | 150 | | 0 |
| 6 | 7 | | | | | | 15 | 7 | 15 | 150 | 10 | |
| 7 | 5.6 | 154.7 | 121 | 1.32 | 1.5 | 2.89 | 14.626 | 7.223 | 37.7 | 55.7 | | 0 |
| 8 | 7 | | | | | | 15 | 7.22 | 40 | 60 | 70 | |
| 9 | 4 | 183.4 | 133 | 0.42 | 2.25 | 9.01 | 4.481 | 7.499 | 198 | 26.9 | | 48 |
| 10 | 7 | | | | | | 15 | 7.36 | 230 | 30 | 100 | |
| 11 | 4 | 177.5 | 134 | 0.56 | 0.95 | 0.29 | 2.446 | 7.32 | 211 | 44 | | 0 |
| 12 | 4 | 140 | 111 | 1.05 | 14.64 | 5.18 | 24.227 | 7.352 | 76.5 | 38.6 | | 645 |
| 13 | 7 | 133.7 | 109 | 1.47 | 7.02 | 3.66 | 19.046 | 7.454 | 54.8 | 20 | | 170 |
| 14 | 5.38 | 156.2 | 117 | 0.92 | 0.76 | 7.51 | 10.524 | 7.49 | 362 | 20 | | 19 |
| 15 | 4 | 166.7 | 123 | 0.59 | 6.67 | 7.1 | 14.172 | 7.375 | 90.6 | 35.7 | | 188 |
| 16 | 3.7 | 168.3 | 127 | 0.71 | 6.94 | 2.2 | 18.222 | 7.18 | 33.8 | 77.1 | | 159 |
During a day of test, the levels of the parameters of each mixture drifted somewhat away from the initial level. However, this did not influence the quality of the study as each double measurement on an ABL8xx FLEX analyzer was complemented by corresponding measurements on the five ABL 735 analyzers. The concentrations of the measured mixtures represent the entire test/reportable range of all the parameters.
e. Analytical specificity:
pH/blood gas the following interference results are found for the pH and blood gas electrodes:
| Substance | Test Conc. | Interference on pO2 Electrode |
| --- | --- | --- |
| Halothane | 3% | 5 % increased sensitivity |
{19}
Intralipid (20 % solution) in a concentration greater than 4 % (the final Intralipid level being 0.8 %) will give interference on pH measurements.
Electrolytes The following interference results are found for the electrolyte electrodes:
| Substance Test Concentration | Interference on | | | | |
| --- | --- | --- | --- | --- | --- |
| | | cK+(4 mmol/L level) | cNa+(150 mmol/L level) | cCa2+(1.25 mmol/L level) | cCl-(110 mmol/L level) |
| Li+ | 4 mmol/L | 0 | 0 | 0 | |
| K+ | 12 mmol/L | | -1 | -0.01 | |
| Na+ | 100-180 mmol/L | 0.1 to -0.1 | | | |
| NH4 | 1 mmol/L | 0 | 0 | | |
| Ca2+ | 5 mmol/L | | 0 | | |
| Mg2+ | 5 mmol/L | 0 | 0 | 0.05 | |
| Br- | 10 mmol/L | | | | 41 |
| F- | 1 mmol/L | | | | 0 |
| Γ- | 3.0 mmol/L | | | | 30-90 |
| ClO4- | 1.5 mmol/L | | | | 8-30 |
| HCO3- | 25-50 mmol/L | | | | 0.1 mmol/L Cl- per mmol/L HCO3- |
| Lactate | 10 mmol/L | | | | 0 |
| Acetyl-salicylic acid | 3.0 mmol/L | | | | 2 |
| Ascorbic acid | 1.0 mmol/L | | | | 0 |
| pH ≤ 7.2 | | 0 | 0 | 0.01 | -1 |
| pH≥ 7.6 | | 0 | 0 | -0.01 | 1 |
Sulphide will give erroneously high cCl results.
# Metabolites
The following interference results are found for the metabolite electrodes:
| Substance Test Conc. (mmol/L) | Interference on | | |
| --- | --- | --- | --- |
| | | cGlucose (4.0 mmol/L level) | cLactate (1.5 mmol/L level) |
| Acetylsalicylic acid | 3 | < 0.1 | < 0.1 |
| Ascorbic acid | 2 | < 0.1 | < 0.1 |
| Chlorpromazine HCl | 0.2 | < 0.1 | < 0.1 |
| Dopamine HCl | 1.0 | < 0.1 | < 0.1 |
| Ethanol | 79 | < 0.1 | < 0.1 |
| Salicylic acid | 4 | < 0.1 | < 0.1 |
| Ibuprofen | 2 | < 0.1 | < 0.1 |
{20}
| Substance | Test Conc. (mmol/L) | Interference on | |
| --- | --- | --- | --- |
| | | cGlucose (4.0 mmol/L level) | cLactate (1.5 mmol/L level) |
| Thiocyanic acid | 24 | Interference | Interference |
| Paracentamol-4-acetamidopenol | 2 | < 0.1 | < 0.1 |
| Acetoacetic acid | 2 | < 0.1 | < 0.1 |
| Bilirubin (unconjugated) | 0.34 | < 0.1 | < 0.1 |
| Bilirubin (conjugated) | 0.46 | < 0.1 | < 0.1 |
| Creatinine | 3 | < 0.1 | < 0.1 |
| Urea | 84 | < 0.1 | < 0.1 |
| Uric acid | 1.5 | < 0.1 | < 0.1 |
| Lactic acid | 12 | < 0.1 | |
| Pyruvate | 2 | < 0.1 | < 0.1 |
| Glycolic acid | 1 | < 0.1 | Interference |
| D-glucose | 67 | | <0.1 |
| Citrate | 50 | -0.37 | 0.19 |
| Oxalate | 90 | -0.47 | 0.14 |
| Heparin | 8000 IU/dL | < 0.1 | < 0.1 |
| EDTA | 3 | < 0.1 | < 0.1 |
| Fluoride | 50 | -0.36 | <0.1 |
| Maltose | 13.3 | 0.75-4.2* | <0.1 |
cGlu level measure on Cal 1 (10 mmol/L) and Cal 2 (0 mmol/L).
| Hematocrit % | ΔcLactate % at: | |
| --- | --- | --- |
| | 5 mmol/L | 15 mmol/L |
| 0 | 0.7 % | 0.7 % |
| 45 | 0.0 % | 0.0 % |
| 60 | -0.5 % | -2.0 % |
| 75 | -2.2 % | -5.0 % |
# Oximetry Parameters
The substances against which the oximetry parameters (cHb, $\mathrm{sO}_2$ , $\mathrm{FO}_2\mathrm{Hb}$ , FCOHb, FMetHb, FHHb, FHbF) and ctBil were tested for interference given in the table below:
(SAT100 blood reference test sample: ctHb = 15 g/dL, sO₂ = 100 %, FO₂Hb = 0.7%, FMetHb = 0.5 %, ctBil = 0, pH = 7.4. Parameters sensitivity from the influence on the absorbance spectrum from various substances.)
{21}
| Substance | Test conc. | Change on | | | | | | | |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| | | ctHb(g/dL) | sO2(%) | FO2Hb(%) | FCOHb(%) | FMetHb(%) | FHHb(%) | FHbF(%) | ctBil(μmol/L) |
| Intralipid | 4Vol %e) | -0.5 | 0.1 | -1.3 | 0.5 | 0.9 | -0.1 | 11 | 04b) |
| Intralipid | 2 Vol %f) | -0.4 | 0.1 | -0.3 | 0.3 | 0.1 | -0.1 | 11 | 72b) |
| HbF a), c) | 20 % | -0.02 | 1.17 | 0.04 | 0.73 | 0.37 | -1.14 | 0 | -14 |
| SHb | 10 % | 0 | -1.0 | 0.9 | -0.1 | 0.1 | -0.9 | Not Tested | |
| pH | 7.1 | -0.5 | -0.5 | -0.2 | -0.4 | 0.1 | 0.5 | -19 | 0 |
| | 7.9 | -0.6 | 0.6 | -0.5 | 1.0 | 0.1 | -0.6 | 13 | -5 |
| Cardio Greenc) | 5 mg/L | -0.16 | 0.29 | 1.14 | 0.07 | -0.93 | -0.29 | -5 | -20 |
| Evans Bluec) | 5 mg/L | -0.04 | 0.14 | 0.28 | -0.20 | -0.20 | 0.14 | -5 | 5 |
| Betacarotene in plasmac) | 3.7 μmol/L | 0.0 | -0.02 | 0.03 | -0.01 | -0.04 | 0.02 | 0.1 | -0.2 |
| Patent Bluec) | 10 mg/L | -0.16 | 0.39 | 0.86 | -0.47 | 0.00 | -0.38 | -21 | 38 |
| Methylene Bluec) | 30 mg/L | -0.7 | -3.4 | 5.6 | -3.0 | -6.2 | 3.6 | -37 | -25 |
| HiCNC) | 0.11 mmol/L | 0.26 | -1.5 | -3.0 | -0.5 | 0.5 | 1.5 | 24 | 47 |
| MCHCc),d) newborn range | 320 g/L | No Interference | -12 | | | | | | |
| | 350 g/L | | | | | | | | 17 |
| Sedimentation rate | 100 arb. Units | <±0.5 | No Interference | | | | | | Not Tested |
Notes: a) If function "Correction for HbF levels less than $20\%$ is activated, the change is 0 for all parameters.
b) Plasma sample.
c) Calculated value from mathematical superposition of measured pure interference spectrum on measured reference spectrum.
d) ctBil = 400 μmol/L
e) Intralipid (20 % solution) at 4 Vol % gives final test level of 0.8 %.
f) Intralipid (20 % solution) at 2 Vol % gives final test level of 0.4 %.
There is no interference from fetal hemoglobin (HbF when the analyzer applies HbF correction.
{22}
There is no interference from bilirubin (conjugated/unconjugated) up to 1000 $\mu \mathrm{mol} / \mathrm{L}$ .
# Known interfering substances
The following substances are known to affect or interfere with measurements on the ABL 800 FLEX analyzers.
| Substance | Interference |
| --- | --- |
| Halothane (anesthetic) | May give unreliable pO2results. |
| Liquid therapy, protamine sulphate treatment | In OXI measurements.After measurement on blood from a patient who has received liquid therapy of protamine sulphate it may be necessary to clan the analyzer using the Cleaning program. |
| Methylene Blue HiCN (medication) | In Oxi measurements. |
| Anions: Br-, Γ, S2- and CIO4(drugs) | Erroneously high cCL results |
| Anticoagulant (sampling) | Anticoagulants that contain sodium salts will give erroneously high cNa+ results.Sodium fluoride with or without EDTA and oxalate (di Na) influence cGlu results.Sodium fluoride gives erroneously high cNA+ and low cCa2+, cGlucose, and cLactate results. Tri sodium citrate influences cNA+,cK+ and cGlu results.Thus radiometer recommends the exclusive use of heparin as anticoagulant. Solutions containing organic preservatives may damage the ion-selective membranes of the K and Glu electrodes when introduced into the analyzer. |
| Thiocyanic Acid (degradation product from treatment with Nitroprusside. Also produced in thiosulphate treatment of cyanide poisoning) | Erroneously high cGlu and CLac measurements. |
| Glycolic Acid (ethylene glycol degradation product) | Erroneously high cLac measurements |
{23}
| Substance | Interference |
| --- | --- |
| Insufficiently stabilized blood. Caustic fluids (e.g. strong acids or bases, detergents, etc.). Fluids that precipitate. Fluids that affect the sensor enzymes. Fluids that form complexes with the analyzer solutions (calcium). High viscosity fluids. Hydrophobic fluids. Reactive fluids. | Other fluids mode allows you to measure on fluids other than heparinized human blood. Warning/Caution: Be aware that some substances, such as listed in the left column, measured in the Other fluids, mode may damage the instrument or the electrodes. This can affect the subsequent measurement on human blood or quality control solutions. |
| Carboxymethyl cellulose (CMC) | Some auto-venting arterial blood samplers contain carboxymethyl cellulose (CMC) in the porous vent. CMC can dissolve into the sample and give erroneously low cCa2+ results. Therefore we recommend Radiometer accessories together with our analyzers, e.g., PICO 70 arterial blood sampler which is specifically designed to minimize sample contamination with CMC. |
| Glucosamine | Interference on cGlu up to 1.06 mmol/L |
| Galactose, maltose, mannose, xylose | Interference – see Interference Tests in chapter 5 of the ABL800 FLEX Reference Manual. |
d. Assay cut-off:
Not applicable
2. Comparison studies:
a. Method comparison with predicate device:
# Sample Types
The study was performed on samples of whole blood. The samples included syringe samples having volumes of $20\mathrm{ml}$ and $50\mathrm{ml}$ and capillary samples having volumes of $224\mu \mathrm{l}$ , $104\mu \mathrm{l}$ , $94\mu \mathrm{l}$ , $83\mu \mathrm{l}$ , $57\mu \mathrm{l}$ , $50\mu \mathrm{l}$ and $35\mu \mathrm{l}$ .
# Number of measurements
The number of measurements in macro- and micromodes, and the total number of measurements during the test are listed below:
{24}
| Parameter | Nmacro | Nmicro | Total |
| --- | --- | --- | --- |
| pH | 3334 | 421 | 3755 |
| pCO2 | 2768 | 397 | 3165 |
| pO2 | 282 | 2912 | 3194 |
| cK+ | 22 | 1364 | 1786 |
| cNa+ | 423 | 1362 | 1785 |
| cCa2+ | 407 | 1148 | 1555 |
| cCl- | 426 | 1360 | 1786 |
| cGlu | 423 | 1825 | 2248 |
| cLac | 412 | 1829 | 2241 |
| ctHb | 415 | 032 | 447 |
In the study, a total of approx. 4,700 measurements were performed on the ABL8xx FLEX with corresponding ABL735 reference values. As not all parameters are relevant for all measuring modes or ABL8xx versions, the values in the table shown above differ according to parameter.
$\mathbf{S} =$ Syringe Mode sampling
$\mathbf{C} =$ Capillary Mode sampling
# pH
Bias on the ABL800 FLEX analyzers:
| pH | ABL835/25/15 FLEX. Capillary - FLEXMODE | | | | | | | |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
| | S195 | C195 | S95 | C95 | S55 | C55 | S35 | C35 |
| 7.0 | -0.0023 | -0.0003 | -0.006 | -0.006 | -0.002 | -0.003 | 0.011 | 0.011 |
| 7.4 | -0.0008 | 0.0004 | -0.002 | -0.002 | 0.006 | 0.005 | 0.008 | 0.008 |
| 7.7 | 0.0015 | 0.0024 | 0.001 | -0.002 | 0.001 | 0.003 | 0.005 | 0.005 |
# $\mathbf{pCO}_2$
Bias on the ABL800 FLEX analyzers:
| pCO2mmHg | ABL835/25/15 FLEX, Capillary - FLEXMODE | | | | | |
| --- | --- | --- | --- | --- | --- | --- |
| | S195 | C195 | S95 | C95 | S55 | C55 |
| 15 | -0.03 | -0.2 | 0.1 | 0.1 | -0.5 | -0.7 |
| 40 | -0.01 | -0.3 | 0.3 | 0.3 | 0.2 | -0.4 |
| 60 | 0.4 | 0 | 0.4 | 0.3 | 2.3 | 0.6 |
| 80 | 0.4 | 0.1 | 0.8 | 0.5 | 2.5 | -0.8 |
| 150 | 1.1 | 0.2 | 2.2 | 0.7 | 4.6 | -4.7 |
# $\mathbf{pCO}_2$ (expired air samples)
Bias for the ABL800 FLEX analyzers (expired air samples)
| pCO2 mmHg | Bias |
| --- | --- |
| 15 | 0.2 |
| 40 | -0.2 |
| 60 | -0.4 |
| 80 | -0.2 |
| 150 | 1.6 |
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$\mathbf{pO}_2$
Bias on the ABL800 FLEX analyzers:
| pO2mmHg | ABL835/25/15 FLEX, Capillary – FLEXMODE | | | | | |
| --- | --- | --- | --- | --- | --- | --- |
| | S195 | C195 | S95 | C95 | S55 | C55 |
| 15 | -0.379 | -0.28 | -0.8 | -0.7 | -0.4 | -0.9 |
| 50 | -0.1 | -0.23 | 0.3 | 0.3 | -3.2 | -2.0 |
| 150 | 0.3 | -0.07 | 5.3 | 4.0 | 5.0 | 3.2 |
| 250 | 1.47 | 0.09 | 2.7 | 1.4 | 7.2 | -1.2 |
| 530 | 1.44 | -0.03 | -16.5 | -28.6 | 17.3 | -39.5 |
$\mathbf{pO}_2$ (expired air samples)
Bias for the ABL800 FLEX analyzers (expired air samples)
| pO2 mmHg | Bias |
| --- | --- |
| 15 | -1.3 |
| 50 | -1.0 |
| 150 | 0.5 |
| 250 | -1.4 |
| 530 | 7.8 |
$\mathbf{cK}^{+}$ NIST certified Standard Reference Material SRM 909b (human serum).
Bias REF
The FLEXMODE on the ABL 805/35 analyzers was tested using SRM 909b
| c K+ (mmol/L) | Bias REF | N |
| --- | --- | --- |
| 3.424 | -0.03 | 20 |
| 6.278 | 0.23 | 20 |
$\mathbf{cNa}^{+}$ NIST certified Standard Reference Material SRM 909b (human serum) and Radiometer specified standard serum material (specified using flame photometry).
Bias REF
The FLEXMODE on the ABL 805/35 analyzers was tested using SRM 909b:
| cCl- (mmol/L) | Bias REF | N |
| --- | --- | --- |
| 120.76* | -0.25 | 20 |
| 138.5 | -0.28 | 20 |
$\mathbf{N} =$ number of measurements on several analyzers used for the test
(*NIST certified Standard Reference Material ** Serum (Radiometer specified).
$\mathbf{cCl}^+$ NIST certified Standard Reference Material SRM 909b (human serum).
Bias REF
The FLEXMODE on the ABL 805/35 analyzers was tested using SRM 909b:
| cCl- (mmol/L) | Bias REF | N |
| --- | --- | --- |
| 89.11 | 0.6 | 20 |
| 119.43 | 2.4 | 20 |
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$\mathrm{N} =$ number of measurements on several analyzers used for the test
$\mathbf{cCa}^{2+}$ The calcium transfer standards were used. These are traceable to NIST SRM915 and have an ionic strength of $160.0 \mathrm{mmol}$ per kg of water and pH 7.40 at $37^{\circ} \mathrm{C}$ , using $1 \mathrm{mmol} / \mathrm{L}$ ( $37^{\circ} \mathrm{C}$ ) HEPES buffer.
Bias REF
The FLEXMODE on the ABL 805/35 analyzer was tested using SRM915:
| cCa2+ mmol/L | Bias Ref | N |
| --- | --- | --- |
| 0.4879 | 0.038 | 150 |
| 1.2700 | 0.025 | 150 |
| 2.5657 | 0.052 | 150 |
$\mathrm{N} =$ number of measurements on several analyzers used for the test
cGLU Spectrophotometry, using the hexokinase (HK) method recommended by NCCLS [5], measured on serum
Bias REF
The FLEXMODE on the ABL 805/35 analyzers was tested:
| cGLU (mmol/L) | Bias REF | N |
| --- | --- | --- |
| 0.08 | 0.03 | 30 |
| 2.09 | 0.06 | 30 |
| 5.08 | 0.12 | 30 |
| 14.73 | -0.02 | 30 |
$\mathrm{N} =$ number of measurements on several analyzers used for the test.
cLac Spectrophotometry using lactate dehydrogenase (LDH) method, measured on serum [10].
Bias REF
The FLEXMODE on the ABL 805/35 analyzers was tested:
| cLac (mmol/L) | Bias REF | N |
| --- | --- | --- |
| 0.08 | 0.03 | 30 |
| 2.09 | 0.06 | 30 |
| 5.08 | 0.12 | 30 |
| 14.73 | -0.02 | 30 |
$\mathrm{N} =$ number of measurements on several analyzers used for the test.
ctHb HiCN method recommended by NCCLS [6].
Bias REF
The FLEXMODE on the ABL 830/35 analyzers was tested:
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| ctHb (mmol/L) | Bias REF | N |
| --- | --- | --- |
| 15 (SAT0) | 0.32 | 145 |
| 7 (SAT100) | 0.04 | 145 |
| 15 (SAT100) | 0.37 | 145 |
| 25 (SAT100) | 0.97 | 145 |
N = number of measurements on several analyzers used for the test.
b. Matrix comparison:
The ABL800 FLEX is designed for use on undiluted whole human blood and expired air.
3. Clinical studies:
a. Clinical sensitivity:
Clinical studies are not typically submitted for this device type.
b. Clinical specificity:
Clinical studies are not typically submitted for this device type.
c. Other clinical supportive data (when a and b are not applicable):
Not applicable
4. Clinical cut-off:
Not applicable
5. Expected values/Reference range:
None provided
N. Conclusion:
The submitted material in this premarket notification is complete and supports a substantial equivalence decision.
