Evaluation of comparison measurements of sampling tubes for heavy metal / trace element tests in medical laboratories

In their studies, Tiryaki, Ö. & Kelağalar, E. et al. stated that laboratory test results are of vital importance in the follow-up of the diagnosis and treatment of the patient, in making decisions to be made in hospitalization, discharge and drug initiation, and that the most important factors affecting the correct and timely performance of diagnostic tests are that blood samples should be taken by trained people in accordance with good practice standards and appropriate materials should be used during this time, For this reason, laboratory processes in order to diagnose patients in a timely and accurate manner It should be carried out correctly and effectively, as well as nurses related to taking blood samples in the preanalytical period. They stated that the state of information should be examined. With various questions, it was mentioned that the work done caused material and moral conditions to the patient. The importance of training given to nurses for the improvement of processes was mentioned. All of the 282 nurses who participated in the study were working in the inpatient clinic once a year. It was reported that they received "Blood Sampling Training" in in-service trainings, 46.1% of the participants said that the tubes When the answers of the nurses to the question "What is the cause of the confusion in the tube order?" were evaluated: 51% stated that there was a lack of information, 34.3% stated that the workload was not important, 6.1% stated that the order of the tubes was not important, 2.9% stated that carelessness and the examination that should be looked at as essential were given priority, 1.7% stated that taking blood into too many tubes caused confusion, 1.1% stated the reasons such as habit. At the end of the study, it was seen that the level of knowledge of nurses about preanalytical blood sampling was partially sufficient (46.1%), it was stated that it was seen that the tube sequencing was not paid attention to due to lack of information (51%), and the most important reason for sample rejection was insufficient sample (53.6%), and it was stated that patient safety and health system results would be further improved by increasing in-service trainings (1). Aykal et al. mentioned the clinical importance of laboratory test results in their studies. Approximately 60-70% of the errors related to the results are mentioned in the presence of preanalytical errors in venous blood collection The steps of the preanalytical stage were examined. The GP41-A6 guideline published by the Clinical Laboratory Standards Institute (CLSI) in 2007 and the blood collection guideline published by the World Health Organization (WHO) in 2010 on phlebotomy, which is defined as the blood collection process, are international It has been stated that they are considered as a source in the study as the most accepted documents on the platform. Antalya Training and Research Hospital and 5 hospitals by the Turkish Biochemistry Society Preanalytical Phase Working Group In the study carried out, the personnel who took blood in the blood collection units were surveyed by non-participant observation method. application and compliance with the CLSI GP41-A6 guideline was evaluated. It has been stated that venous blood collection is one of the important steps of the preanalytical stage and the most frequently performed interventional procedure in health services, consisting of different steps and each step is open to potential errors in terms of patient safety. Observational Questionnaire of Compliance with CLSI EP 41-A6 Guideline 1. Didn't the sampler prepare all their materials before the purchase? (Is the equipment enough?) 2. Did the sampler check the expiration date of all the material he used? 3. Does the person taking the sample do identification? 4. The sampler should put his hands on the procedure Did it disinfect? 5. Did the specimen inquire about the patient's preparation before the procedure? 6. Is the blood collection chair suitable for this procedure ? 7. If the patient is lying down, is the arm given the appropriate position? 8. Did the sampler fasten the tourniquet four fingers wide (10 cm) above the area where the blood was drawn ? 9. The person taking the sample has proper blood collection 10.Did the specimen wear a clean pair of gloves on each patient? By asking questions such as, in venous blood collection; It was stated that the expiry date, patient identification and sample labeling steps of the material used were defined as red zones. The pre-analytical phase working groupconcluded their study: "A review of current practices related to blood collection and important steps Adaptation and use of the CLSI 41-A6 guideline in EU countries that do not have a national blood collection guideline, the need for national societies to develop basic and continuing education programs There is a "competency certificate application". There are very few and insufficient studies on workplace trends and health worker compliance with venous blood collection practice guidelines, and it is planned to standardize the training and practices of blood collection workers in future studies, and for this purpose, national blood collection certification programs should be established and with in-service training and controls. By monitoring the process, it has been determined that the CLSI GP41-A6 guideline (CLSI 2007) and the venous blood collection guideline published by WHO will help to improve the processes (2). Hacı Kemal Erdemli et al. found that various tests were affected by additional substances placed in blood collection tubes. Tests in trademarks that cause interference in tests studied with various methods, different tubes Adequate validation studies on which tests can be used for tubes affected by additives It has been stated that it has not been done. The tests requested in the study were performed by taking blood from at least 3 serum tubes By controlling preanalytical conditions, Vacutest REF11030 (Group A), Becton Dickinson (BD) Vacutainer CAT Validation with REF367896 (Group B) and BD Vacutainer SST TM II Advance REF367953 (jelli) (Group C) tubes Measurement interference was tried to be determined by conducting a study. It has been stated that blood collection tubes cause interference in the tests measured in mmunassay methods, especially due to the various chemicals contained in different brands of tubes in production (3). Özbolat G. et al. talked about what heavy metals are and their toxic effects. The classification of heavy metals as vital (essential) and non-essential (non-essential) according to their degree of influence on biological processes is found in the components of vitamins and hormones that play a role as a co-factor in an enzymatic reaction, which must be present in a certain concentration in the organism structure, In addition, they act toxically after a certain concentration (1-10 ppm: part per million) (Fe, Cu, Zn, Ni and Se). On the other hand, it has been mentioned that non-vital heavy metals (Hg, Cd and Pb) have a toxic effect from their initial concentrations and can cause health problems by affecting the psychological structure even at very low concentrations, and they can be toxic even at very low concentrations such as Hg and Cd 0.001-0.1 ppm. The general properties of some of the heavy metals are mentioned. Mercury (Hg) is widely used in modern technology, especially as a catalyst in the production of plastics, in various measurement and control devices (barometer, thermometer), as a filling material in the electrical and cement industry, mining, cellulose production, paint and paper industry and dental treatments, The toxicity of mercury varies depending on its chemical form, its toxicity and the organs it affects, In the definitive diagnosis of mercury exposure, it is frequently used and its validity has been proven. methods of measurement of urine and blood levels are used. It has been mentioned that it is recommended to evaluate the values in blood and urine (24-hour) levels together in determining the Hg contact of a person. Lead (Pb) is widely found in organic and inorganic form industrially, its toxicity and the organs it affects, There are a number of methods used to determine lead exposure The quantitative amount of lead found in blood samples is most commonly made using atomic absorption spectrophotometer (AAS) Apart from this, it has been mentioned that Anodic Stripping Voltameter (ASV) and Inductively Coupled Plasma Mass Spectrometry (ICP-MS) are also used. Copper (Cu) is one of the essential micronutrients abundant in various rocks and minerals, it is used in the electrical and paint industry, in the production of plumbing pipes, copper salts have a wide range of uses as anthelmintics in veterinary medicine, as fungicides in agriculture, and high-sensitivity analytical techniques are needed for the quantitative determination of copper in its toxicity and affected organs. Atomic Absorption Spectrophotometer (AAS), Inductively Coupled Plasma Atomic Emission Release (ICP-AES), Inductively Coupled Plasma Mass Spectrophotometer (ICP-MS) and voltammetric methods are used, but it is mentioned that the articles made with AAS are the most. Arsenic (As), arsenic compounds are classified as inorganic and organic, arsenic compounds without carbon bonds are defined as inorganic arsenics, while arsenic compounds with carbon bonds in their structure are also known as organic arsenics Inorganic arsenic types are arsenate and arsenide, and some of the organic types are methylated types of monomethyl arsenic acid and dimethyl arsinic acid Arsenide, arsenate, monomethyl arsonic acid (MMA) and dimethyl arsinic acid (DMA) are the types of arsenic found in waters, the toxicity of arsenic is due to its dependence on its chemical structure and generally soluble inorganic arsenic types are more toxic than organic arsenic types (such as MMA and DMA), and the organs it affects. In general, the toxic effects of heavy metals vary according to the properties of each metal. However, in general, all of them affect more than one organ and system. Toxic heavy metals; It damages nerves and bones, blocks the functions of important enzyme groups and causes cancer. While; As a result of studies conducted on subjects, it has been stated that behavioral disorders due to mental and neurological effects, neurotransmitter production and irregularities in their function have been observed in people exposed to heavy metals. [4]. CLSI EP15A2 User Verification Of Performance For Precision And Trueness; Approved Guideline [5] CLSI EP15A3 User Verification of Precision and Estimation of Bias, [6] IFCC International Federation of Clinical Chemistry and Laboratory Medicine [7] College of American Pathologists (CAP) [8] ISO 15189:2012. Medical laboratories – Requirements for quality and competence. [9] Westgard JO. Basic method validation, 3. baskı, Madison, 2008. [10] The Clinical and Laboratory Standards Institute (CLSI), [11]