Sampling conditions for biological fluids for trace elements monitoring in hospital patients: a critical approach

Lack of coherence in the results of trace element (TE) analyses produced by various laboratories has been such as to necessitate much needed technical improvements and more detailed control over sample preparations. For too long, except for a few praiseworthy researchers, the importance of sampling conditions has been underestimated as a source of erroneous TE results. Many of the precautionary procedures for previously studied TE collection materials have proven to be so cumbersome that they cannot be applied in a hospital setting. This report deals with sampling material and conditions from a workday standpoint; a rigorous description of the contaminating roles of ambient air and routine handling of specimens places emphasis on the practical. While some metals, including cobalt, copper, iron, and selenium, present no significant risk of contamination, others, such as aluminum, cadmium, chromium, manganese, and nickel, pose quite a significant risk. They warrant attention with respect not only to the sampling itself but also the selection of the material to be used. Drawing on our hospital experience, we propose a critical approach toward the collection of samples of biological fluids (blood, urine, dialysis fluids). Needles, catheters, tubes (open and evacuated systems), and anticoagulants on the market are likewise assessed in terms of their contaminative roles. For each one elementary rules as well as realistic choices of materials and methods for a hospital environment are proposed.