Heavy Metals and Toxicology Collections

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Course Objectives
  1. Discuss the importance of heavy metal and toxicology testing and collections
  2. Recognize contamination sources and potential errors as well as to provide guidance on best safety practices for phlebotomists
  3. Explain the importance of chain of custody, documentation, handling and transportation of specimens
  4. Evaluate potential workplace scenarios

Course Content
Course Creator: Nichelle Volker RMA
Total CE Hours: 1 Credit Hour 
Pace Course #: 586-2418-25

Key Terms:
  • Heavy Metals
  • Toxicology
  • Specimen Integrity
  • Chain of Custody
  • Trace element-free tube
  • Contamination
  • Hemolysis
  • Stability
  • Chelation therapy
  • CLIA
  • HIPAA
  • OSHA

Outline:
  • Introduction
    • Why the special focus
    •  Heavy metals
    •  Toxicology
  • Heavy Metal Testing
    • Specimen Types
      • Blood collection
      •  Urine collection
      •  Hair collection
    •  Lead poisoning
    •  Arsenic poisoning
    •  Mercury poisoning
    •  Cadmium poisoning 
      • Scenario: Suspected Arsenic exposure
    •  Common errors and best practices
  • Toxicology testing
    • Specimen types
    •  Clinical toxicology uses
    •  Forensic toxicology uses
    •  Blood collection
    •  Urine collection
    •  Hair collection
      •  Scenario: Preemployment toxicology screening
    •  Common errors and best practices
  • Preventing Contamination
    • Sources
    •  Best practices
    •  Equipment considerations
    •  Handling pediatric samples
      •  Scenario: Contamination risk in heavy metals collection 
  • Handling and Transport
    • Transport conditions
    •  Stability concerns
    •  Packing shipments
      •  Scenario: Specimen Transport error
  • Chain of custody and documentation
    • CoC basics
    •  Labeling requirements
    •  Specimen sealing
    •  Documentation/forms
    •  Common errors and best practices 
      • Scenario: CoCo in forensic toxicology
  • Phlebotomist Role in Patient Interaction
    • Patient prep
    •  Informed collection process
    •  Pediatric lead screening
    •  Communicating limitations
      •  Scenario: Pediatric lead screening
  • Safety and Compliance
    • Phlebotomist safety
    •  HIPAA considerations
    •  Compliance 
      • HIPAA
      •  OSHA
      •  CLIA
    • Scenario: Toxicology screen in the ED
  • Closing thoughts

 
References: 
  1. Professional, C. C. M. (2025, May 13). Heavy Metal test. Cleveland Clinic. https://my.clevelandclinic.org/health/diagnostics/22797-heavy-metal-test
  2. Professional, C. C. M. (2025b, June 5). Drug test. Cleveland Clinic. https://my.clevelandclinic.org/health/diagnostics/10285-drug-testing
  3. 042580: Heavy Metals Profile I, Whole blood. (n.d.). Labcorp. https://www.labcorp.com/tests/042580/heavy-metals-profile-i-whole-blood?query=trace%20metal%20testing
  4. 250281: Heavy Metals Profile II, Urine. (n.d.). Labcorp. https://www.labcorp.com/tests/250281/heavy-metals-profile-ii-urine
  5. Arsenic poisoning. (2025b, August 26). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/24727-arsenic-poisoning
  6. Accurate hair follicle drug testing: Processes & benefits. (n.d.). Labcorp. https://www.labcorp.com/organizations/capabilities/employee-testing-wellness/pre-employment-drug-testing/hair-drug-testing
  7. Lead poisoning - Symptoms & causes - Mayo Clinic. (2022, January 21). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/lead-poisoning/symptoms-causes/syc-20354717
  8. Mercury poisoning. (2025, June 2). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/23420-mercury-poisoning
  9. Heavy Metal Poisoning (Toxicity). (2025, July 3). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/23424-heavy-metal-poisoning-toxicity
  10. 700902: Drug Screen 16 with Reflex Confirmation (AMP,BAR,BZO,COC,PCP,THC,OPI,OXY,MD,FEN,BUP,PPX,MEP,TRAM,GABA,CAR), Whole blood. (n.d.). Labcorp. https://www.labcorp.com/tests/700902/drug-screen-16-with-reflex-confirmation-amp-bar-bzo-coc-pcp-thc-opi-oxy-md-fen-bup-ppx-mep-tram-gaba-car-whole-blood 
  11. 912081: Drug Screen 17 with reflex Confirmation (Pregnancy profile; ETG, AMP, BAR, BZO, COC, PCP, THC, 6AM, OPI, OXY, TAP, MD, FEN, BUP, PPX, TRAM, NIC), urine. (n.d.). Labcorp. https://www.labcorp.com/tests/912081/drug-screen-17-with-reflex-confirmation-pregnancy-profile-etg-amp-bar-bzo-coc-pcp-thc-6am-opi-oxy-tap-md-fen-bup-ppx-tram-nic-urine
  12. Office of the Deputy Director of Infectious Diseases. (n.d.). Specimen storage and shipping guidance. https://www.cdc.gov/laboratory/specimen-submission/pdf/Specimen-Packing-and-Shipping-Guidance-Infectious-Diseases-Laboratories.pdf
  13. Badiye, A., Kapoor, N., & Menezes, R. G. (2023, February 13). Chain of custody. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK551677
  14. United States Department of Labor. (2019, May 14). 1910.1030 - Bloodborne pathogens. Occupational Health and Safety Administration.https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030
  15. United States Department of Labor. (n.d.). Bloodborne Pathogens and Needlestick Prevention. https://www.osha.gov/bloodborne-pathogens
  16. Clinical Laboratory Improvement Amendments (CLIA) | CMS. (n.d.). https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA

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