Specimen Handling in Pathology

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Questions and Answers

Which type of specimen is typically exempt from preservation in formalin?

Frozen section tissue

Muscle tissue

Teeth (correct)

Liver tissue

What information is essential to label on a specimen container?

Date of surgery

Type of surgical procedure

Patient's identification number (correct)

Surgeon's hospital ID

How should specimens be transported to the lab?

In a plastic bag or additional container (correct)

Accompanied by a surgeon's notes

With no identification forms

In an open container without a bag

Which of the following is NOT a basic component of a pathology requisition form?

Staff member's contact details Signup and view all the answers

What should be done after handling a specimen to prevent contamination?

Wash hands thoroughly Signup and view all the answers

What is the primary purpose of specimen collection in a clinical setting?

To provide potential legal or forensic evidence Signup and view all the answers

Which of the following specimen types is specifically collected to assess the presence of microorganisms?

Culture Signup and view all the answers

Which method involves removing a part of a lump while preserving the surrounding tissue?

Incisional biopsy Signup and view all the answers

What is a requirement regarding specimens removed from patients?

They must be sent to the pathology department for documentation Signup and view all the answers

What document governs the care of specimens in a hospital setting?

The Joint Commission regulations Signup and view all the answers

During which phase is immediate intraoperative assessment typically conducted?

During specimen collection Signup and view all the answers

What type of biopsy uses a thin, hollow needle to extract tissue samples?

Core needle biopsy Signup and view all the answers

What characteristic distinguishes an anaerobic culture from an aerobic one?

Prohibition of oxygen in the specimen container Signup and view all the answers

What is the recommended solution for preserving pathologic tissue specimens until processed?

10% formalin Signup and view all the answers

Why is it crucial to handle specimens minimally?

To reduce contamination risk Signup and view all the answers

When collecting cord blood, what is the optimal time frame for initiation after birth?

Within 10 minutes Signup and view all the answers

How should muscle biopsy specimens be stored to prevent artifacts?

In saline-moistened gauze Signup and view all the answers

What should be labeled on a radioactive specimen container?

'Caution Radioactive Material', type of radioisotope, and date administered Signup and view all the answers

What should be done immediately after removing gloves used for specimen handling?

Wash hands thoroughly Signup and view all the answers

Which practice is essential when transporting cultures to avoid drying?

Send to the lab immediately Signup and view all the answers

What must always be included on a pathology requisition form for frozen section specimens?

Operating room intercom number Signup and view all the answers

In which container should the placenta be stored if needed for further analysis?

Biohazard bag Signup and view all the answers

What is a critical requirement when collecting specimens from foreign bodies with legal significance?

Enforce chain of custody Signup and view all the answers

When taking an anaerobic culture, what should be checked before transporting the specimen?

Color of the solution in the tube Signup and view all the answers

What aspect should never be allowed for pathologic tissue specimens?

To dry out Signup and view all the answers

What is the primary reason for prompt transportation of aerobic cultures to the lab?

To ensure proper processing Signup and view all the answers

What should be done with hard objects when handling surgical specimens?

Handle by hand to prevent alteration. Signup and view all the answers

How should stones or teeth be prepared for laboratory examination?

Place in a dry container and label. Signup and view all the answers

What is the proper way to handle an amputated limb for disposal?

Wrap it in plastic and store in the lab refrigerator. Signup and view all the answers

What is the correct procedure for receiving a pathologic specimen on the sterile field?

Use a sterile basin or glass to receive the specimen. Signup and view all the answers

Which method should be used to retain optimal integrity for a moist specimen?

Place a small amount of sterile saline on it. Signup and view all the answers

What should be documented when transferring a specimen?

Recipient of the specimen and time of transfer. Signup and view all the answers

How should small specimens like needle biopsies be handled?

Keep them in the specimen basin until all tissue is removed. Signup and view all the answers

Which type of containers can be used for storing surgical specimens?

Plastic, glass, or waxed cardboard containers. Signup and view all the answers

What action should be taken if the outside of a specimen container is contaminated?

Wipe it with a tuberculocidal disinfectant. Signup and view all the answers

What is the purpose of marking the borders or margins of specimens with sutures?

To ensure proper identification by the pathologist. Signup and view all the answers

When should a consent form be verified regarding an amputated limb?

Before disposal of the limb. Signup and view all the answers

What should be done if multiple specimens are received during a procedure?

Ensure several containers are available to avoid mislabeling. Signup and view all the answers

What is required before handing off a specimen from the sterile field?

Validate correct identification. Signup and view all the answers

What must be removed from a specimen before sending it to the lab?

Contaminated instruments, sponges, or needles. Signup and view all the answers

Study Notes

Specimen Handling Objectives

Primary Objectives: To comprehend the completion of pathology requisition forms for specimens, along with the safe transfer and reception of specimens in sterile environments.

Specimen Handling Terminology

Culture: Cultures are used to grow microorganisms for identification and testing.
- Aerobic: Oxygen-rich environment in the culture container.
- Anaerobic: Oxygen-free environment in the culture container.
- Sensitivity: Tests to determine the effectiveness of various medications in inhibiting specific microorganisms.
Fixative: Chemical solutions that preserve and stabilize tissue structures for microscopic examination.
Formalin: A common fixative made from a 10% aqueous solution of formaldehyde.
Frozen Section: Frozen tissue sections are used for rapid, intraoperative diagnosis.
Pathology: The study of diseases and causes of death, typically examining tissue and fluid samples.
Smear: A thin, spread layer of cells on a slide for microscopic examination.
Specimen: Any sample of tissue, fluid, or foreign object taken from a patient for examination.

Purposes of Specimen Collection

Preservation:
- Short-term or long-term storage of body fluids, waste, tissues, organs, limbs, or foreign objects.
- Potential legal or forensic evidence for trauma patients.
Examination:
- Preoperative diagnostics to confirm the need for surgery.
- Immediate intraoperative assessment to guide surgical procedures.
- Routine postoperative examination.
Identification and Documentation:
- Documentation of items surgically removed as per hospital policy.

Types of Specimens

Blood, fluids, and washings: Samples of blood, bodily fluids, and fluid recovered from body cavities.
Bone: Samples of bone tissue.
Culture: As described previously, cultures are used to identify and test microorganisms.
Product of Conception: This type pertains to specimens of tissue associated with pregnancy, including embryos or fetuses.
Foreign Objects: Any object not naturally found within the body, such as fragments of instruments, bullets, or glass.
Frozen Section: Rapidly frozen tissue sections for immediate microscopic examination.
Implantables: Materials implanted into the body, such as artificial joints or pacemakers.
Amputated limbs: Complete or partial removal of limbs.
Forensic Material and Legal Evidence: Tissue, fluids, or foreign objects collected for legal investigations.
Old Scars: Tissue samples collected from previous surgical scars.
Organs: Complete or partial removal of organs for examination.
Cytologic Smears: Thin layers of cells spread on a slide for microscopic examination.
Stones: Samples of calculi (stones) found in the body, such as kidney or bladder stones.
Teeth: Teeth removed during surgical procedures.
Fresh Tissue: Fresh tissue samples, not preserved with fixatives, intended for special studies.
Tissue Bank: Specialized facilities that store and distribute tissue samples for research or transplantation.

Methods of Obtaining Specimens

Excisional Biopsy: Complete removal of a lesion, including surrounding normal tissue.
Incisional Biopsy: Removal of a portion of a lesion for examination.
Needle Aspiration Biopsy: Cells are collected using a thin needle.
Core Needle Biopsy: A hollow needle is used to remove a small cylindrical core of tissue.

General Specimen Care Guidelines

All removed tissues, exudates, and foreign objects are sent to pathology for documentation.
Proper care of each specimen is the responsibility of the surgical team, especially the surgical technologist.
Specimen handling is guided by hospital policy and The Joint Commission regulations.
Preservation and correct identification of surgical specimens are critical.
Handling of specimens should be minimized.
Specimens should be protected from drying out. Saline or 10% formalin is used as preservation solutions, but not on stones or teeth.

Special Considerations for Specimen Handling

Cord Blood:
- Collected from the umbilical cord either before or after delivery.
- Collected using a closed or semi-closed system through the umbilical vein under aseptic conditions.
- Collection is typically more successful within 10 minutes after birth.
- The collection container should be labeled with the product, source, destination, donor, and storage conditions.
Muscle Biopsy:
- Used for diagnosing muscle disorders.
- Kept cool and stored in saline-moistened gauze for several hours.
- Avoid immersing the specimen in saline, fixatives, or other liquids.
- Rapid freezing should be used to prevent freezing artifacts.
Placenta:
- A source of stem cells.
- May be stored in a cryopreservation bag for further analysis.
- Often placed in a biohazard bag and treated as medical waste.
- Some hospitals retain the placenta for a period of time in case it needs to be sent to pathology for further analysis.
Radioactive Material:
- Used for diagnostic studies and cancer treatments.
- Procured by the nuclear medicine department and often sent to pathology.
- Radioactive specimens emit radiation, which can damage normal cells.
- The specimen container is labeled “Caution Radioactive Material” with the type of radioisotope and date of administration.
- The primary concerns with radioactivity are determining medical risk and minimizing exposure.

Specimen Handling: Standard Precautions

Handle all specimens using standard precautions.
Place blood, body fluids, and tissues in containers to prevent leakage during transport.
Ensure the outside of the container is clean.
Use non-sterile gloves to disinfect the outside of cultures or specimen containers.
Avoid contaminating the outside of the container with blood or fluids.
Wash hands after removing gloves used for specimen handling.

Proper Care and Handling of Surgical Specimens

Cultures:
- General guidelines:
  - Send to the laboratory immediately to prevent drying.
  - Obtain under sterile conditions.
  - Always label the culture tube and complete the lab form with the specimen source.
- Anaerobic:
  - Check the color of the solution in the tube before taking the sample.
  - Replace the swab in the tube quickly to prevent air from entering.
- Aerobic:
  - Take smears and fluids to the lab for processing as soon as possible.
Frozen Sections:
- Fill out pathology requisition form completely.
- Include the operating room intercom number for the pathologist to report results.
- Alert the pathologist if the patient is under local anesthetic for reporting directly to the surgeon.
- Place the specimen in a labeled container without formalin.
- Deliver the specimen to a designated staff member in pathology.
Foreign Objects:
- Dispose of or preserve foreign bodies based on hospital policy and maintain records for legal reasons.
- Forensic materials—Foreign bodies may have legal significance and be claimed as evidence by law enforcement.
  - Enforce a chain of custody protocol for forensic evidence.
  - Do not leave these specimens unattended.
  - Follow hospital policy regarding who receives forensic evidence.
  - Handle hard objects by hand, not with instruments, to avoid altering them.
  - Place in a specimen container.
  - Use only paper or glass for packaging.
  - Fixative is not needed for metal or glass objects.
  - Record the recipient of the object and the time.
  - Document specimen transfers.
  - Always follow hospital policy.
Stones or Teeth:
- Place in a dry, labeled container.
- Send to the lab for gross examination before returning to the surgeon or patient.
Amputated Limbs:
- Verify that the patient has signed a consent form for limb disposal.
- Remove all drapes and instruments from the limb.
- Avoid placing the limb in view of the patient, especially if they received spinal or epidural anesthesia.
- Attach a patient label and pathology requisition form to the limb.
- Transport the limb to the lab.
- Never leave a limb on a specimen cart.
- Wrap amputated extremities in a plastic bag before storing in the lab refrigerator.
- Patients may request that the amputated extremity be sent to a mortuary for burial.

Procedures for Receiving a Pathologic Specimen

Receiving the Specimen:
- Make a sterile basin or medicine glass available.
- Never place a specimen on a sponge to prevent confusion with sponge counts.
- If the specimen is attached to a clamp, place it in a container, then remove the clamp.
- Ensure clamping doesn't crush small specimens, which can hinder identification.
- Specimens from endoscopic procedures may be retrieved in endobags.
Specimen Integrity:
- Moist: Place a small amount of sterile saline on the specimen to prevent drying.
- Dry: Do not apply saline to specimens intended for fresh tissue or frozen sections.
Intraoperative Handling:
- Minimize handling of tissue specimens.
- Surgeons may mark the specimen's edges with sutures (tags) for identification by the pathologist.
- If multiple specimens are expected, ensure sufficient containers are available.
- When receiving each specimen, the surgical technologist confirms the type, origin, side, or site with the surgeon.
- Exercise special care when receiving small specimens to prevent loss.
- Keep the specimen basin on the field until all tissue is removed.
- Keep the specimen on the sterile back table until the surgeon authorizes its transfer from the sterile field.
Specimen Labeling and Documentation:
- Note any anomalies, location, orientation, or surgeon's tags.
- Keep specimens separate.
- If unsure, ask the surgeon to identify the specimen.
- Place each specimen in a separate, labeled container.
Handing Off the Specimen:
- Hand off each specimen to the circulator one at a time to validate correct identification.
- Hand off the specimen from the field in a basin, on a Telfa™ pad, or on a towel.

Specimen Preparation and Labeling: Circulator Responsibilities

Specimen Container Selection:
- Specimens should be placed in specimen containers to ensure safety.
- Container types:
  - Sterile
  - Non-sterile
  - Procedure-specific
  - Cytological specimen collectors
  - Small specimens such as stones
- Choose a container large enough for easy removal and potential tissue enlargement in formalin.
Specimen Container Decontamination:
- Wipe the outside of contaminated containers with a tuberculocidal disinfectant.
- Decontaminate the exterior of containers touched by sterile team members.
- Remove all instruments, sponges, and/or needles from the specimen before sending it out of the room.
Specimen Preservation:
- Use formalin for most specimens, excluding stones, teeth, limbs, or tissue designated for cultures or frozen sections.
- Options:
  - Formalin
  - Saline
  - Dry
Specimen Container Labeling:
- Label each specimen separately.
- Label each container with patient name, ID number, specimen type, and date/time.
- Ensure label accuracy.
- Attach the appropriate patient label and pathology requisition form.
Specimen Transport and Processing:
- Place the closed, labeled container in a plastic bag or an additional container for transport.
- Accompany the specimen with a pathology requisition form specifying the required tests.
- Transfer directly to the lab or refrigerate non-critical specimens.
- Handle and transport with care.
- If diagnostic images are ordered, take the specimen directly to the imaging department.
Decontamination: Wash hands after handling specimens.
Pathology Requisition Form Components:
- Date and time
- Patient name and hospital number
- Surgeon
- Accurate specimen identification
- Preoperative and postoperative diagnoses
- Log number
- Precise test required

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Description

This quiz focuses on the objectives and terminology related to specimen handling in pathology. It covers important concepts such as culture types, fixatives, and the safe transfer of specimens. This knowledge is essential for anyone working in a laboratory or clinical setting.