Specimen handling in the operating room

CARE OF SPECIMENS
Purposes of Specimen Collection
1. Preservation of a body fluid, body waste,
tissue, organ, limb or foreign object
• Dry or wet containment for short
-
or long
-
term
preservation
• Potential legal or forensic evidence in the case of
trauma patients
2. Examination of fluid, tissue, organ or
foreign object
• Pre
-
surgical diagnostic tests which may prove the
necessity of surgery
• Immediate intra
-
operative assessment, which
determines further surgical action
• Routine post
-
surgical exa
mination
3. Identification and documentation of those items
surgically removed, depending on hospital policy
Specimen
Any tissue, foreign body, prosthesis or fluid removed
from a patient
Types of specimens
1. Blood specimens
Examples: White blood count, bloodborne diseases
2. Bone
Examples: Femur, rib, lamina
3. Culture
a. Aerobic
b. Anaerobic
c. Sensitivity
a. Oxygen permitted in specimen container
b. Prohibition of oxygen in specimen container
c. Tests to
determine effective inhibition of undesirable
microorganisms with various medications
4. Fetus, aborted
Products of conception
5. Foreign objects
Examples: Metal, glass, debris
6. Frozen section
Specimens that need to be done immediately during
the
surgical procedure
7. Implantable
Examples: Screws, plates, prostheses
8. Limbs
Examples: Arm, leg, finger, toe
9. Old scars
Keloids
10. Organs
Examples: Gallbladder, appendix, liver
11. Pus or fluid drained from a joint, surrounding
structure or woun
d
Infected materials and fluids
12. Smears
Fluids that are spread on a glass slide for study
13. Stones
Examples: Kidney or gallbladder stones
14. Teeth
Decayed teeth, wisdom teeth
15. Tissue
Examples: Breast, fat, lymph nodes
Culture
A growth of
living material and microorganisms in a
prepared media
Frozen section
A piece of tissue or organ quickly frozen and then cut
into a thin slice and stained to be studied
microscopically
Smears
Material spread thinly on a slide or other surface for
microscopic study
Guidelines for Care and Handling
1. All tissues, exudates and foreign objects removed from a patient must be sent to the pathology
department for legal documentation.
2. Proper care of each specimen is the responsibility of the total nu
rsing team, and especially the surgical
technologist while the specimen is in his/her possession.
3. The care of specimens is regulated by hospital policy and rulings from the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO).
4. Preser
vation and identification of surgical specimens are crucial. The container housing the specimen will
be labeled with appropriate patient information. A pathology requisition form will also accompany the
specimen to the lab.
5. Handling of specimens should
be kept to a minimum.
6. Pathologic tissue specimens should not be allowed to dry out. Saline or a
solution of aqueous
formaldehyde (10% formalin) is used until processed in the
lab.
7. Never place formalin on stones or teeth.
Pathology
The study of disea
ses
Formalin
An aqueous solution of 37% formaldehyde with methanol added; commonly
used
as a preservative on specimens
Standard Precautions
1. Handle all specimens using standard precautions.
2. Place all specimens of blood, body fluids, and tissues in
a container to prevent leaking during transport to
the lab.
3. Ensure the outside of the container is clean.
4. Wear non
-
sterile gloves to disinfect the outside of the culture tube or specimen
container as it is handed
from the sterile field.
5. Avoid cont
amination of the outside of the container with blood or body fluids.
6. Always wash hands after removing gloves that have been worn to handle
specimens.
Proper Care and Handling
1. Cultures
• General guidelines
—
Send to the laboratory immediately before
cultures dry.
—
Obtain under sterile conditions. The tips of the swabs must not be
contaminated by any other source.
—
Always label the culture tube and complete the laboratory form including
the source
of the specimen
• Anaerobic
—
Always check the
color of the solution in the bottom of the tube when
taking an anaerobic culture. Discard if it is pink, because this means oxygen is
present in the tube. Exposure to room air can kill anaerobes in just a few
minutes.
—
Replace the swab in the tube as quic
kly as possible after taking an
anaerobic culture to prevent air from entering the culture tube.
• Aerobic
—
Take smears and fluids to the lab as soon as possible to be processed
correctly.
2. Frozen sections
• Fill out pathology requisition form as
completely as possible.
—
Include the operating room intercom number/phone number on the
specimen
card so the pathologist can report the results to the surgeon.
—
Alert the pathologist if the patient is under a local anesthetic so the report
can be shown t
o the surgeon rather than using the intercom, which could be