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Care and Handling of Surgical Specimens Objectives • Define the types of surgical specimens. • Understand the Surgical Technologist’s role in caring for each type of specimen. • Discuss the methods of specimen preparation for laboratory studies. Specimens • Fluid, tissue, or foreign bodies may be removed from the body to determine nature or treatment of a disease or condition. • The STSR must be familiar with the proper care and handling of all surgical specimens. Specimen Methods • Needle aspiration • Incisional biopsy – Core biopsy – Cultures • Excisional biopsy Needle Aspiration • Fine needle and syringe are used to withdraw a fluid sample for laboratory testing. Incisional Biopsy • Lesion is incised and a portion is removed for study. Incisional Biopsy • Core or punch biopsies allow for removal of tissue sample with a minimal invasive technique. Incisional Biopsy • Special culture tubes are designed with cotton tipped swabs to study fluid in or around the lesion. Excisional Biopsy • The entire lesion or tumor is removed for study. Laboratory Studies • • • • Permanent/Fixed Fresh/Frozen section Culture and sensitivity Gram stain Permanent/Fixed • Tissue specimen is placed in an appropriate cup and a preservative such as formalin is added. – Kidney stones and fresh/frozen section specimens must never be placed in formalin. Permanent/Fixed • Permanent specimens are sent to the pathology department for routine studies. – Usually sent to pathology anytime after procedure is completed. Fresh/Frozen Section • Tissue specimen is placed in an appropriate cup without any preservative added. (as is) • Specimens are submitted to pathology intraoperatively as soon as they are obtained. Fresh/Frozen Section • Pathologist will freeze the tissue and slicing a very thin portion for microscopic examination. • Pathologist will then inform the surgeon of the findings. – Clear margins Culture and Sensitivity • Bacteriological studies performed on fluid/tissue obtained during a biopsy to identify the organism. • Aerobic • Anaerobic Gram Stain • Bacteriological studies performed on fluid/tissue obtained during a biopsy. • Sample is stained with crystal violet and iodine to identify the type of organism. – Gram Positive stain Blue – Gram Negative stain Pink Responsibility for Specimens • The STSR and the circulator are both ethically and legally responsible for proper handling of surgical specimens. • Proper labeling and handling are of the utmost importance. Responsibility for Specimens • Lost, mishandled, or mislabeled specimens could lead to: – Misdiagnosis – Unnecessary surgery – Unnecessary trauma or disfigurement Specimen Handling in the Sterile Field • Specimens will be obtained by the surgeon and passed to the STSR. • The STSR should be aware of the identity and origin of location of the specimen. – Ask the surgeon how the specimen is to be labeled. – Ask how the specimen is to be prepared. ? Specimen Handling in the Sterile Field • The STSR must have a appropriate container or area ready. – Specimen cup – Emesis basin – Telfa pad **Special considerations for contaminated specimens. Specimen Handling in the Sterile Field • Never use a counted sponge to store or transport a specimen. • Multiple specimens must be maintained in separate containers and labeled correctly. • Unless indicated, specimens should be kept moistened with saline solution. Specimen Handling in the Sterile Field • The surgeon may choose to orientate the specimen with special markings or sutures. • Example: – Left breast mass, short suture is superior, long suture is lateral. Passing the Specimen to the Circulator • Before passing any specimen off the sterile field ask permission from the surgeon. • Communicate to the circulator the type of specimen and how the specimen is to be prepared. Passing the Specimen to the Circulator • Remove the specimen without contaminating the sterile field. – Use a basin or instrument to pass to circulator. • The circulator uses standard precautions and PPE during the transfer. Passing the Specimen to the Circulator • The specimen is placed in the proper container and labeled appropriately. • If a permanent specimen, formalin is added to the container until the tissue is submerged. • If the outside of the container is contaminated with bioburden, it must be decontaminated before it is submitted to pathology. Review and Summary • • • • Specimen methods Laboratory studies Specimen responsibility Specimen handling