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
• Pre-surgical diagnostic tests which may prove the
necessity of surgery
• Immediate intra-operative assessment, which
determines further surgical action
• Routine post-surgical examination
2. Examination of fluid, tissue, organ or
foreign object
3. Identification and documentation of those items
surgically removed, depending on hospital policy
Specimen
1. Blood specimens
2. Bone
3. Culture
a. Aerobic
Any tissue, foreign body, prosthesis or fluid removed
from a patient
Types of specimens
Examples: White blood count, bloodborne diseases
Examples: Femur, rib, lamina
a. Oxygen permitted in specimen container
b. Anaerobic
b. Prohibition of oxygen in specimen container
c. Sensitivity
c. Tests to determine effective inhibition of undesirable
microorganisms with various medications
Products of conception
Examples: Metal, glass, debris
Specimens that need to be done immediately during
the surgical procedure
Examples: Screws, plates, prostheses
Examples: Arm, leg, finger, toe
Keloids
Examples: Gallbladder, appendix, liver
Infected materials and fluids
4. Fetus, aborted
5. Foreign objects
6. Frozen section
7. Implantable
8. Limbs
9. Old scars
10. Organs
11. Pus or fluid drained from a joint, surrounding
structure or wound
12. Smears
13. Stones
14. Teeth
15. Tissue
Culture
Frozen section
Smears
Fluids that are spread on a glass slide for study
Examples: Kidney or gallbladder stones
Decayed teeth, wisdom teeth
Examples: Breast, fat, lymph nodes
A growth of living material and microorganisms in a
prepared media
A piece of tissue or organ quickly frozen and then cut
into a thin slice and stained to be studied
microscopically
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 nursing 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. Preservation 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 diseases
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 contamination 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
— Send to the laboratory immediately before cultures dry.
• General guidelines
— 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 quickly 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 to the surgeon rather than using the intercom, which could be
3. Foreign objects
Fixative
4. Stones or teeth
5. Amputated limbs
1. Receive the specimen
heard by the patient.
• Place the specimen in a labeled container without formalin. It will be handcarried to the pathology department by a member of the OR staff
• Always give the specimen to a designated staff member in the pathology
department. Never just set it on the shelf or cart.
Dispose of or preserve foreign bodies according to hospital policy and keep a
record for legal reasons.
Forensic materials—Foreign bodies may have legal significance and may be
claimed as evidence by the police.
— Do not leave these specimens unattended at any time.
— Hospital policy will dictate who should be given forensic evidence, i.e.,
medical examiner or pathologist.
— Handle hard objects by hand, not with an instrument, since this might alter
the object.
— Place in specimen container.
- Use only paper or glass to package evidence. Plastic encourages any item
containing moisture to grow bacteria, degrading DNA evidence.
- Fixative is not needed for metal or glass objects, including bullets, knives and
bottle shards.
— Record on operative record the recipient of the object and the time.
— Document the specimen transfer tor the protection of hospital personnel.
Always follow hospital policy, which is written according to individual laws.
A substance used to harden and preserve specimens
• Place in dry container and label.
• Always send to the lab for gross examination prior to returning to the
surgeon or patient.
• Verify the patient has signed a consent form for disposal of the limb.
• Remove all drapes and instruments from the limb.
• Avoid placing an amputated limb in view of the patient, particularly if the
patient has received a spinal or epidural anesthetic.
• Attach patient label and pathology requisition form to the limb and take to
tab.
• Never leave an amputated limb lying on a specimen cart.
• Wrap amputated extremities in a plastic bag before storing in the lab
refrigerator.
• The patient may request that the amputated extremity be sent to a
mortuary for preservation for burial with his or her body after death. This
request must be noted on the pathology requisition form. Always follow the
hospital policy in regard to amputated limbs.
Receiving a Pathologic Specimen
• Make a sterile basin or medicine glass available to receive the specimen.
• Never put a specimen on a sponge, because this may confuse sponge count.
• If the specimen is attached to a clamp, place the specimen in a container,
then remove clamp. Place the container with the specimen on the sterile back
table. Always ask the surgeon how the specimen is to be labeled.
• Make certain that clamping does not crush small specimens, because this
makes tissue identification very difficult.
• Specimens from endoscopic procedures may be retrieved in endo-bags or
specimen retrieval bags. Remove the specimen from these plastic pouches
before sending the specimen to the laboratory.
2. Select method for
• Moist
retaining optimal specimen
Place a small amount of sterile saline on the specimen to keep it from drying
integrity
out. Keep specimens moist, but do not soak in the saline solution.
• Dry
Do not place saline on specimens to be sent for fresh tissue or frozen
sections.
3. Intra-operative handling
• Minimize handling of tissue specimens.
• Some surgeons will want to mark the borders or margins (edges) of
specimens with sutures known as "tags" for ease in identification by the
pathologist.
• If multiple specimens are expected, have several specimen containers
available to receive the specimens and to avoid possible mislabeling.
• Keep the specimen basin on the field until you are certain all tissue has
been removed or all contaminated items are in it.
4. Note anomalies, location, • Keep each specimen separate.
orientation or surgeon's
• If you are unsure, ask the surgeon to identify the specimen.
"tags" and reflect this
• Place each specimen in a separate container and properly label the type of
information when labeling
tissue and area or location of its removal.
5. Handing a specimen from • Hand off the specimen to the circulator one at a time for correct
the sterile field
identification. Be sure to clearly communicate the origin of the specimen.
• Hand a specimen from the field in a basin, on a wrapper, or on a towel.
Specimen Preparation and Labeling
1. Selection of a container— • Container types
Specimens should be placed Containers for storing specimens may be made of plastic, glass, or waxed
in a specimen container to
cardboard.
ensure safety.
—- Sterile
— Nonsterile
— Procedure-specific
— Cytological specimen collectors such as Lukens are used to hold secretions
as they are obtained.
— Small specimens such as stones
• Select a specimen container that is large enough for the specimen to be
easily removed in the laboratory, since tissues enlarge or swell in formalin.
• If the outside of the specimen container is contaminated with blood or body
fluids, wipe the container with a tuberculocidal disinfectant.
• Decontaminate the outside of specimen containers touched by sterile team
members before sending to the lab.
• Remove all instruments, sponges and/or needles from the specimen before
sending it out of the room.
2. Proper preservation of the Use formalin in most instances, with the
specimen
following exceptions: never place on stones, teeth, limbs, or tissue scheduled
for cultures or frozen sections
• Formalin
• Saline
• Dry
3. Labeling of a container
• Label each specimen separately.
• Label each container with the patient's name, identification number and
type of Specimen.
• Ensure label is accurate. Incorrectly labeled specimens can result in an error
in diagnosis, which may have critical implications for the patient or patients.
• Attach the appropriate patient name label and pathology requisition form
to the specimen container.
4. Transport and processing • Place the closed, labeled container in a plastic bag Of an additional
of specimen
container for transport to the lab.
• Ensure the specimen is accompanied by a pathology requisition form that
specifies the type of lab test requested by the surgeon.
• Transfer directly to the lab or refrigerate non-critical specimens.
• Handle and transport with care. The loss of a tissue or biopsy specimen
could result in additional surgical procedures to obtain another specimen
5. Decontamination
Wash hands after handling the specimen to avoid contamination
Pathology Requisition Form
1. Date
6. Specimen description
2. Patient name lid medical record number 7. Preoperative and postoperative diagnosis
3. Patient's date of birth, age, and sex
8. Log number
4. Surgeon
9. Requested lab study
5. Attending/admitting physician