Transcript Care and Handling of Surgical Specimens

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
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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.
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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
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Specimen methods
Laboratory studies
Specimen responsibility
Specimen handling