Introduction to the Operating Room
LESSON 3: Safety in the Operating Room
3-16
3-16. CARE OF TISSUE SPECIMENS AND FOREIGN BODIES
a. Handling of Specimens. A specimen is anything surgically removed from the patient. It may include bone, soft tissue, or foreign body. The improper handling of specimens may result in a mistaken diagnosis, a delay in treatment, or a second operative procedure, any of which may jeopardize the life of a patient. The circulator is responsible for the proper handling of the specimen. He should take the following measures:
(1) Label the specimen container properly, in accordance with local policy. The circulator must identify the specimen on all the proper forms. A gummed label is usually completed and placed on the specimen container. In addition, Standard
Form 515, "Medical Record--Tissue Examination," should be filled out in duplicate.
(2) Place the specimen in the appropriate container with the appropriate solution, usually a ten percent formaldehyde solution for routine specimens. However, the solution to be used is prescribed by the pathologist.
(3) Give special handling to those specimens requiring it. Always ask the OR nurse or the surgeon before placing a specimen in the routine solution. Examples of situations in which specimens may require special handling are as follows:
(a) Some specimens cannot go into the ten percent formaldehyde solution right away. Tissue for frozen section is one example. It is a specimen prepared for immediate diagnosis by quick-freezing, cutting a cell-thick layer, and viewing under the microscope. When the surgeon requests a frozen section which is usually indicated on the OR schedule, the specialist must be sure that the pathologists has been notified in advance, since the patient is on the OR table under anesthesia while the surgeon waits to hear if the tissue is malignant or benign. There cannot be undue delay! This specimen is placed in a moist towel or a Petri dish, never a sponge, by the scrub and handed to the circulator. He will give it to the designated person, probably someone from the laboratory. It is recorded immediately in the specimen log and signed for upon delivery. It must be delivered immediately to the pathologist. His results will be reported directly to the medical officer or nurse.
(b) Specimens of tissue to be examined for tuberculosis organisms are to be placed in saline solution. In addition, other specimens may be taken to the laboratory in saline solution when the surgeon wants the specimen examined immediately.
(c) When the specimen is a pap (Papanicolaou) smear (done in certain operative procedures to determine the presence of cancerous cells without having to excise tissue), glass slides with secretion from the suspected area are placed in solution of equal parts of ether and dehydrated alcohol (absolute alcohol).
(d) Specimens to be photographed are to be placed in saline solution or covered with a towel moistened with saline because formaldehyde solution discolors tissue.
(e) Some specimens are handled using sterile technique to avoid the possibility of introducing new bacteria. The pathologist's report and in turn the medical
officer's diagnosis may be affected if sterile technique was not observed by all personnel when handling the specimen and foreign bacteria were allowed to
contaminate it. Cultures are examples of specimens handled using sterile technique. A sterile member of the OR team uses two cotton tip applicators to swab the pus or fluid. When the material has been swabbed for culture, it is passed off to the circulator and should be placed in a culture tube and delivered to the laboratory as soon after being taken as possible.
b. Disposition of Foreign Bodies. Foreign bodies removed from a patient should be cared for according to local hospital policy. Such items may have legal significance outside the hospital; for example, police may desire a bullet that has been removed. The giving over of a foreign body to other than the appropriate hospital personnel is done only by the responsible medical officer.
