1ST DRAFT Spec Lic Amb

Safety In the OR

ambulatory Licensed Competency 2026

Specimen Handling

Objectives

• Recognize proper handling of specimens and containers, including the use of gloves, appropriate labeling to prevent misidentification, and appropriate packaging for delivery to the destination lab (label appearance, additional information needing to be written on label, and the need for a requisition)
• Define the roles of the surgical team (circulator, scrub person, and surgeon) in ensuring accurate specimen naming and patient identification (including the two-person verification process between the scrub person and circulator)
• Discuss special circumstances with specimens that would require additional steps or specific processing considerations (muscle biopsies, prostate biopsies, etc.)
• Identify common errors in specimen handling, labeling, and verification, and apply strategies to prevent such errors through attention to detail, adherence to protocols, and teamwork

Laboratory Techniques

Specimen Handling Basics

• Save all specimens.
• If you are unsure if tissue is a specimen, ask the surgeon!
• Each specimen bag must contain only one specimen per bag (never mixing specimens from multiple patients in a single bag).
• Each specimen container must hold only one specimen.

• Every individual specimen container or tube must have a label adhered to it (not loose in the bag) or it will be rejected.
• Do not pre-label containers or tubes.
• Label only one container or tube at a time.

• Always complete the Post-op Checklist with the surgeon
• Among the items you will review together, ensure all specimens collected in the case are listed

Specimen Handling Basics

• The circulator and scrub person are responsible for performing positive patient identification and labeling the specimen correctly according to the name the surgeon provides
• This is ALWAYS a two-person verification between the circulator and the scrub person:
• The circulator creates the label
• The scrub person validates the specimen name and the patient information against the Flightboard before passing to the circulator
• The circulator immediately affixes the specimen label

Labels and Requisitions

• In eStar/Epic, do not sign an order until you are ready to deliver the specimen(s) listed in the order to the destination lab/dropoff point
• If a Lab Ready Labels (LRL) is written on, the lab will have to replace the label and this will delay the tests up to 5 hours
• LRLs are used for Clinical Pathology and Cytopathology.

FEL

Click here to view the Specimen Labeling/Requisition Comparison Table

VHBM

VSCF

Add Wilson County Surgery Center?

Special Situations

• Muscle biopsies are sent fresh to Anatomic Pathology
• Do not add saline to the specimen cup
• Do not put it in formalin

Special Situations

• Prostate biopsies are ordered using the "Prostate Biopsy" order under the Orders Preference List
• Review the Prostate Biopsy Specimens Tip Sheet for detailed steps
• Use pre-printed labelswhere available forstandard specimennaming conventions
• Indicate the name of thespecimen as well as thespecimen number for"Region of Interest"specimens
• Place biopsies in formalin

Try Again

Clarify the name of the specimen with the surgeon if there is a discrepancy. Then, correct the specimen label and all other documentation.

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Interactive Question

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VHBM has a specimen lab on site. FEL delivers specimens to Anatomic Pathology on main campus. VSCF deposits specimens to a dropbox outside the facility.

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A two-person verification is required (and moving over the sterile field is not ok).

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All specimens except Clinical Pathology specimens (e.g., CBC, BMP, etc.) require a printed requisition.

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For some Anatomic Pathology specimens, other orders may be used (e.g. Prostate Biopsy).

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Numbering specimens only occurs in eStar/Epic but region of interest specimens need an additional name before it. On the physical specimen cup, a patient sticker is applied and only the specimen name is to be written.

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Completing the Post-op Checklist is when the nurse reviews information (including specimens, wound class, and procedures performed) with the surgeon.

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When testing occurs in different labs, there have to be separate specimens. It is appropriate to prompt the surgeon to send separate specimens if needed.

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Clarify with the surgeon on the specimen name as needed, and do not hand off the specimen until patient sticker and specimen name are correct on the label.

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Cultures and muscle biopsies are types of specimens that should never be introduced to formalin.

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References

[SOP] Handling of Surgical Specimens

[Policy] Submission of Surgical Specimens to Pathology

[Policy] Blood Product Administration

[VUMC2Go Tip Sheet] Collecting a Blood Bank Specimen - HR/PACU and Procedural Areas

[VUMC2Go Tip Sheet] Electronic Ordering of Labs

[Tip Sheet] Prostate Biopsy Specimens

Specimen Label & Requisition Comparison Table

Review: Will have to re-link due to PowerPolicy go-live after 10/27

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Course Complete!

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Specimens collected at VHBM are delivered to the on-site Specimen Lab and recorded in the log just inside

Not applicable for ambulatory sites.

Specimens collected at FEL are delivered to the adult inpatient Anatomic Pathology drop-off (3rd floor of the Vanderbilt University Hospital building) and recorded in the log at the window

Specimens collected at VSCF are placed in the drop box outsideThe leader must call the courier to retrieve the specimens

Ask the surgeon for the patient's clinical history

The specimen name for a Region of Interest is indicated where "xxx" is shown in the image.