26 Specimen (Lic MC)

Safety In the OR

main campus 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 (forensic specimens, oncologic breast specimens, muscle biopsies, prostate biopsies, etc.)
• Recognize standards for Type & Screen specimens in preparing a patient for possible blood product administration and scenarios which would require further action on the part of the nurse.

• 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 specimens for one patient (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

Specimen Handling Basics

• Per the Pneumatic Tube System SOP, do not send via the pneumatic tube system:
• Specimens for Anatomic Pathology
• Any specimens in a syringe with the needle still attached

Labels and Requisitions

• In eStar/Epic, place separate orders:
• For specimens going to different places (Anatomical Pathology and Clinical Pathology), or
• For specimens that need to go to the lab at different times (routine specimens and frozen specimens)The circulator creates the label
• Do not sign an order until you are ready to send the specimen(s) listed in the order to the destination lab
• 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.

Click here to view the Specimen Labeling/Requisition Comparison Table

Special Situations

• Oncology breast specimens must be delivered within 30 minutes of removal and within certain timeframes for appropriate fixation and diagnostic analysis
• Before 5:30pm on Tuesday, Thursday, and Friday
• Before 7:30pm on Monday and Wednesday
• In eStar/Epic, answer "Yes" to oncologic breast specimen question to validate the timing instructions.

• If utilizing a specimen runner, emphasize the timing of delivery when handing off the specimen(s)

Special Situations

• Chain of custody: Forensic specimens must be desposited into the lock box in the Anatomic Pathology department and never be released directly to police
• Metal instruments should not be used to handle bullets or other metal forensic material
• 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

Type & Screen

• Per the Blood Product Administration policy, all patients must have two independent verifications of their blood type prior to the receipt of a crossmatched RBC unit
• If a patient arrives to the OR without a Type & Screen without a historical type & screen at the current VUMC campus, the collection of two separate Type & Screen specimens is required and must be from separate collections/times unless drawn from a central line

• Both positive patient identification (PPID) and the completion of the collection task within eStar/Epic must be completed with all blood bank specimens
• When electronic PPID is not possible, a dual sign-off requisition will automatically print to mapped printer (see the form in the steps below). This form is sent with the labeled specimen to the blood bank.
• The collector (anesthesia) must verify that the date on the lab ready label matches the date of collection documented in eStar; if these do not match, the collector must hand write the collection date on the label.

Step 2

Step 1

Type & Screen

• If electronic PPID is not performed and dual sign-off form is not completed appropriately, the sample will be rejected.
• If samples are drawn in the same draw (same time), one will be rejected. A second sample collection is still required per protocol.

In this section of the module, you will be presented scenarios to manage specimens appropriately using specimen handling principles already covered. The examples given may differ from your experience (type of specimen, naming convention, order of specimens, etc.).

ACKNOWLEDGE

Patient 1: Partial mastectomy with lymph node dissection

Mrs. Isabella Lesrois, a 20-year-old female, is diagnosed with stage IIA invasive ductal carcinoma in her left breast. After discussions with her surgical and oncology team, she elects to undergo a partial mastectomy (lumpectomy) with sentinel lymph node dissection to determine lymph node involvement and guide further treatment. Proper specimen management is critical to ensure accurate pathological evaluation, diagnosis, and treatment planning.

Next

Patient 1: Partial mastectomy with lymph node dissection

The surgeon announces the primary specimen that she calls "left partial mastectomy." You've collected the specimen, entered the order, and packaged the specimen for delivery to Anatomic Pathology.

Next

Patient 1: Partial mastectomy with lymph node dissection

Next

Also, the surgeon changed her mind about sending the specimen for culture in this case.

Patient 1: Partial mastectomy with lymph node dissection

Next

Patient 1: Partial mastectomy with lymph node dissection

Later in the case, the surgeon announces a frozen specimen but you could not quite make out the name.

Next

Patient 1: Partial mastectomy with lymph node dissection

Next

Patient 1: Partial mastectomy with lymph node dissection

The surgeon clarifies that the frozen specimen is "left axillary lymph node." Click the sterile field to collect the specimen.

Patient 1: Partial mastectomy with lymph node dissection

Next

Patient 1: Partial mastectomy with lymph node dissection

Next

Patient 1: Partial mastectomy with lymph node dissection

Next

Patient 1: Partial mastectomy with lymph node dissection

Next

Patient 1: Partial mastectomy with lymph node dissection

Next

Patient 1: Partial mastectomy with lymph node dissection

Let's get that order and requisition done then. Click the Clinical Workstation.

Patient 1: Partial mastectomy with lymph node dissection

Click "+ New" to open the Orders Preference List.

Patient 1: Partial mastectomy with lymph node dissection

"Intra-op Labs" is on the sidebar but it's also a section that starts in the middle of the dialogue box. For this order, select "Intra-OP Surgical Pathology."

Patient 1: Partial mastectomy with lymph node dissection

Click "Accept."

Patient 1: Partial mastectomy with lymph node dissection

The order was changed to STAT. The surgeon's name, specimen name, and special considerations response was added. Click the arrow to scroll down.

Patient 1: Partial mastectomy with lymph node dissection

Click "Diagnosis" as the Exam for this frozen specimen.

Patient 1: Partial mastectomy with lymph node dissection

Next

The phone number has been entered for you.

Patient 1: Partial mastectomy with lymph node dissection

In this case, the surgeon does want the Sentinel Lymph Node Protocol and it is now selected for you. Click the arrow to scroll down.

Patient 1: Partial mastectomy with lymph node dissection

The collection date and time have been entered for you. Click "Accept" and then complete submission of the order.

Patient 1: Partial mastectomy with lymph node dissection

Click "Sign."

Patient 1: Partial mastectomy with lymph node dissection

The surgeon's name has been entered for you.

Patient 1: Partial mastectomy with lymph node dissection

The requisition printed, and you verified the information is correct.

Next

Patient 1: Partial mastectomy with lymph node dissection

Go to Pathology

Patient 1: Partial mastectomy with lymph node dissection

Deliver the specimen!

Patient 1: Partial mastectomy with lymph node dissection

Next

Patient 1: Partial mastectomy with lymph node dissection

Click to stamp the requisition.

Patient 1: Partial mastectomy with lymph node dissection

Now, ring the doorbell.

Patient 1: Partial mastectomy with lymph node dissection

The tech came to the desk. You communicated that you are delivering a frozen specimen, and he accepted the specimen to begin processing.

Back to the OR

Patient 1: Partial mastectomy with lymph node dissection

When you return, the surgeon has obtained a specimen for cytology.

Next

Patient 1: Partial mastectomy with lymph node dissection

Next

Patient 1: Partial mastectomy with lymph node dissection

Next

Now, let's go to the next case.

Patient 2: Prostate Biopsy

Mr. Terrance Tiradentes, a 65-year-old male, has elevated PSA levels (6.9 ng/mL) which was noted during routine screening, abnormal digital rectal exam (DRE). Terrance has no prior history of prostate biopsies. Dr. Rebecca Reborn will be performing a transrectal ultrasound-guided prostate biopsy and plans on gathering core samples from various zones of the prostate to send to pathology. Remember, specimen management is a critical component of the biopsy process, as any errors in handling, labeling, or transporting specimens could compromise diagnostic accuracy and patient safety.

Next

Patient 2: Prostate Biopsy

For this case, you want to start collecting specimens from the sterile field. Click the back table to view the collected specimens.

Patient 2: Prostate Biopsy

Right base was the first specimen the surgeon obtained from the patient. Click "R base" to zoom in on this specimen.

Patient 2: Prostate Biopsy

Collect

Patient 2: Prostate Biopsy

Label is created, and the two-person verification is done. This specimen is placed directly into formalin.

Next

Patient 2: Prostate Biopsy

Let's start charting the specimens.

Patient 2: Prostate Biopsy

Click "+ New" to open the Orders Preference List.

Let's start charting specimens.

Patient 2: Prostate Biopsy

Next

Let's start charting specimens.

Patient 2: Prostate Biopsy

Click "Prostate Biopsy" and then "Accept"

Let's start charting specimens.

Patient 2: Prostate Biopsy

Click "Accept"

Let's start charting specimens.

Patient 2: Prostate Biopsy

The surgeon and the specimen number for "Right Base" have been entered for you.

Click the arrow to scroll down.

Let's start charting specimens.

Patient 2: Prostate Biopsy

Later in the case, if you get a "region of interest," you will enter the name and specimen number in the field here. If you need to leave the Orders function and come back later, click "Accept" and then "Save Work."

Let's start charting specimens.

Patient 2: Prostate Biopsy

Let's start charting specimens.

Patient 2: Prostate Biopsy

Click "Not Ready" and then "Save Work."

Let's start charting specimens.

Patient 2: Prostate Biopsy

Let's start charting specimens.

Patient 2: Prostate Biopsy

This order will be here when we are ready to complete it.

Next

Let's start charting specimens.

Patient 2: Prostate Biopsy

Next

Let's jump into the next case.

Patient 3: Muscle Biopsy

Ms. Sarah Johnson, a 32-year-old female, has had progressive muscle weakness over the past year, difficulty climbing stairs and standing from a seated position, elevated creatine kinase (CK) levels, and abnormal electromyography (EMG) findings. Dr. Kendrick will be performing an open muscle biopsy of the left quadriceps muscle for suspected inflammatory myopathy (e.g., polymyositis or dermatomyositis).

Next

Patient 3: Muscle Biopsy

Click the back table.

Patient 3: Muscle Biopsy

Next

Patient 3: Muscle Biopsy

Next

Patient 3: Muscle Biopsy

Next

Now, we will go right into the next case.

Patient 4: Liver resection

Mr. Mark Thompson, a 67-year-old male, has diagnosed with hepatocellular carcinoma (HCC) involving segments IV and VIII of the liver. Mark has underlying cirrhosis secondary to hepatitis B and elevated alpha-fetoprotein (AFP) levels. Imaging studies confirmed the tumor is resectable, with no evidence of vascular invasion or distant metastases. Due to his clinical history, Dr. Knox is electing to perform a partial liver resection (right hepatic lobectomy).

Next

Patient 4: Liver resection

Setting up for this case, the team realizes that no collections were sent for Type & Screen on this patient. They have no historical Type & Screen on file.

Next

Patient 4: Liver resection

Next

Patient 4: Liver resection

Next

Patient 4: Liver resection

Next

All Scenarios Finished

Next

Course Complete!

Resources

It is not ideal or preferable to use uncrossmatched blood if the Type & Screen can be performed for this patient. The other statements are TRUE.

Always stamp the requisition. Then ring the doorbell provided and wait for someone to whom you can pass on the frozen specimen.

This specimen is not ready because the second clinical staff member has not signed off on the form.

For this case, you should select the "Prostate Biopsy" order.

Specimens for culture, frozen specimens, and muscle biopsies should never be exposed to formalin. Only oncologic biopsies need to be placed in formalin.

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

Only collect the specimen from the scrub person after a two-person verification of the specimen label.

Since this specimen is a lymph node, you should ask the surgeon if it needs to be sent for Sentinel Lymph Node Protocol.

You can complete the dual-sign off PPID form for one sample, but the second one cannot be sent because it was collected at the same time.

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.

The specimen label just verified with the scrub person should be applied to the specimen container immediately after collecting it from the scrub person. The only exception to this is when you have the specimen label applied to a container in which the scrub person will place the specimen.

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.

These tests need to be sent with a unique specimen. Inform the surgeon so she can come up with a solution rather than than altering the specimen yourself or leaving it as is.

What's wrong?

In this photo, the tubes have a printed label which show the same collection times. The collector has also indicated what time the sample was drawn. If no time was written, it would appear as if both samples were drawn at 2:10 PM. With the times written, it appears as if both samples were drawn at 2:20 PM. Since both samples seem to have been drawn at the same time, the Blood Bank will reject one of them because a second collection is required.

Clarify the specimen name with the surgeon if there is any uncertainty about it.

Muscle biopsies need no additional preparation. They are to be sent fresh with no additives to Anatomic Pathology.

This question is asking for the INCORRECT action. Specimens for other patients should not be in the room, and specimens for only one patient are to placed in a single bag.

If the patient information is incorrect on the specimen label you show the scrub person, do not collect the specimen from the scrub person before fixing the label and verifying with the scrub person.

If you have pre-printed labels, you will have to write the specimen name on a blank label because these are one-offs that are not part of the standard biopsy pattern. Only the eStar/Epic order shows the specimen number; the specimen containers do not need to be numbered.

Pre-printed labels may be available for standard specimen naming (but containers should NOT be pre-labeled). The two-person verification must be done immediately before accepting the specimen into the labeled formalin cup.

All of these require a printed requisition except Clinical Pathology.

Communicating the urgency of the delivery of this specimen is the priority in handle this specimen.