26 Specimen (C/T MC)

Safety In the OR

main campus Certified/Tech 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.)
• 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 container must hold only one specimen.
• Do not pre-label containers or tubes.
• Label only one container or tube at a time.

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

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

• In cases where multiple small specimens are obtained, priorities for the scrub person are:
• To manage those specimens in such a way that they do not get mixed up
• To monitor the collection and report if no tissue was obtained
• Place biopsies in formalin

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.

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Patient 1: Partial mastectomy with lymph node dissection

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The surgeon announces the primary specimen that she calls "left partial mastectomy."

Patient 1: Partial mastectomy with lymph node dissection

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

Patient 1: Partial mastectomy with lymph node dissection

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Patient 1: Partial mastectomy with lymph node dissection

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

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Patient 1: Partial mastectomy with lymph node dissection

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Patient 1: Partial mastectomy with lymph node dissection

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

Patient 1: Partial mastectomy with lymph node dissection

You write the specimen name on the cup.

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Patient 1: Partial mastectomy with lymph node dissection

Click the label to inspect it closely and compare it to the Flightboard.

Patient 1: Partial mastectomy with lymph node dissection

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Patient 1: Partial mastectomy with lymph node dissection

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Patient 1: Partial mastectomy with lymph node dissection

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Now, let's go to the next case.

Patient 2: Prostate Biopsy

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Let's jump 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.

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Patient 2: Prostate Biopsy

For the next case, you are managing specimens on the field for a prostate biopsy. Click the back table to view the collected specimens.

Patient 2: Prostate Biopsy

You can click on "R base" to zoom in.

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On this case, you also want to alert the surgeon if no tissue was obtained from each attempt to biopsy.

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).

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Patient 3: Muscle Biopsy

Click the back table.

Patient 3: Muscle Biopsy

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Patient 3: Muscle Biopsy

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All Scenarios Finished

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Course Complete!

Resources

Different tests usually need separate specimens. While you may not know if a test is sent to a separate lab, you should ask about it so it is addressed.

Verify the patient information on the Flightboard to validate that the circulator is not mislabeling the specimen.

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

[Tip Sheet] Prostate Biopsy Specimens

ROI = Region of InterestThe surgeon will give a specific name. Write the full name!

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

Keeping track of specimens and completing the two-person verification are priorities in specimen management.

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

Only pass off a specimen if the label (both patient sticker and name of specimen) is correct.

Oncologic breast specimens must be delivered within 30 minutes to Pathology.