Specimen Handling

Clinical Significance

In the surgical setting, specimen handling directly impacts patient safety and surgical outcomes. Relevant sterile field principles include:

• Sterile drapes are placed from the operative site outward (near to far)
• Moisture strikes through: wet drapes are contaminated, use impervious drapes and keep the field dry
• Edges of anything that encloses sterile contents are considered unsterile (1-inch border)
• Only sterile items may be placed on a sterile field
• Movement around the sterile field must not cause air currents, no reaching over the field, no turning back to the field

Step-by-Step Procedure

Procedural steps relevant to specimen handling in the surgical setting:

1. Initial count performed before incision: sponges, sharps, instruments, miscellaneous
2. Closing counts: first closing count (deep layers), second closing count (skin closure)
3. All counts are audible, visual, and concurrent (scrub tech and circulator together)
4. Sponges counted in groups of 5, radiopaque sponges only used on the field
5. Incorrect count protocol: notify surgeon then recount then wound search then X-ray if unresolved
6. Sharps counted on a needle counter/magnet, broken needles: account for all pieces
7. Add-on items must be counted when added and at subsequent count times

Safety Considerations

Maintaining safety during procedures involving specimen handling requires adherence to sterile technique:

• Sterile drapes are placed from the operative site outward (near to far)
• Movement around the sterile field must not cause air currents, no reaching over the field, no turning back to the field
• Sterile persons touch only sterile items; unsterile persons touch only unsterile items

Related Procedures

Related surgical procedures and specimen handling requirements:

• Frozen section: fresh specimen (no fixative) sent immediately to pathology for rapid diagnosis (15-20 min)
• Stones (renal, gallstones): send dry, no fixative, chemical analysis requires dry specimen
• Culture specimens: send in sterile container, anaerobic transport medium if indicated
• Formalin (10% buffered formaldehyde) is standard fixative for pathology specimens

Exam Focus Areas

On the Cst Surgical Tech, Medical Assistant exam(s), questions about specimen handling typically test:

1. Counting procedures and protocols for discrepancies
2. Sterile technique maintenance and contamination recognition
3. Instrument identification, function, and proper passing technique

Key Values & Ranges

Proper collection, identification, containment, and transfer of surgical/clinical specimens. Tested on CST and MA exams.

Related instrumentation: Babcock clamp (Grasping) for Atraumatic tissue grasping (bowel, fallopian tubes, ureters).