BIO 1030 - Specimens Study Guide

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Specimens Surgical Interventions Surgical interventions may involve removal of samples to assist with diagnosis of a disease process or to determine treatment of a condition. These samples may be bo ... dy fluids, tissue, or bone. With very few exceptions, any sample that is removed during a surgical procedure is sent to pathology for analysis in accordance to recommendations set by JCAHO and other accrediting organizations. Facility policies and procedures should be reviewed to learn which, if any, exceptions may exist. Samples may be removed by several methods: Excisional biopsy - An entire section of tissue is sent for examination. Incisional biopsy - A small portion of tissue is incised and sent for examination. Needle aspiration - A fine gauge needle and syringe are used to aspirate the sample. Preparation for specimen handling should be planned before the procedure to ensure that supplies needed for transport are available, personnel are available for processing specimens, the proper lab requisitions are obtained, and that the correct method of collection and transportation will be followed. This preplanning minimizes the time spent intraoperatively and reduces the potential for mishandling of specimens. Importance of Surgical Specimens Specimens are sent to pathology to:  Identify the specimen  Ensure that there will be a record of the specimen  Provide proof of the surgical procedure  Provide a means for diagnosis and eventual treatment and related therapy based on the diagnosis It is the responsibility of the circulating nurse to correctly identify, label, preserve, and document the removal and transportation of specimens. Any error may cause a specimen to become lost. Errors such as mislabeled containers, crushed specimens, incorrect spelling of the patient’s name, incorrect transcription of the medical record number, dried out specimens, or the incorrect surgical site and/or description of a specimen can result in an inaccurate diagnosis, improper therapy, or delayed treatment, and possibly the need for a second operation The "Five Rights" of Specimen Handling. Right specimen Right laboratory test Right patient Right surgeon Right medical record number The perioperative nurse uses two unique identifiers to confirm the patient’s identity before he/she enters the OR.  Confirming the spelling of the patient’s name and medical record number with the patient and against the chart will help to ensure that the specimens removed during surgery will be properly identified in the laboratory.  This also allows the laboratory and pathology reports to be put on the proper chart with follow-up to the surgeon.  This verification process also confirms the correct procedure is to be performed by the correct surgeon Specific Information Completed laboratory or pathology requisition slip and label the specimen with the following information:  Patient’s name and medical record number  Name of surgeon  Date and time of collection  Identification and source of specimen  Number of the OR suite. This is very helpful if the pathologist needs to confer with the surgeon especially in large facilities with many ORs. This also helps track the specimens in the logbook.  Telephone number of the OR suite for the pathologist if a consult with the surgeon is needed  Patient’s level of awareness. The pathologist needs to know if the patient is under local or local sedation before speaking.  Initials and signatures of the circulating nurse  Patient’s medical diagnosis This applies to all surgical specimens obtained, whether it is for frozen section, cytology, routine, or biopsy: Types of Surgical Specimens a. Routine specimens b. Frozen section c. Biopsy specimens d. Cultures e. Slides f. Cytology specimens g. Forensic specimens h. Gross analysis specimens Routine Specimens Specimens that are designated as routine do not require immediate processing by the pathologist. These specimens are collected, placed in a preservative fluid and sent to pathology at the conclusion of the procedure. Once the pathologist has viewed and examined the specimen, a diagnosis is made and the findings are dictated, a copy of the report is sent to the surgeon to assist with further treatment. A copy of the report is also placed into the patient’s chart. Specimens that are sent for routine analysis may be obtained from aspiration or from an incisional or excisional biopsy Frozen Section Frozen sections are specimens that require immediate examination by the pathologist with a verbal report of the findings communicated to the surgeon as soon as possible during the procedure. Depending on the results of the frozen section, the surgeon may or may not proceed with the planned surgery. A fixed, permanent, section will be done which reaffirms the preliminary findings. Examples of specimens that require immediate analysis for determination of tissue pathology include: Breast biopsy Biopsy of tumors Biopsy of lesions Rectal biopsy for ganglion cells Once in the laboratory, the tissue is frozen, and thinly sliced into sections to be examined under a microscope by the pathologist. Lymph nodes sent for frozen section are important for a diagnosis. Facility policy and procedure should be referred to ensure the proper handling and preserving of lymph nodes, especially during offshifts when there is limited pathology staff available. Staging laparotomy for Hodgkin’s disease and oophorectomy for ovarian cancer are examples of procedures that require lymph nodes for diagnostic purposes. Transportation of Frozen Section  Specimens sent as frozen sections should be sent dry (a small amount of saline may be used to keep the specimen moist during transportion  The specimen should be placed either on or in a specimen container, towel, or basin. If there is a delay in transportation, precautions should be taken to prevent the specimen from drying.  Very small specimens such as needle biopsies or tissue from a cup biopsy forceps, can be placed on a section of dampened non-adherent wound dressing e.g., Telfa, and then placed into a sterile container before being passed off the field.  A counted surgical sponge is never used for transportation of the specimen.  The surgeon should verify the specimen.  The specimen is properly labeled with the identification of the source of the specimen, patient’s name and medical record number, surgeon’s name, date of procedure, OR suite number, and the test(s) required and taken immediately to the pathologist with a tissue requisition slip.  Depending on the facility, procedure, or surgeon, the pathologist may be requested to come into the Operating Room to collect the specimen.  To prevent unnecessary delay in communication from the pathologist, or the processing of the specimen, specific facility process should be followed. General guidelines for transportation of frozen sections include: Biopsies Tissue that is surgically removed for diagnostic purposes is referred to as a biopsy. The pathologist will study the cells under a microscope and possibly perform a histologic and/or cytologic analysis. The type of tissue to be examined will determine how it is to be handled and transported. Examples are a biopsy of the breast, liver, colon, or lung. Specimens may be so small that a needle is needed to remove the tissue from the forceps. It can then be placed on a piece of dampened non-adherent wound dressing (e.g., Telfa) or non-radiopaque surgical sponge before placing into a specimen container. Dipping the forceps into a medicine glass that contains a small amount of saline is another method that may be used.  A biopsy can be incisional, where a portion of the tumor is removed, or excisional, where the whole tumor is removed.  A needle biopsy removes a core of tissue for diagnosis.  A frozen section is usually performed on the tissue with a permanent stain to follow. The resulting surgery, as well as other therapy (e.g., chemotherapy, radiation therapy), will depend on the pathology findings and diagnosis.  Once removed from the body, nerve, muscle, testicular, and bone marrow biopsies must be prepared and processed by specialized methods to preserve the cells.  Bone marrow biopsy requires specialized needles, which can puncture, directly or with a twisting motion, to penetrate the bone.  A muscle biopsy requires specialized forceps that are applied to the muscle before it is removed and keeps the muscle stretched during processing. Cultures and Slides Tissue or fluid that is suspected of being infected may be cultured so that the pathogen can be identified and treated. This is called culture and sensitivity. The culture is performed to determine the exact organism and which treatment it will be sensitive to once identified.  Sterile cotton-tipped applicators are used to remove small amounts of the tissue or fluid to be cultured, and then placed into a transport medium.  The swab should be placed into the transport tube immediately because anaerobic bacteria die quickly if exposed to air.  Another method of collecting specimens for culture is excision of tissue; a small piece of tissue is excised and placed into a dry, sterile specimen container and transported to the laboratory for analysis. Slides are prepared from tissue or body fluid. An example of this is the Pap (papanicoleous) smear. Many times slides are taken from cultures. Cytology Cytology is the study of cell biology. Tissue and body fluid may be obtained during a procedure and sent to the laboratory for cytology for the identification of the function and origin of cells in that fluid or tissue. This is done when a malignancy is suspected. Some specimens for cytologic examination may be obtained through “washings.” The physician injects saline though an endoscope and aspirates fluid into a collection device such as a Luken trap, consequently obtaining cells for cytologic examination. Examples of cytology washings are:  Bronchial  Bladder  Pelvic Forensic Specimens This refers to physical evidence from a person involved as a victim or suspected perpetrator in a crime. Any patient’s belongings, body tissue, fluids, or foreign bodies removed from the patient must be handled as potential evidence. They are submitted to the pathology department labeled as “forensic specimens” and then released to law enforcement officials, according to the facility’s policies and procedures. Information obtained from this type of specimen will be used as evidence in a court of law to help reconstruct events of an accident, civil or criminal complaint, or crime. Gross Analysis Surgery is often performed to remove implanted items. The removed item is called an "explant". Depending on facility specific policy and procedure, explants are sent either to the pathology department for gross analysis (the pathologist reports the removal of the implant), or returned to the patient. Examples of items that may be sent for gross analysis include:  Orthopedic plates and screws  Pacemaker generators and lead wires  Foreign bodies, such as a coin Documentation on the surgical record includes any serial numbers or manufacture codes that are on the explants. The same information should be on the pathology requisition. Requests for return of these specimens should follow facility policy. The request should be noted on the pathology requisition. Medical devices removed due to apparent defectiveness must be retained by the facility and sent to pathology for identification purposes without decontaminating or sterilizing. Preparation of Pathology There are various types of tests done on pathology specimens. Specific preparation is required for the specimens in each of these tests. Tests done on pathology specimens can be classified into three basic types. Fluid tests  Bacteriology  Virology  Cytology  Genetic studies  Cell count Nonbiologic specimen tests  Foreign body  Projectile from crime scene  Clothing of crime or accident victim  Explanted prosthesis Tissue tests  Permanent section  Frozen section  Biopsy  Hormonal assay  Donor tissue  Calculi  Ova  Muscle Fluid Tests Preparation required and examples of fluid tests are as given. Test - Bacteriology Preparation : Aerobic and anaerobic on culture swab in sterile tube Example : Exudate Test - Virology Preparation : Fresh in sterile container Example : Cerebral spinal fluid Test - Cytology Preparation: Fresh or solution of choice of facility’s pathologist in sterile container Example : Cell washings Urine Test - Genetic studies Preparation : Fresh in sterile container Example : Amniotic fluid Test - Cell count Preparation Fresh in sterile container Example Cerebral spinal fluid Semen for infertility study Test Preparation Example Tissue Permanent section Formalin or fresh in sterile container Gallbladder Frozen section Fresh in sterile container Malignant lesion for margins Biopsy Fresh in sterile container or in formalin (discretion of surgeon) Suspicious lesion or mass Hormonal assay Fresh in sterile container Breast tissue Donor tissue Fresh or added solution of pathologist’s choice Cadaver skin Calculi Dry in sterile container Kidney stone Ova Fresh or added solution of surgeon’s choice Human egg for preservation Muscle Fresh in sterile container, extended in special clamp Test for diagnosis of malignant hyperthermia Nonbiologic Specimen Test Preparation required and examples of nonbiologic specimen tests are as given Foreign body Preparation Fresh in a sterile container Example Glass Wood fragments Test - Projectile from crime scene Preparation Dry, in nonmetallic container Do not mark specimen to ID Example Bullet Test - Clothing of crime or accident victim Preparation Dry, in porous paper Example Undergarments of rape victim Test - Explanted prosthesis Preparation Dry, in a sterile container Example Orthopedic screws or plates Pacemakers Surgical Tissue Banking Surgical tissue banking is the retrieval, processing, preserving, and storing of selected human tissue for later transplantation back into the patient, or into another patient. AORN has recommended practices for surgical tissue banking. However, it is beyond the scope of these recommended practices to address all areas of tissue banking. Rather, these recommended practices provide guidance for developing institutional procedures that are specific and compatible with the patient’s needs, the practice setting’s facility, and personnel capabilities and expertise. Standards for tissue banking are published by the FDA (US Food and Drug Administration). These standards are applicable to hospitals and ambulatory and office-based surgery centers that store, issue, or implant human, nonhuman, and synthetic tissue, and to other areas outside of the clinical laboratory such as tissue banks Types of Surgical Tissues  Bone , Bone marrow  Cartilage  Cord blood  Cornea  Dura mater  Eggs and embryos  Fascia  Heart valves and conduits  Skin  Sperm  Stem cells  Synthetic tissue e.g., artificially prepared human and non-human based  Tendons  Veins and arteries ,Other cellular and tissue-based transplant or implant products Documenting Surgical Tissue Implants As part of the preplanning process, the perioperative nurse must confirm that tissue and cells acquired from outside sources have been procured, processed, stored, and distributed by tissue banks registered with the FDA and licensed by state agencies.  Documentation of implanted tissue must be on the patient's permanent record and in the intraoperative record.  Documentation should include, but be limited to; • Type of implanted tissue • Lot and serial number • Manufacturer • Size, if applicable • Expiration date • Location and position of the implant • Name of surgeon • Facility name and telephone number  If the tissue is being removed, the disposition of the tissue should be documented.  Specific facility policy should be reviewed in addition to the FDA standards for Tissue Banking for further information. Organ Procurement Organs that may be removed during this process include: v Heart v Lungs v Pancreas v Liver v Kidneys v Spleen v Bones v Eyes v Lungs Organ donation is a unique type of specimen collection. Organ donation may be obtained from a living donor such as in kidney donation, or retrieved from nonliving donors. Permission to retrieve tissue from nonliving donors is sought from the next of kin in order of legal precedence. Both federal and state laws mandate that local organ-procurement facilities be notified of potential donors. The perioperative nurse must be familiar with the state’s definition of brain death and the facility’s criteria for the declaration. Once the patient becomes a potential donor, the patient is no longer charged. Forensic Evidence Forensic evidence becomes important in the OR because of the number of violent crimes that occur in our society. The perioperative nurse may have to care for a patient who may have been either the victim, or the perpetrator of a crime.  When the patient comes to the OR, all healthcare professionals must be knowledgeable about the care and handling of forensic evidence.  Critical evidence that could be used to determine how a crime was committed could be lost, discarded, mishandled, or never collected if not handled properly.  Many times, legal cases may be decided based on the medico legal evidence. If the evidence in destroyed or mishandled, it could affect the outcome of the case. Unlike surgical specimens, forensic specimens can involve much more than just the tissue removed at the surgical site. Forensic specimens can include:  Body fluids  Hair  Fibers  Fingernails  Debris  Foreign bodies  Patient’s clothing Description of Patient's Injuries Objective descriptions of the patient’s injuries are very important to document. Such descriptions should include: The exact location of the wound Size, shape, and depth Characteristics of edges Discolorations around the wound Any observable patterns of tissue direction that may indicate a foreign object's point of entry If more than one wound exists, the exact number should be counted and documented along with the aforementioned documentation Include pictures whenever possible Collecting Forensic Evidence The following specimens are collected as forensic evidence. Body fluids Hair Fibers Broken fingernails Debris Foreign objects Fabric and clothing Body Fluids, Hair, Fibers and Fingernails Preservation methods, medico legal implications and examples of body fluids, hair, fibers and fingernails are as given. Specimen Body fluid • Blood • Urine • Gastric contents • Seminal fluid Preservation methods • Collect large amounts of fluid in tubes or specimen containers • Collect fluids around wounds or wet body fluid stains with swabs • Absorb stain onto clean cotton swab • Allow to air dry • Place swab in paper envelope • Label • Seal well Medicolegal implications • Patient may have swallowed containers (e.g., balloons) of drugs • Leakage of a lethal substance could be the cause of death • Body fluids may be used to associate the crime victim and suspected perpetrator or liminate suspected perpetrator from consideration Hair, Fibers • Loose hair strands • Shaved hair from around wound sites • Carpet remnants • Strings Preservation methods • Collect and place in separate paper envelopes • Label • Seal well Medicolegal implications • Hair and fibers may be transferred between victim and suspected perpetrator or victim and the crime scene Broken fingernails • Fingernails Preservation methods • Place in paper envelope • Label • Seal well Medicolegal implications • Striations are unique to each person • Convictions have been made on the basis of this evidence • Can determine sex, race, and ABO type Debris and Foreign Objects Debris • Glass • Paint chips • Wood splinters • Animal teeth Preservation methods • Collect and place in separate paper envelopes • Label • Seal well Medicolegal implications • May connect victim or suspected perpetrator with the crime scene Foreign objects • Bullets • Fragments • Pellets • Knives Preservation methods • Handle as little as possible • Remove with rubber-tipped clamps or forceps or latex gloves • Do not mark specimen • Do not drop bullet into metal basin or bowl • Avoid wrapping bullet in cotton or tissue paper • Place bullet in sterile plastic specimen container • Do not rinse bullet with saline or water • Handle each bullet or fragment separately and not grouped in one container Medicolegal implications • Excessive handling may alter specimen • Stainless steel clamps damage the rifling marks on the bullet, occluding valuable comparison markings • Dropping bullets into a metal basin or bowl removes engraved markings, abrades, and mars • Cotton or tissue wrapped around bullet absorbs or rubs off blood and other trace evidence • Rinsing the bullet removes valuable trace evidence Fabric and Clothing • All garments • Pieces of garments • Footwear • Bed linens (including linens from prehospital care, emergency department, OR.) Preservation methods • Remove carefully as intact as possible • Avoid cutting through holes, tears, or rips • Air dry if possible • Place on flat piece of paper; insert paper between layers of clothing • Roll or leave in flat position • Place each article in a separate paper bag Medicolegal implications • Minimizing the number of pieces facilitates reconstruction • Shoes may bear imprints of gas/brake pedals, which may assist in accident reconstruction • Close examination by experts of clothing tears and gunshot wound residue patterns provides information about firearm distance and direction of a bullet or other assault instrument • Blood/body fluid on clothing deteriorates if not dried • Bacterial/fungal growth increases when evidence is stored in closed plastic bags Preserving, Transferring and Transporting Specimens Surgical specimens are procured according to established facility policies and procedures. The following basic guidelines should be followed to properly procure and preserve the transferring specimens.  Save all tissue removed from the patient, even if it appears to be of no value.  Do not use large crushing instruments on specimens.  Use a needle to remove very small specimens from instrumentation.  Keep specimen moist with saline.  Place the specimen in a basin until it can be passed off the field.  Never hand specimen off on a counted or radiopaque surgical sponge.  Verify with the surgeon if the specimen is to be placed in formalin (formaldehyde) for a permanent section or kept dry for frozen section.  Make sure the fluid (saline or formalin) covers the specimen in the container.  Store only one specimen per container. Identifying and Labeling Specimens Mislabeling or error in identification of a specimen can be disastrous to the patient. The following basic guidelines should be followed while identifying and documenting the specimens. Complete the patient label placed on the outside of specimen container with: • Patient’s name • Patient’s facility identification number • Identification of specimen • Source of specimen • Surgeon • Date • OR number • Initials or name of nurse collecting specimen  Complete the laboratory or pathology requisition.  Ask the surgeon to verify specimen.  Complete the documentation on the surgical record (according to facility policy – at the minimum this should be the number of specimens removed)  Save all specimens according to the facility’s policy and procedure.  Edges and margins of the specimen may be tagged for orientation such as anterior, posterior, right, or left.  A glove wrapper and surgical marking pen may be used to document right and left orientation of the specimen and to hand the specimens off the surgical field.  Do not use abbreviations to identify specimens. Containing and Disposing Specimens The following basic guidelines should be followed while handling the specimens.  All specimens are biohazardous.  Avoid contaminating the outside of the specimen container with blood and body fluids.  If contamination occurs, disinfect exterior surface of container with a tuberculocidal, hospital-grade disinfectant or a 1:10 dilution of household bleach before removal from the OR.  If tubes or containers cannot be disinfected, place them in an impervious clear bag marked biohazardous for transportation to the laboratory or pathology department Routine Guidelines - General Routine specimens  Routine specimens that do not require immediate attention by the pathologist can be collected, placed in a container with preserving fluid (formalin), and taken to a holding area, such as a refrigerator or a storage container in the decontamination room.  The specimens will be transported to the pathology department at a later time.  A pathology logbook is kept in this area. The patient’s name, identification number, identification of the specimen(s), and nurse’s initials are logged into this book. When the specimen is transported to the pathology department, the person transporting the specimen initials the logbook. Formalin  Formalin (formaldehyde) is the main chemical used by most facilities for preserving surgical specimens.  This chemical is very toxic if inhaled or splashed on mucus membrane of the eyes, face, or skin of the hands.  If there is exposure to formalin, rinse the affected area with copious amounts of water or saline. Cultures  Cultures from body fluid or tissue should be sent to the laboratory department immediately, because the air and warmth of the OR can affect the bacteria and cell count.  In the laboratory, cultures can be placed onto a media plate and stored (refrigerated). Smears  A smear on a glass slide can be made from tissue or body fluids.  This smear is then sprayed with a fixant and should be labeled, handled, and documented in the same way as cultures. Stones, calculi, and foreign bodies  Stones, calculi, or foreign bodies are placed in a dry container and sent to the pathology department for gross (size and shape) and stone analysis (chemical analysis of the stone).  Foreign bodies, such as bullets or knives, for forensic identification or evidence will be addressed later.  Facility policy and procedure should be followed to ensure proper handling and requisition. Amputated limbs  Amputated limbs or extremities usually are wrapped in an impervious stockinet or Mayo stand cover.  Make sure all surgical instruments are removed from the limb before passing it off the field.  To transport the amputated limb through hospital corridors, the limb may be placed in a box to be taken to a refrigerator located in the morgue.  The logbook is used to inform the pathologist of the location of the limb in the morgue.  The disposition of amputated limbs must follow the specific protocol of the facility. Biohazard  All surgical specimens are biohazardous, and gloves should be worn when handling or transporting the specimens to their containers.  If the outside of the container becomes contaminated with blood or body fluids, the container must be wiped off before transportation. Routine Guidelines - Handling Forensic Evidence Forensic evidence is handled differently than regular surgical specimens.  Patient tissue and foreign bodies (bullets, knives) will usually go to the pathologist.  Clothing and other items (hair, fibers, and debris) are immediately turned over to the police.  Always follow the facility’s policy and procedure when relinquishing medicolegal evidence.  It is very important to preserve the “chain of evidence or custody.”  Evidence should be sealed whenever possible.  Always document a description of the evidence and to whom the evidence was transferred or relinquished to.  The number of times a given piece of evidence changes hands or locations should be minimized to protect its integrity and credibility.  Failure to protect the chain of evidence may cause it to be inadmissible in court, even though the evidence is physically present.  Any time perioperative team members are involved in suspicious or unclear cases, it is wise to collect evidence and then allow the legal authorities to decide whether it is necessary to keep or discard the items. Documenting Forensic Evidence Depending on facility policies and procedures, the documentation of forensic evidence is the same as for a surgical specimen. It is also necessary to document the following information:  Objective description of the patient’s injuries.  Any “evidence” taken from the patient while in the OR, including: • Description of the evidence • Name of the person collecting the evidence, such as the circulating nurse, surgeon, or scrub nurse  Transfer of any evidence from the operating room: • Maintain the chain of custody • Name of the person receiving the evidence • List of items • Date of transfer • Time of transfer  Some facilities have standard forms used to document chain of custody and/or release forms for this purpose Module Summary  Surgical interventions may involve removal of samples to assist with diagnosis of a disease process or to determine treatment of a condition. These samples may be body fluids, tissue, or bone. With very few exceptions, any sample that is removed during a surgical procedure is sent to pathology for analysis. Samples may be removed by several methods such as: Needle aspiration, Incisional biopsy and Excisional biopsy.  It is the responsibility of the circulating nurse to correctly identify, label, preserve, and document the removal and transportation of specimens.  The perioperative nurse should know the "Five Rights of Specimen Handling" to ensure proper handling of surgical specimens. these are right patient, right medical record number, right procedure and right surgeon.  Specimens collected intraoperatively are classified as: Routine, Frozen section, Biopsy, Cultures, Slides, Cytology, Forensic and Gross analysis.  Specimens that are designated as routine do not require immediate processing by the Pathologist.  Frozen sections are specimens that require immediate examination by the pathologist with a verbal report of the findings communicated to the surgeon as soon as possible during the procedure.  Tissue that is surgically removed for diagnostic purposes is referred to as a biopsy.  Tissue or fluid that is suspected of being infected may be cultured so that the pathogen can be identified and treated. The culture is performed to determine the exact organism and which treatment it will be sensitive to once identified.  Cytology is the study of cell biology. Tissue and body fluid may be obtained during a procedure and sent to the laboratory for cytology for the identification of the function and origin of cells in that fluid or tissue.  Forensic evidence refers to physical evidence from a person involved as a victim or suspected perpetrator in a crime. Any patient's belongings, body tissue, fluids, or foreign bodies removed from the patient must be handled as potential evidence.  Removed implants or explants are sent either to the pathology department for gross analysis.  Pathology tests can be performed on fluid, tissue or nonbiologic specimen. There are various pathology tests done and the preparation required for each varies as per the specimen and the test.  Surgical tissue banking is the retrieval, processing, preserving, and storing of selected human tissue for later transplantation back into the patient, or into another patient.  The perioperative nurse must confirm that tissue and cells acquired from outside sources have been procured, processed, stored, and distributed by tissue banks registered with the FDA and licensed by state agencies.  Organ donation may be obtained from a living donor such as in kidney donation, or retrieved from nonliving donors. Permission to retrieve tissue from nonliving donors is sought from the next of kin in order of legal precedence.  Forensic evidence becomes important in the OR because of the number of violent crimes that occur in our society. The perioperative nurse may have to care for a patient involved in a violent crime who may be the victim or the perpetrator.  Objective descriptions of the patient’s injuries are very important to document as forensic evidence.  Forensic specimens can include: body fluids, hair, fibers, fingernails, debris, foreign bodies, and patient's clothing.  The perioperative nurse needs to follow certain guidelines while collecting and preserving forensic evidence.  The AORN Standards, Recommended Practices, and Guidelines provide guidance for the implementation of containment, identification, labeling, preservation, transfer, transport, and disposition of surgical specimens.  Documentation of the intraoperative surgical specimen is of vital importance. The intraoperative surgical record or chart is the legal document of what took place in the OR. This documentation accounts for each and every specimen and/or culture obtained during the surgical procedure. [Show More]

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