Shipping Of Autopsy Material

CONTAINERS FOR DRY MATERIAL Most commonly, slides and paraffin blocks are sent. Paraffin Blocks should be sealed with paraffin after microtomy to prevent tissue from drying out. Blocks can be wrapped in paper or plastic, but cotton should not be used because cotton fibers may stick to the paraffin and cause knife lines and abrasions. Glass slides should be shipped in unbreakable slide containers cushioned with cotton or other material. The packages should be sealed with tape because staples may injure personnel in the accessioning areas.

CONTAINERS FOR WET MATERIAL Two containers should be used, one within the other. Absorbent material (see below) is placed between the two containers. Paper, plastic, glass, or metal jars are used. Ordinarily, plastic jars are most convenient for shipping autopsy tissues. However, for toxico-logic examinations, the inner container should be of glass, particularly when the tissues or body fluids are to be analyzed for volatile substances. Plastics may be permeable to gases, and corrosion of metal containers may interfere with toxicological studies. Stoppers, corks, and lids should be taped in place.

For use as an absorbent, cotton can be soaked with 10% formalin solution and wrapped around the tissues. Towels and gauze cause marks on tissue surfaces and should not be used for wrapping or covering of tissues. Fixatives should not be used if the material is sent for toxicologic or microbiologic examination. Enough cotton or paper should be placed between the inner container (or plastic bag) and the outer container to take up all liquid in case of breakage or leakage. The absorbent material is also useful for cushioning the inner container.

Shipping of frozen material is recommended for submission for toxicologic and biochemical examinations. Ordinary ice is sufficient if the specimen is transported by a messenger who will replenish the ice if necessary. Dry ice will be effective for about 24 h. For longer periods, refilling is required, or the specimen has to be sent in dry ice with ether or acetone in a thermos bottle of appropriate size. The dry ice is put around and on top of the specimen and on the inside of the absorbent material. The mailing container should be insulated.

As mailing containers, durable shipping cartons, wooden boxes, or metal containers are used. For frozen material, the mailing container should be insulated e.g., with styrofoam. Shipping cartons are sealed with strips of gummed paper.

Inside the mailing container, a tag or letter should be placed, giving: 1) name and address of the submitter; 2) name and address of receiver of the shipment; 3) name, clinic number or other alphanumeric identifier, and autopsy number and year of the patient from whom the material came; and 4) type of examination requested, together with pertinent data. If a separate letter has been sent, a copy should always be put into the mailing container. This may help to avoid much confusion and delay. It is a continuing problem for many institutions to receive slides, blocks, or tissues without any further information, and a frustrating search follows for a misfiled or lost letter to match the shipment. If a clinician or person other than the submitting pathologist has requested the consultation, that address should be supplied also. The pathologist does not always know why the request for the shipment had been made.

Letters and addresses in the shipping container should be protected from leaking fluids by sealing them in plastic.

Mailing containers should be marked on the outside with appropriate warnings such as "Biohazard," "Glass, Handle With Care," and "Perishable Material." Additional labels are recommended for medicolegal or microbiologic material (see below).

SHIPPING AND LABELING FOR MEDICOLEGAL MATERIAL Medicolegal material is sent by messenger, registered mail, or air express. Care must be taken that the chain of custody remains uninterrupted (see Chapter 2). Medicolegal material will often be passed through local police authorities to the state bureau of criminal identification or investigation laboratory. The address for shipments to the laboratories of the FBI is: Director, Federal Bureau of Investigation US Department of Justice Washington, DC 20012 Attention: FBI Laboratory

Specimen labels should contain: 1) name and address of the submitter; 2) name and address of the receiver of the shipment;

3) description of the container and of the source and nature of its contents; 4) a tag describing the shipment as "evidence;" and 5) if applicable, a request for specific examination.

Containers with medicolegal material should be sealed before shipping so that the contents cannot be tampered with. Sealing wax imprinted with the thumb of the submitter may serve this purpose.

The mailing container should show: 1) the name and address of the submitter; 2) the name and address of the receiver; and 3) warning tags such as a red "Biohazard" label, "Glass, Handle With Care," "Perishable Material," or "Fragile, Rush, Specimen for Toxicological Study."

SHIPPING OF BLOOD AND TISSUES FOR CARBON MONOXIDE DETERMINATION For blood, 10 mL is placed over 10 mg of lithium oxalate in a screwcap test tube. The blood is covered with mineral oil, and the cap or stopper is sealed with hot paraffin or plastic tape. Tissues can be packed in plastic and shipped in dry ice in an insulated mailing container.

SHIPPING OF TISSUES AND BODY FLUIDS FOR MICROBIOLOGIC STUDY (BY BRENDA WATERS) Three goals should be met when shipping specimens taken from a patient at autopsy: 1) preservation of the specimen during transit, 2) supplying sufficient clinical information for proper handling and interpretation, and 3) providing adequate protection of postal and other mail handlers. The United States Postal Service publishes regulations for the proper shipping of such materials in their publication, "Domestic Mail Manual," which undergoes revision every one to two years. The autopsy service may find it prudent to review this manual from time to time to ensure that federal requirements are met. The postal recommendations are paraphrased below.

"All clinical specimens destinedfor shipping must be placed in a securely sealed, break-resistant inner container which must be surrounded by sufficient cushioning to withstand the shocks of normal handling. If the specimen is liquid, the cushioning material must have enough absorbent capacity to completely absorb the liquid. In addition, liquid materials must be placed in a container with sufficient extra volume to accommodate expansion in low pressure environments, such as during air travel. The inner container and cushioning material must then be placed in a larger outer container, which will carry the labels and mailing addresses. This larger container must also be break-resistant and have a surface to which labels will firmly affix. Clinical specimens exceeding 50 mL must be packaged in fiberboard or other material of equivalent strength. Single containers must not contain more than 1 L of material. No more than 4 L of specimen may be enclosed in any single outer container."

Any information for the receiving laboratory, such as requisitions, patient information, and accompanying letters from the sender should be placed in the outer container. In some situations, it may be advisable to send a separate letter to the medical director or chief technologist of the receiving laboratory. Telephoning the receiving laboratory at the time of shipment may also facilitate proper and timely handling of the specimen upon arrival.

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