Facing Information and Courses from MediaLab, Inc.
These are the MediaLab courses that cover Facing and links to relevant pages within the course.
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|Regularly Shaped, Medium Sized Pieces|
When embedding medium sized specimens with greater than one piece, locate any inked or cut surface and place all pieces facing in the same direction using these markers.If multiple levels will be cut from the block, select the smallest mold size that will contain the pieces and still allow a border of paraffin on the outside of the specimen. This will make it easier to place more than one section on a slide during microtomy. As with other types of specimens, you will still seek to make sure all the specimens harden in the same plane so that a single representative section is easier to obtain.
|Gynecological (GYN) Specimens|
Several types of GYN specimens are routinely submitted to clinical histology laboratories such as cervical loop electro-cautery excision (LEEP) procedures, cervical cone, endometrial curettage, and vulvar biopsies. Although for most GYN specimens you will follow the same general guidelines as for other similarly shaped and sized tissue specimens, it is especially helpful to understand a little about the surgical procedures used to obtain these specimens and also the common methods for dissection used.Cone biopsiesThis procedure is a conical excision of the cervical canal using a laser or cold blade.The wider part of the cone is the ectocervix, and the tapered tip contains the endocervical margin.The ectocervix by convention is described as a clock face, with the most superior midpoint of the anterior lip designated at 12 o'clock.Sections will usually be submitted sequentially and designated in the gross description by their clock face orientation.These sections should be embedded so that perpendicular sections will be shown of the cut surface.Cervical LEEPThese related procedures remove less tissue than a cone biopsy and are obtained by electro-cautery of the cervical transformation zone.The specimen may be divided either perpendicularly or by using a radial dissection method.Endometrial curettageCurettage is a scraping method, in this case of the endometrial lining.The specimen obtained will consists of bloody fragments.These may be submitted in biopsy bags to contain the fragments during tissue processing.The surface of the bags or paper should be scraped lightly to remove as much material as possible.Embed to keep the fragments centralized in the block face and to arrange for the greatest surface area to be shown in one plane.Wipe forceps and all surfaces well after these specimens; it is easy to transfer the loose bloody fragments to other specimens.Embed all fragments with respect to the ink present with inked edges facing all in the same direction.
Shave procedures are used frequently with removal of skin growths that measure approximately 4 to 5 mm in diameter. A small, spoon-shaped piece of skin is removed using a scalpel. Following tissue processing, the skin shavings may resemble crescent shapes, or small slivers of skin. Embed the cut surface of the skin sliver "on edge" to be cut perpendicularly on the cut surface, so that all the skin layers will be visible on the section. Arrange the pieces so that the hardest portion (typically the epidermis) will meet the microtome blade last. Use the epidermis surface (often marked with ink) to assist orientation. Orient all the skin surfaces and inked edges facing in the same direction.Carefully press down the thinnest fine points of the slivers to make it easier to obtain a complete section without cutting portions of the specimen pieces away.
Needle biopsies are commonly obtained from the prostate or liver. They will resemble long, thin cores of tissue. Due to the very thin diameter typical of these specimens, it is absolutely essential that they be oriented in the same plane, as flat as possible. It is common for multiple level section protocols to be requested as well as special stains with these specimens, so select the smallest mold that is appropriate for the specimen to make it easier to place multiple sections on the same slide. It is best to arrange the long strings in a parallel arrangement, and not randomly with the long strings facing in many directions. Diagonal arrangement can assist if folds or compression are a problem, since this will reduce the distance that the knife blade travels across the specimen.
|Tips for Successful Venipuncture When Using Hand Veins|
Hand position: It is best practice to position the patient's hand slightly downward with the top of the hand facing the phlebotomist. The fingers of the patient's hand should be rolled underneath and wrapped around the fingers of the phlebotomist's "anchoring" hand forming a loose fist. The phlebotomist should use his or her thumb to pull back gently on the surface of the skin, making the skin taut. The vein should be anchored adequately to proceed with venipuncture. The phlebotomist may have the patient roll his/her fingers over a pillow or a rolled up washcloth to make the hand vein more prominent.Tourniquet Position: The tourniquet should always be applied 3 - 4 inches above the needle insertion point. Therefore, when assessing for a usable vein in a hand, apply the tourniquet 1 - 2 inches above the wrist. If the tourniquet is on longer than one minute, release and reapply prior to venipuncture to avoid hemoconcentration.Cautions: Choose a straight section of the hand vein-- avoid the "intersection" or "V" where a vein branches into another vein. This juncture may contain a valve and could be damaged if punctured. Only use the top of a hand or thumb-side of the wrist for puncture. Avoid the fingers or the underside of the wrist. This will prevent the inadvertent puncture of hidden arteries, tendons or nerves in the area.
|Hints For Successful Pediatric Venipuncture|
While pediatric phlebotomy can be challenging, these guidelines can contribute to success.Communication: Always be honest with the child. Never lie to a child and say that it won't hurt. If asked by the child if it will hurt, you could explain that it may feel like an insect bite or it may sting, but if he/she holds really still, it will be over very soon.Correct hold of child: Ask the parent or guardian to assist. If you have determined that the child's parent is willing and able to assist throughout the procedure, have the child sit on the parent's lap . The parent can gently "hug" the child in a way to limit the child's movement and stabilize the arm that will be used for venipuncture. Alternately, the child can lie on a bed or exam table. If the parent does not choose to help, ask for assistance from a coworker. Correct hold of the child's arm: A health care professional familiar with the procedure should assist by holding the arm that will be used for the blood collection. The holder should face the child and gently position the child's arm so that the arm is straight and palm facing up. Next, the holder should place one hand underneath the child's elbow grasping lightly yet firmly to stabilize the elbow. With the other hand, the holder should hold the child's hand firmly. This hold will help prevent movement of the arm, even if the child is moving his/her body. This hold also allows the phlebotomist easy access to the venipuncture site during the procedure. Distractions: At times, the phlebotomist may employ a technique to distract the child during the procedure. For example, to help the child keep still, tell the child that the only thing he/she can move is his/her eyelashes. This places the child's focus on moving only their eyelashes and before you know it, the procedure is done!