[Histonet] Xylene substitute

[Gareth Davis via Histonet]

Hello all,
Looking for information on Xylene substitutes.  I have never used it before
and wondered:
1. Is it cost effective?
2. How do you dispose of it?
3. Do you use it just like Xylene - just as many times, or change more
often?
4. Can you recycle it?
Thanks in advance,

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[Histonet] EPA

[Gareth Davis via Histonet]

I have read CAP accredited labs need an EPA number.  Are all labs getting
one, or have one, and how difficult was it to get one?

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[Histonet] Tech component and professional component

[Gareth Davis via Histonet]

Are there any labs that do the tech component only and have a different lab
read the slides?  We would like to discuss with rural labs, who are also
CAP, how you handle the process.  Please send contact info or call me at
928-248-5259. We spoke with CAP, but would like to see others do it.
Thanks.



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Yuma Gastroenterology
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928-248-5259
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[Histonet] TC/PC component lab

[Gareth Davis via Histonet]

Are there any labs out there that just do the technical component, just making
the slides and send those slides to a pathologist at another lab to be
read?  And what would be the concerns with this situation? Can a medical
director also be the laboratory director for the lab doing the technical
side?

For the TC component, can the claim and medical director be a
non-Pathologist (i.e. Gastroenterology)

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Yuma Gastroenterology
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928-248-5259
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[Histonet] Laboratory Equipment services and supplies

[Gareth Davis via Histonet]

Has anyone used Laboratory Equipment Services and supplies, LLC for their
preventative maintenance? Just wondering if they are good. They sent me a
quote that was really good and much less than what I have been quoted.  Any
feed back would be appreciated.
Gareth

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928-248-5259
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Re: [Histonet] Bleach Regs

[Gareth Davis via Histonet]

Hi Maryann,
Nosy Med techs.  I have bleach under my sink and never had a CAP inspector
say anything about it being there.


On Thu, Jan 31, 2019 at 8:31 AM Maryann Deathridge via Histonet <
histonet@lists.utsouthwestern.edu> wrote:

> Hello Histonetters!
> Has anyone heard of a regulation by CAP, CLIA or OSHA regarding commercial
> bleach stored under the laboratory sink.  My lab routinely has a gallon
> container of dated/ bio-labeled commercial bleach stored under the sink for
> cleaning purposes. Daily use to clean special stain coplin jars,etc..  I
> had a suspicious med tech tell my pathologist that is was against
> regulations to have it in the lab anytime !
> HUH
> Responses welcomed.
> Have an awesome Thursday!
>
>
>
> Maryann  Deathridge, Lab Manager
> Pathology Assoc. of  St. Thomas
> 4220 Harding  Pike
> Bldg. SE,  Suite 504
> Nashville, TN  37205
> madeathri...@pastnashville.com
>
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[Histonet] Eosin on biopsy tissue

[Gareth Davis via Histonet]

Thanks for all the responses, I will keep the eosin in alcohol for now.
Don't worry, I will follow all CAP rules.
Thanks again.

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[Histonet] Opinion on dye on biopsies

[Gareth Davis via Histonet]

So, I work in a small GI lab, and I put Eosin in my first formalin on my
processor.  My biopsies are very small and this helps, somewhat, to see the
specimens for embedding and cutting.  But, unfortunately, the esophagus
tissues do not absorb the eosin much.  Anyway, the hospital lab I work,
part-time, in has started using hematoxylin to help see their biopsies.  I
happen to embed there and I think it just makes a big mess and the tissue
does not absorb much of the stain.
What are other labs doing to aid in making their small biopsies easier to
see?  What are pros and cons to doing this, in your opinion?
Thanks!

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Yuma Gastroenterology
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928-248-5259
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[Histonet] Fwd: Specimen's from hospital to lab.

[Gareth Davis via Histonet]

I sent this question out last week, someone answered and I guess I
accidentally deleted the email.  So, if anyone remembers answering my
question about private labs doing hospital outpatient biopsies, please
email me again.
Thanks,
Gareth Davis
-- Forwarded message --
From: Gareth Davis 
Date: Mon, Nov 20, 2017 at 9:36 AM
Subject: Specimen's from hospital to lab.
To: "Histonet@lists.utsouthwestern.edu" 


Are there any labs that are private, but receive specimens from a
hospital?  If so, what kind of protocol or policy do you give the hospital
to follow in order for them to submit specimens to the lab?
Thanks,

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*Ms. Gareth B. Davis*, B.S., HT, QIHC (ASCP)cm
Yuma Gastroenterology
Yuma, AZ 85364
928-248-5259 <(928)%20248-5259>




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928-248-5259
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[Histonet] Specimen's from hospital to lab.

[Gareth Davis via Histonet]

Are there any labs that are private, but receive specimens from a
hospital?  If so, what kind of protocol or policy do you give the hospital
to follow in order for them to submit specimens to the lab?
Thanks,

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Yuma Gastroenterology
Yuma, AZ 85364
928-248-5259
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[Histonet] Backup Power Supply

[Gareth Davis via Histonet]

Hello All,
​We need back-up power supply via CAP regulations.  Besides a generator or
a dedicated supply through a hospital back-up generator, what are labs
using.  We are a small lab located in a clinic.  There is no back-up power
supply in the clinic.  Wondered if there was anything out there that could
be used, like a battery back-up.  My only concern is our processor, which
is run overnight.  But, we need something.
Thanks,
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Yuma Gastroenterology
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928-248-5259
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[Histonet] Proficiency Testing for small labs

[Gareth Davis via Histonet]

I was wondering what other small CAP accredited GI labs did for proficiency
testing.  The lab I work in only does H, and two IHC stains (H. pylori
and CD8). that's it.   All the PT programs with CAP are overkill for what
little we do.  In the past I have sent slides reflecting my work to an
outside pathologist to review.  He would send back a evaluation based on my
work.  But, this year my inspection is due and the letter informing me of
the inspection stated that a CAP approved PT had to be used.
If anyone has any first hand knowledge on what I should do, please feel
free to email me.  Thanks!

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928-248-5259
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[Histonet] Now I have ribbons

[Gareth Davis via Histonet]

Thanks to everyone for their response to my problem with cutting last
week.  Things are much better, getting ribbons, now that I have increased
my angle to 8.  The humidity in Yuma is now actually above 10%, so I really
think that helps too.  I did try trimming the blocks to sharper corners,
but that didn't help much.  For some reason when trimming it made the block
"sticky" , even when I tried to smooth it out, and the ribbon would stick
onto the block.  But, like I said I am getting ribbons with the angle.
Thanks again.

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928-248-5259
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Re: [Histonet] No Ribbon

[Gareth Davis via Histonet]

Yes, I use ice for my blocks and get them as cold as possible.  It is a
high profile blade holder.  The paraffin is good for embedding and
processing.  I was told to use a low angle for Statcut blades, but I will
try it at 10.
Thanks

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[Histonet] No Ribbon

[Gareth Davis via Histonet]

I feel like I should be able to figure this one out, but I have been having
trouble with getting a ribbon for a while now.  I have a Leica Microtome
RM2125 and I use either a AccuEdge blade (I get one block to cut then it
starts to compress) or a StatCut blade (sections do not stick together at
all), both High Profile.  The angle is about 4 microns.  I change the angle
a lot to see if that makes a difference and it doesn't.  There are so many
factors that could be the issue, I think lack of humidity may be the main
one. So, suggestions please!!

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Re: [Histonet] solvent recyclers

[Gareth Davis via Histonet]

I have a CBG recycler and it has never given me any problems in the two
years I have been here.  The last two labs I worked in (in the past 15
years) both had CBG recyclers and loved them.
Gareth Davis

On Fri, Mar 24, 2017 at 11:00 AM, Bob Richmond via Histonet <
histonet@lists.utsouthwestern.edu> wrote:

> A few years ago the B/R spinning-band stills were definitely the still of
> choice for recovering histologic solvents, and the older generation of CBG
> machine were inadequate. I think though that the later generation of CBG
> stills predominates today. I don't know how they work. Could somebody give
> us an update on this subject?
>
> Bob Richmond
> Samurai Pathologist
> Maryville TN
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Re: [Histonet] : Recycled reagents in VIP processor

[Gareth Davis via Histonet]

Thank you for your perspective.  All input is helpful in our decision.
Gareth

On Wed, Mar 1, 2017 at 11:32 AM, White, Lisa M. via Histonet <
histonet@lists.utsouthwestern.edu> wrote:

> We have recycled here for over 14 years.  The cost of the recycling unit
> is not small.  It will take a while to recoup the cost.  We have found that
> xylene recycles well.  The substitutes are not infinitely recyclable.  The
> biggest savings is that you are not paying to have drums of xylene picked
> up as hazardous waste.  That is a savings in itself.  Yes you are pouring
> into a 'dirty carboy' and loading and unloading onto a machine, but you are
> either doing that or pouring dirty product into a bottle to be sent for
> pick up as well as placing new in the processor carboys.  Either way you
> have to handle product.
> If xylene or other solvent are out of range when your monitors are
> performed then the lab you work at must improve the ventilation as well as
> possibly provide chemical filter apparatus to be utilized by the staff.
>
> Just one more perspective.
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Re: [Histonet] Recycled reagents in VIP processor

[Gareth Davis via Histonet]

When using Xylene in a lab, it's my opinion that the savings is associated
with the size of the lab.  I am in a very small lab, where I am the only
Histotech.  I recycle both alcohol and Xylene and monitor both closely.
For me, it would cost effective to recycle and use as much as possible,
instead of purchasing fresh.  But, I agree, if it's a larger lab it may not
be as cost effective.  Also, if the lab is in the position to order a
substitute for Xylene, where it would be cheaper, than that seems to be the
optimum thing to do.

On Tue, Feb 28, 2017 at 1:39 PM, Margaryan, Naira <
naira.margar...@hsc.wvu.edu> wrote:

> Absolutely agreed!
>
> Naira
>
> -Original Message-
> From: Frazier, John [mailto:john.fraz...@roche.com]
> Sent: Tuesday, February 28, 2017 2:31 PM
> To: Jay Lundgren <jaylundg...@gmail.com>
> Cc: Margaryan, Naira <nmargar...@luriechildrens.org>; Gareth Davis <
> garethdavisy...@gmail.com>; histonet@lists.utsouthwestern.edu; Margaryan,
> Naira <naira.margar...@hsc.wvu.edu>
> Subject: Re: [Histonet] Recycled reagents in VIP processor
>
> As a six sigma consultant to histology laboratories, it has been my
> experience that recycling xylene and alcohol overall is not a cost saver.
> When you factor in both capital dollars and operational dollars, the
> savings is neutral. In addition to the neutral cost in recycling, you have
> to concern yourself with the quality of your in product on a daily basis.
> The last piece in the equation is the handling of Xylene with multiple
> touch points in between.  A movement within the histology world has begun
> with handling xylene (hazard
> waste) as little as possible and/or reducing or eliminating its use where
> possible.
>
> Sent from my iPhone
>
> > On Feb 27, 2017, at 6:25 PM, Jay Lundgren <jaylundg...@gmail.com> wrote:
> >
> > When people say they are saving money by recycling reagents I always
> > wonder if they are including tech time (to run the still) in their
> calculations.
> >
> > Sincerely,
> >
> > Jay A. Lundgren, M.S., HTL (ASCP)
> >
> > On Wed, Feb 22, 2017 at 2:32 PM, Margaryan, Naira via Histonet <
> > histonet@lists.utsouthwestern.edu> wrote:
> >
> >> WOULD LIKE TO KNOW AS WELL - IT IS WASTE OF MONEY
> >>
> >> Thanks,
> >> Naira
> >>
> >>
> >> Ranked nationally in all 10 pediatric specialties by U.S. News &
> >> World Report  (LCHOC Ver 1.0)
> >>
> >>
> >> This message contains confidential information and is intended only
> >> for the individual named. If you are not the named addressee you
> >> should not disseminate, distribute or copy this e-mail. Please notify
> >> the sender immediately by e-mail if you have received this e-mail by
> >> mistake and delete this e-mail from your system. E-mail transmission
> >> cannot be guaranteed to be secure or error-free as information could
> >> be intercepted, corrupted, lost, destroyed, arrive late or incomplete,
> or contain viruses.
> >> The sender therefore does not accept liability for any errors or
> >> omissions in the contents of this message, which arise as a result of
> >> e-mail transmission. If verification is required please request a
> >> hard-copy version.  (LCHOC VER 1.0)
> >>
> >> 
> >> From: Gareth Davis via Histonet [histonet@lists.utsouthwestern.edu]
> >> Sent: Wednesday, February 22, 2017 2:23 PM
> >> To: histonet@lists.utsouthwestern.edu
> >> Subject: [Histonet] Recycled reagents in VIP processor
> >>
> >> Hi,
> >> I was always told not to use recycled reagents, i.e. Alcohol and
> >> Xylene, in processors.  I am using a VIP 300, refurbished, and I
> >> would rather not use recycled reagents in it.  But, during the last
> >> CAP inspection they suggested I use the recycled to save money.  And
> >> now my administration wants to cut cost.  Just wanted to know what labs
> were doing.
> >> Thanks,
> >>
> >>
> >> --
> >> Ms. Gareth B. Davis, B.S., HT, QIHC (ASCP)cm Yuma Gastroenterology
> >> Yuma, AZ 85364
> >> 928-248-5259
> >> ___
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> >> Histonet mailing list
> >> Histonet@lists.utsouthwestern.edu
> >> http://lists.utsouthwestern.edu/mailman/listinfo/histonet
> >>
> >
>



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[Histonet] Great input on recycled reagents

[Gareth Davis via Histonet]

Thank you so much.  I will start using them on the processor, but start
slowly.  Then I can monitor to make sure no problems occur.  I really
appreciate all the responses.
Thanks,

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928-248-5259
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[Histonet] Recycled reagents in VIP processor

[Gareth Davis via Histonet]

Hi,
I was always told not to use recycled reagents, i.e. Alcohol and Xylene, in
processors.  I am using a VIP 300, refurbished, and I would rather not use
recycled reagents in it.  But, during the last CAP inspection they
suggested I use the recycled to save money.  And now my administration
wants to cut cost.  Just wanted to know what labs were doing.
Thanks,


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928-248-5259
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[Histonet] IHC Medicare policy

[Gareth Davis via Histonet]

Okay, I know that for Medicare cases we cannot order Special or IHC stains 
upfront.  They can be ordered after the pathologist reads the slide.  But, what 
are labs doing for other insurances?  The lab I work in only does H. Pylori and 
CD 8 on GI cases. I understand cancer cases are different.  I am basically 
interested in what labs, like our GI lab, are doing about non-Medicare cases.  
Are you doing Special and IHC stains, the clinical doctors order, upfront? 
Thanks, 
Gareth Davis, B.S., HT, QIHC (ASCP)cm

Sent from my iPhone
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[Histonet] correction on CAP policy

[Gareth Davis via Histonet]

After researching and calling CAP I have realized it is not a CAP policy
for pathologist to order IHC/SS only after viewing the H  But, it is an
active LCD.  I am new to regulations in labs, being my first time to run
one.  Pardon my mistake and thanks for the responses.

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[Histonet] pathologist adding IHC stains

[Gareth Davis via Histonet]

How are labs indicating, on reports, that the pathologist has ordered IHC
stains after reading the H slides. With the new CAP rules regarding
ordering IHC stains, i.e. H. pylori and others, that are usually ordered
initially.  I basically would like an example of wording for the reports,
when the pathologist does order a stain.  Any suggestions?
Thanks

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[Histonet] Processing time for small biopsies

[Gareth Davis via Histonet]

Hi,
Recently I saw a post from someone looking for a protocol for processing
small biopsies.  I looked on the histonet search, but found that to be too
time consuming to locate the post.  Anyway, I hoping to get some opinions
on good process times for small biopsies.  I recently changed my paraffin
brand and now I have chatter on my sections.


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[Histonet] H.pylori question

[Gareth Davis via Histonet]

Okay, so I know I have heard rumors about the H.pylori testing being
affected by Medicare.  We currently do the H. pylori IHC stain on all
gastric biopsies.  Has anyone heard that Medicare will change, and we will
no longer be able to do it on all cases?  The last lab I worked in, in
Tennessee, stopped doing it all cases, because of the Medicare changes.
But, here in Arizona, they are still doing it.
What's the scoop?


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[Histonet] Ventana Ultra vs. Leica Bond Max

[Gareth Davis via Histonet]

I was interested in anyone's opinion on the new Ventana Benchmark Ultra and
Leica's Bond Max.  I currently use the Ventana Benchmark XT.  Ventana wants
us to upgrade to the Ultra.  Because our contract will be up in a year, my
manager and lab owners want me to check out other options.  Hoping to get a
better deal and a better instrument.  The Benchmark XT slide heaters keep
going out and the H. pylori is awful, Ventana swears it's the instruments
fault.
Thanks,

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[Histonet] Transport training for formalin fixed specimens

[Gareth Davis via Histonet]

Okay, is there a training course for just transportion formalin fixed
specimens.  CAP told me last year that anyone picking up specimens for us
has to go through a training course.  The inspector seemed to be more
concerned with the employees knowledge of formalin and possible spills.
So, does anyone know what course I am suppose to be using?
 I have looked on the CDC website, but all the courses I find refer to
specific infectious disease.
Thanks in advance.
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Re: [Histonet] Ventana/Roche H. pylori

[Gareth Davis via Histonet]

Thank you to all who have been responding.  Very helpful information.
I have been seeing this problem for almost a year.  We have contacted YRMC
and know their option.  Unfortunately, we are under contract.
But, the previous lab I worked in had the same issue, but with DAKO. But,
the debris showed up in the negative slides also.  They finally started
only using fresh DAB, it made a difference. Wonder if they should filter
everything too.

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[Histonet] Ventana/Roche H. pylori antibody

[Gareth Davis via Histonet]

Hi,
I have read on the Histonet, in the past, that other labs are having
trouble with the H.pylori antibody from Ventana/Roche.  I get "debris" that
looks like the H. pylori bug, except it appears to "float" above the
section and not in the normal areas that H. pylori stains.  Is anyone else
still having the problem?  Or if you had the problem, was it resolved?
Roche did a decon on our machine on two different occasions, which did not
help. Now Roche seems to think that our machine is old and causing the
problem.
Anyone's help would be appreciated.
Thanks

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[Histonet] Medical waste in Arizona

[Gareth Davis via Histonet]

Does anyone know if Arizona considers the cassette lids, bio bags and kim
wipes,  used on water baths, as medical waste.  The recent post about being
dinged for not putting those in medical waste, was the first I heard of
anything like that.  But was hoping that was just California.

-- 
Gareth B. Davis, HT
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