Re: [Histonet] Losing sections
Terri this sounds entirely logical! I will try running a blank rack to warm the drying station up before running a single deeper slide. My pathologist and I will both be very happy if it makes a difference! Thank you! -Original Message- From: Terri Braud Sent: Friday, June 16, 2023 12:56 PM To: histonet@lists.utsouthwestern.edu Cc: Kolman, Kimberly D. Subject: [EXTERNAL] RE: Losing sections I may have an answer for you. Your Prisma stainer only runs the heater when needed. With full runs, the oven stays warm, but later stain runs allow for the heater to cool down. When your rack goes into the dry station, the heat comes up from the bottom to start to dry the slide, thus the bottom sections have enough dry time, but the top don't, and they wash off. We used to encounter the same problem and that is what we hypothesized was happening, because, when we ran a blank rack through 10 minutes before loading the late rack, we were fine. Or, when we dried in a 60'C oven for 15 minutes when loading that lone late rack, we were fine. Just an idea, but for us, no more wash offs of top sections. Terri L. Braud, HT(ASCP) HNL Laboratories for Holy Redeemer Hospital 1648 Huntingdon Pike Meadowbrook, PA 19046 Ph: 215-938-3689 Fax: 215-938-2021 Message: 4 Date: Fri, 16 Jun 2023 14:25:31 +0000 From: "Kolman, Kimberly D." Subject: [Histonet] losing sections For your entertainment, I have a bizarre phenomenon to share with the group: I am occasionally losing the TOP section on a deeper cut H&E slide. Full run of daily slides do not show this issue. A deeper slide cut later in the day might, or a deeper slide cut first thing in the morning may, when I've not run a full daily run. I have switched to a different lot number of standard slides. I have used adhesive slides. Distilled water for the water bath same as I have used for 20 years. Using Sta-On adhesive in the water bath. H&E stain done on a Prisma Plus stainer, with no changes in staining procedure. There have been NO changes to any of my procedures. This is a very random happening that is boggling my mind! If any section was going to fall off, I'd think it would be the 2nd section - (last one picked up from the water bath). I've tried to make sure the slide has thoroughly dried before putting it on the stainer. Slides appear clean, and no greasy fingerprints on the slide. The one I always lose is the TOP section/very first level taken. Any ideas? Do I just have a Histo Gremlin here? Thanks for your input. Kim Kimberly D. Kolman, HT (ASCP) Eastern Kansas Health Care System Eisenhower VA Medical Center - Histology 115 4101 S. 4th St. Trfwy. Leavenworth, KS 66048 913-682-2000 x 62537 Fax: 913-758-4193 ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] losing sections
For your entertainment, I have a bizarre phenomenon to share with the group: I am occasionally losing the TOP section on a deeper cut H&E slide. Full run of daily slides do not show this issue. A deeper slide cut later in the day might, or a deeper slide cut first thing in the morning may, when I've not run a full daily run. I have switched to a different lot number of standard slides. I have used adhesive slides. Distilled water for the water bath same as I have used for 20 years. Using Sta-On adhesive in the water bath. H&E stain done on a Prisma Plus stainer, with no changes in staining procedure. There have been NO changes to any of my procedures. This is a very random happening that is boggling my mind! If any section was going to fall off, I'd think it would be the 2nd section - (last one picked up from the water bath). I've tried to make sure the slide has thoroughly dried before putting it on the stainer. Slides appear clean, and no greasy fingerprints on the slide. The one I always lose is the TOP section/very first level taken. Any ideas? Do I just have a Histo Gremlin here? Thanks for your input. Kim Kimberly D. Kolman, HT (ASCP) Eastern Kansas Health Care System Eisenhower VA Medical Center - Histology 115 4101 S. 4th St. Trfwy. Leavenworth, KS 66048 913-682-2000 x 62537 Fax: 913-758-4193 ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] leaky formalin containers
Has anyone been seeing a rash of leaky formalin specimen containers lately? Specifically the small 4oz red lid containers from a certain manufacturer? We are seeing leakage from probably 70-80% of the containers in the last couple of months. Multiple lot #s and multiple clinic locations. It is being addressed inhouse (please tighten/don't over tighten/leave containers upright.) Also - our lot#s could be some older ones as we are just now picking back up from the COVID shut down. These have likely been sitting in the clinics for a while so they might not be any that are currently in circulation out there. Just thought I'd see if there is a problem elsewhere. TIA for any responses. Kim Kimberly D. Kolman, HT (ASCP) VA Eastern Kansas Health Care System Dwight D. Eisenhower VA Medical Center 4101 S. 4th St. Trfwy. Leavenworth, Ks 66048 913-682-2000 x 52537 kim.kol...@va.gov ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] room temperature in Histology labs
Hello All; Can anyone suggest a required temperature range for Histology Labs? Specifically in regards to performing paraffin embedding and microtomy? I think room temperature swings of 66 to 83 degrees F are excessive and I am seeing some issues with paraffin cooling too quickly while embedding as well as my paraffin ribbons blowing around before I get them to the water bath. Engineering insists the temps and air speed are within their "required range" (according to the thermostat on the wall..). Thanks for your input. Kim Kimberly D. Kolman, HT (ASCP) VA Eastern Kansas Health Care System Dwight D. Eisenhower VA Medical Center 4101 S. 4th St. Trfwy. Leavenworth, Ks 66048 913-682-2000 x 52537 kim.kol...@va.gov ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] cervical biopsy method
Looking for any folks out there who have experience with cervical biopsies obtained using the "SpiraBrush" technique. It is from the Histologics Company and employs a fabric 'brush' to obtain the sample instead of the standard punch instrument. One of our gynecologists would like to begin using it here to enhance samples; I am unfamiliar with it; my pathologist as well. We wonder how labor-intensive it is to retrieve the fragments and how they well process. My understanding is that the fragments would be very tiny; it sounds very unlikely to be able to orient them during embedding. Any input appreciated! Thanks, Kim Kimberly D. Kolman, HT (ASCP) VA Eastern Kansas Health Care System Dwight D. Eisenhower VA Medical Center 4101 S. 4th St. Trfwy. Leavenworth, KS 66048 913-682-2000 x 52537 Fax: 913-758-4193 kim.kol...@va.gov ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] baskets for VIP processor
Has anyone noticed the stainless steel baskets for a Sakura VIP-6 tissue processor warping on the sides? Still perfectly useable; mine just start bowing out on each side. They've not been dropped. It does leave a small gap on each side that I suppose a cassette could sneak out of. I occasionally pound them back into shape and they are fine. Thanks, Kim Kimberly D. Kolman, HT (ASCP) VA Eastern Kansas Health Care System Dwight D. Eisenhower VA Medical Center 4101 S. 4th St. Trfwy. Leavenworth, KS 66048 913-682-2000 x 52537 Fax: 913-758-4193 kim.kol...@va.gov ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] fixing fatty skin specimens
Does anyone out there have any tips for getting large fatty skin excisions formalin fixed for gross dissection in a reasonable amount of time? Thank you. Kim Kolman Kimberly D. Kolman, HT, (ASCP) VA Eastern Kansas Health Care System Dwight D. Eisenhower VA Medical Center Histology - 115 4101 S. 4th St. Trfwy. Leavenworth, KS 66048 913-682-2000x52537 Fax: 913-758-4193 kim.kol...@va.gov ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [EXTERNAL] RE: [Histonet] Kim's question - order documentation
Ok I guess I'm coming from a different world; so many things, like adequacy on an FNA, FS or the like are a given, as are ER, PR, etc on tumors. We have access to patient history here so are able to get a more thorough picture of what a clinician is looking for. Of course these are all addressed in the report. Clinicians asking for something 'wild-hair' are not the last word; our pathologists have the final say on what testing may or may not be done. If the clinicians' request is not honored, I don't see the reason for noting it. I think we are well covered with our current practice. Just have to hope CAP thinks so as well.. :) Thanks everyone! Kim -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Martha Ward-Pathology Sent: Tuesday, October 07, 2014 2:03 PM To: Cheryl; histonet@lists.utsouthwestern.edu Subject: [EXTERNAL] RE: [Histonet] Kim's question - order documentation I think this is an interesting question. We frequently get phone calls from clinicians asking for ER, PR, Her2 or sometimes just other IHC stainsjust yesterday someone wanted CYK 7 and CYK 20 on a cytology block. We ask that they either call the pathologist who signed out the case and get them to order the stains, or with something like the breast panel, ask that they fax or email us, stating exactly what they want, the patient demographics and surgical number, etc. That way at least we have a paper trail for the files should anyone ask why we did the testing. Martha Ward, MT (ASCP) QIHC Manager Molecular Diagnostics Lab Medical Center Boulevard \ Winston-Salem, NC 27157 p 336.716.2109 \ f 336.716.5890 mw...@wakehealth.edu -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Cheryl Sent: Tuesday, October 07, 2014 1:14 PM To: histonet@lists.utsouthwestern.edu Subject: [Histonet] Kim's question - order documentation Kim- Your histonet question may not be as complicated as it might seem. Sometimes it's easier to look at these things backwards. What is the desired outcome? If there is an order -- say for a GMS--and it wasn't ordered by one of your pathologists, where did it come from? Can you track back and figure out what doctor ordered it and verify it's a valid request so the testing AND billing is appropriate (not fraudulent). When the surgeon or clinician collects the sample at the surgery or in their office, sometimes they want something specific -- say 'evaluate for fungus'. They may include this in the surgical notes, the office chart -- other places. His support staff will copy this onto the requisition or somewhere you get the request other than the requisition. If you keep copies of the req and other incoming documentation-- you've satisfied the requirement--you can track the source of the order. If you don't, include it in the gross description or notes that are transcribed onto the report so that you have a durable record that you can find (may take a while if it's the archived chart, but you can find it). This goes back to the requirement that orders can't just come from anyone or for any wild-hair reason-- and you have to be able to substantiate or prove the valid source of an ordered (and billed) test. Does that help? Cheryl Cheryl Kerry, HT(ASCP) Full Staff Inc. Staffing the AP Lab - one Great Tech at a time. 281.852.9457 Office 800.756.3309 Phone and Fax ad...@fullstaff.org ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] need help on a cap question
I could use some help clarifying this question: **NEW** 04/21/2014 ANP.11525 Tissue/Cytology Assessment Record Phase I If a statement of adequacy, preliminary diagnosis, or recommendations for additional studies is provided at the time of tissue and cytology sample collection, documentation of that statement is maintained. NOTE: Documentation might include a note in the medical record or in the final report. Is this really asking that if the ordering physician wants something in particular, it must be noted somewhere?I'm hung up on the mention of 'at the time of sample collection'. Thanks, Kim Kim Kolman Kimberly D. Kolman, HT, (ASCP) VA Eastern Kansas Health Care System Dwight D. Eisenhower VA Medical Center Histology - 115 4101 S. 4th St. Trfwy. Leavenworth, KS 66048 913-682-2000x52537 Fax: 913-758-4193 kim.kol...@va.gov ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] RE: [EXTERNAL] RE: slide filing cabinets
Thanks all; now if I can get someone to give me the go-ahead on space, I can get to stacking away! -Original Message- From: wanda.sm...@hcahealthcare.com [mailto:wanda.sm...@hcahealthcare.com] Sent: Monday, August 25, 2014 12:39 PM To: Kolman, Kimberly D.; Histonet@lists.utsouthwestern.edu Subject: [EXTERNAL] RE: slide filing cabinets I have been stacking the TT II plastic block file cabinets 5 high for years and I have never had a problem with them. Yes, they do hold up well! W WANDA G. SMITH, HTL(ASCP)HT Pathology Supervisor TRIDENT MEDICAL CENTER 9330 Medical Plaza Drive Charleston, SC 29406 843-847-4586 843-847-4296 fax This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing, or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email or contact the sender at the number listed. -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Kolman, Kimberly D. Sent: Monday, August 25, 2014 1:06 PM To: Histonet@lists.utsouthwestern.edu Subject: [Histonet] slide filing cabinets Dear Histo-netters: I'm looking to re-arrange my paraffin block storage; currently the plastic block cabinets are on a shelving unit. Does anyone have any experience with how well the old Tissue Tek plastic 6-drawer block cabinets stack - on top of each other? Can I safely do a stack of 5? And will they hold up well? Thanks in advance. Kim Kim Kolman Kimberly D. Kolman, HT, (ASCP) VA Eastern Kansas Health Care System Dwight D. Eisenhower VA Medical Center Histology - 115 4101 S. 4th St. Trfwy. Leavenworth, KS 66048 913-682-2000x52537 Fax: 913-758-4193 ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] slide filing cabinets
Dear Histo-netters: I'm looking to re-arrange my paraffin block storage; currently the plastic block cabinets are on a shelving unit. Does anyone have any experience with how well the old Tissue Tek plastic 6-drawer block cabinets stack - on top of each other? Can I safely do a stack of 5? And will they hold up well? Thanks in advance. Kim Kim Kolman Kimberly D. Kolman, HT, (ASCP) VA Eastern Kansas Health Care System Dwight D. Eisenhower VA Medical Center Histology - 115 4101 S. 4th St. Trfwy. Leavenworth, KS 66048 913-682-2000x52537 Fax: 913-758-4193 ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] cryostat design
Hello all; Is anyone aware of a cryostat design in which the microtome cabinet would sit at bench level? In other words, it would function like any regular bench microtome but be housed in a cold cabinet like a cryostat? This would enable the operator to work in a desk position instead of uncomfortably being hunched over a cryostat cabinet. Thanks in advance, Kim Kimberly D. Kolman, HT (ASCP) VA Eastern Kansas Health Care System 4101 S 4th St Trfwy Leavenworth KS 66048 913-682-2000x 52537 Fax: 913-758-4193 ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] cryostat decontamination
Has anyone come up with a documented and referenced procedure for decontamination of a cryostat using 37% Formaldehyde? I pulled up old notes in the Histonet archives and saw that Tim Morken was working on this but that was a number of years ago. Thanks, Kim Kimberly D. Kolman, HT, (ASCP) Diagnostics 115 VA Eastern Kansas Health Care System 4101 S. 4th St. Trfwy. Leavenworth, KS 66048 ph: 913-682-2000 x 52537/52539 ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] Re: dissecting pins
Thanks everyone for all the replies. I've been perusing the office supply websites but had not thought of sewing supplies - I'll check that out! It will be a challenge to find the items my docs here will adjust to, also to get Supply to order hypodermic needles for this use; I am fighting with them now to get them to order non-sterile 4x4 gauze. Some nice inspection person has insisted to them that all gauze must be sterile.so now I can spend my time ripping open individual sterile 4x4 packs to have ready for coverslipping, cleaning the embedding center, etc nothing better to do with my time, I guess...! -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Bob Richmond Sent: Wednesday, September 12, 2012 8:51 AM To: histonet@lists.utsouthwestern.edu Subject: [Histonet] Re: dissecting pins Kimberly D. Kolman, HT, (ASCP) at the VA center in Leavenworth KS asks: >>Does anyone know where I can find some large-head pins to use when >>pinning out large tissue specimens for fixation? We already use the >>large "T-pins" and the regular bulletin board push-pins are too small. >>We need something with a larger, easier to grip plastic head, and long >>(at least ½ inch) pin shaft. - Thanks for your help (and hope it might >>be one of our 'contract vendors', or I won't be able to use them >>anyway... L)<< Go to any of the big stores that sell sewing supplies - they have innumerable varieties of pins - and pick out what you want. This is one of a number of items used in surgical grossing that you have to buy cheaply on the open market or scrounge, like hacksaws for cutting bone, plastic rulers, metal skewers - I have a whole kit bag of such items that I carry to my various jobs. Bob Richmond Samurai Pathologist Maryville TN ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] dissecting pins
Does anyone know where I can find some large-head pins to use when pinning out large tissue specimens for fixation? We already use the large "T-pins" and the regular bulletin board push-pins are too small. We need something with a larger, easier to grip plastic head, and long (at least ½ inch) pin shaft. Thanks for your help (and hope it might be one of our 'contract vendors', or I won't be able to use them anyway... L) Kim Kimberly D. Kolman, HT, (ASCP) Diagnostics 115 VA Eastern Kansas Health Care System 4101 S. 4th St. Trfwy. Leavenworth, KS 66048 ph: 913-682-2000 x 52537/52539 ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] alcohol hydrometer
Can anyone tell me where I could find a small (6-7 inches long) alcohol hydrometer? Needs to read to 200% proof. All I'm finding is a 12" size and I would like to be able to test in a 100ml cylinder. Thanks for your help, Kim Kimberly D. Kolman, HT, (ASCP) Diagnostics 115 VA Eastern Kansas Health Care System 4101 S. 4th St. Trfwy. Leavenworth, KS 66048 ph: 913-682-2000 x 52537/52539 ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] jpc and broken slides
I'm sure I missed some of the talk on the 'afip closing' thread' but has anyone mentioned a NEW problem with broken slides on JPC consult cases? For those of you able to use JPC for consults: All of the sudden, there have been a number of cases that our lab has sent to JPC that they've called and complained that some slides were broken (they're claiming upon receipt). We've been packaging them the very same way as when they were sent to AFIP. Not sure what else we could do. Kimberly D. Kolman, HT, (ASCP) Diagnostics 115 VA Eastern Kansas Health Care System 4101 S. 4th St. Trfwy. Leavenworth, KS 66048 ph: 913-682-2000 x 52537/52539 ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] paraffin temps
How do you all handle adjustments in paraffin temps depending on different brands of paraffins? Last time I ordered, I received a different brand of Paraplast than my usual and it is obvious that the temp on the tissue processor needs to be adjusted up, as the paraffin is collecting in large amounts all over the top of the cassette basket and is difficult to clean. To adjust the temps on the paraffin baths works just fine (as in up to 60 degrees), which raises the actual paraffin temps up to 62-64 degrees and is then back to easier melting and cleaning, but the manufacturer packaging states 'do not heat over 62 degrees'. I can revise my QC maintenance sheets to alter the temperature ranges so I am not constantly out of range; however there is the issue of the packaging Can't wait to get all this brand used up; I want my McCormick back! Kimberly D. Kolman, HT, (ASCP) Diagnostics 115 VA Eastern Kansas Health Care System 4101 S. 4th St. Trfwy. Leavenworth, KS 66048 ph: 913-682-2000 x 52537/52539 ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] tissue retention times
We are a small Mohs operation, but we just process and paraffin block all our remaining specimens and file them with the rest of our pathology cases. This worked for CAP anyway. Kim Kolman, HT, (ASCP) VA Eastern Kansas Health Care System Leavenworth, Ks 66048 -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Ingles Claire Sent: Thursday, January 21, 2010 12:11 PM To: histonet@lists.utsouthwestern.edu Subject: [Histonet] tissue retention times OK, everybody crack open your JCAHO requirement manuals... We are a MOHS lab and were surveyed by Joint Commission about 2 months ago. During the survey, we were cited because we only retain our physical tissue specimens for 24 hours, as they remain fresh and are not fixed. We throw the tissue the following afternoon vs. retaining for the "1 week after microscopic sections are examined and reports are reviewed and signed." (Standard #QC.2.120) Has anyone else (specifically a Mohs lab) been cited for this? We are currently trying to appeal, but have been denied so far. I am having a teleconference with the JCAHO powers that be to try and get the appeal going again, but I'm not the lawyer type. The letter states that their interpretation is that even if the tissue is not regarded as 'gross' tissue, any 'useable' tissue must be retained for a minimum of a week after the case is signed off on.I am thinking on focusing on the 'useable' bit as related to diagnostic value of delayed retained fresh tissue processing i.e. freeze artifact, tissue degredation, inability to perform ancillary testing, etc. Also, what is the definition of 'reviewed and signed reports'? Does this mean when the case is finalized, or just the tissue sections in question? We sometimes have patients that go a month + between Mohs procedures on the same positive lesion. We will probably have to get a -80 freezer for this if the appeal doesn't go through. Not to mention the fact that some of our cases are not resolved for months. We would have constantly search when cases are finalized to know when we can dispose of the tissue. FYI, the letter also states that the JCAHO standard is more stringent than the CLIA standard, so I'm not even really going to use it in arguments. HELP! Claire Ingles UW Hospital & Clinics Madison WI ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
