NERVE BIOPSY

Instructions for Surgeons and Nurses

Protocol for Treatment Rm 3, Main and Mott OR and VAH

I.*        The specimen should be 5 cm or longer.  The nerve should be gently separated from the surrounding soft tissues and great care should be taken not to let the nerve to dry out or flattened by vigorously moving hemostat under the nerve.  Please remember if not done carefully it will render the nerve specimen flattened, unstretchable, and dry.  In such situations, no meaningful electron microscopy can be performed.  The suture should be placed at the proximal or distal portion of the biopsy and the nerve should be transected beyond the suture.  After that, the nerve should be immediately placed on the dry index card and by holding on to one end of it with forceps gently dragged over the surface of the card so it will adhere to it within seconds.  Next, quickly cut the card around the attached nerve, divide it in two portions, and drop the first portion in the vial with glutaraldehyde.  This procedure should not take longer than several seconds.  The other portion that is intended for formalin may either follow the glutaraldehyde one immediately into formalin fixative or under adverse circumstances, it can wait up to 30 minutes being wrapped in saline moist gauze or tefla pad and then dropped in formalin.

For the good quality of glutaraldehyde specimen it should never be exposed to air for longer than a few seconds and never flattened or damaged by any instrument.

II.        Both specimens of the nerve securely covered by a full vial of fixative should be delivered to the receiving window of the histology lab to be logged in and processed further.

*          See picture attached

Handling of NERVE BIOPSY

(for Lab Personnel and House Officers at the UM and VAH):

1.                  The specimen received fixed in formalin should be placed in a cassette and divided at the embedding into 2-3 cross-sections and 1 or 2 longitudinal sections, depending on the length of the specimen.

2.                  Specimen in glutaraldehyde should be placed in the refrigerator to await to be picked up by the EM personnel.  It is not recommended for the nerve to spend more than 3 to 5 hours in glutaraldehyde.  It renders the specimen brittle and difficult to tease.

3.                  If a fresh nerve wrapped in saline soaked tefla pad received from outside, the nerve should be gently stretched at the normal length by holding to one end with forceps and dragging it over the index card.  It should not take longer than a few seconds, after which the index card close to the nerve immediately cut around and the nerve sectioned in halves with a sharp blade.  As quickly as possible one half should be placed in the vial with glutaraldehyde.  It is of utmost importance not to delay this step of procedure.  The second portion should be placed in formalin.  The formalin fixed specimen remains at room temperature until the processing, whereas glutaraldehyde fixed specimen should be kept in the refrigerator until it is picked up by the EM personnel.

Please remember:  Handle the nerve first.  Dictate the specimen description after it has been placed in the fixative.

* See the picture attached