Tuesday, June 21, 2011

Gross Room Survival Guide Part 4. Frozen sections

Frozen sections are like buses, you wait for ages then 12 arrive at the same time. The key to handling the stress of the frozen station is to be organized and be prepared. During your rotation month familiarize yourself with every cryostat your lab has. You may prefer one machine over the rest but you should be able to cut a good frozen section on all of them. A good tissue to practice on is placenta. Once you are good at that, try cutting gastrointestinal organs and skin. Skin is best cut with the epidermis positioned perpendicular to the blade. Trim excess fat unless it is diagnostically relevant. Once again, have your supplies checked. Everything should be clean and available within easy reach.

How to handle multiple frozen sections? Remember - you have the control of the frozen section. Do not let anyone, your attending included, to manipulate, move, or otherwise interfere with the specimen without checking with you first. This is a HUGE safety issue. If you receive multiple specimens and need help – delegate it. Tell people what exactly you want them to do. There is nothing worse than people coming up to the frozen section bench and grabbing things without asking, albeit trying to help. This creates confusion and compromises patient care as parts and even whole specimens can be switched.

Our gross room has two cryostats. The way I handle multiple frozen sections is as follows. If I receive two or three parts on the same patient I prefer to handle them myself. If it’s more than that, or two different specimens, I’ll ask for help from another resident. The way to go about it is to hand over one of the specimens and then forget about it for the time being and let them have their way with it. They should be able to handle it by themselves, and you should concentrate on the specimen of yours. If you get multiple parts (e.g. multiple margins on a squamous cell carcinoma of the skin) it makes sense to involve a third person to do the staining. This way two people cut and one stains. It is not practical, and even counterproductive, to have more people involved in cutting than you have cryostat units. It only creates unnecessary confusion.

When you get multiple frozens, the reporting time will be above recommended. There is nothing you can do about it. Therefore, there is no point in getting worked up over it. Stay calm at all times and know what you’re doing.

After you are done with a frozen, vacuum or otherwise clean the cryostat. Do it after every specimen and not just at the end of the day. The tissue will occasionally chip off of the chuck and fall down to the bottom of the cryostat. Now imagine having to fish it out from shavings of OCT and tissue that accumulated there from the previous frozen sections, with everything melting and sticking to your fingers. Not pretty.

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