Anatomical Pathology Nerve Biopsy Collection Pre Collection Dispatch Only fresh specimens are suitable for analysis. At least the day prior to biopsy phone the SA Pathology Muscle & Nerve Laboratory (8222 3588) to provide biopsy and patient details. If calling after hours please ring on-call mobile 0435 960 022. yy The Biopsy yy yy yy yy yy Do not use diathermy or traumatise the nerve. Do not dab with gauze or grab with forceps (other than at cut ends). Clip or tie small vessels – avoids haemostasis. yy Cooling has a detrimental effect on biopsies - do not cool or use ice Label the request form: ‘URGENT – SA Pathology MUSCLE & NERVE LAB’ Place specimen, request form and clinical history into a specimen bag, esky or manilla envelope. Cut off and affix label below securely to outer package Specimen Pick Up Follow instructions appropriate to your site: Procedure Private hospitals / Rooms / Public Hosp Path Labs yy yy Phone SA Pathology Call Centre 8222 3000 yy Request a taxi (not SA Pathology courier) to ‘Deliver Urgent Fresh Specimen’ to SA Pathology Frome Rd. yy Give pick up location, your name & contact number. yy yy yy yy yy yy yy yy yy yy Sural nerve is preferred (ankle level). ADULT: Minimum length 6cm. PAEDIATRIC: As much as practicable. Minimise attatched adipose tissue. Tie bleeding points, no diathermy. Excise proximal then distal end. Grab nerve with forceps no more than 1-2mm from either cut end to avoid irreversible compression artifact. Place nerve directly into a sterile container. Leave fresh Never place sample in formalin, saline, ice or on cardboard, and never wrap in dry or saline moistened gauze. Label the container – Patient Name, DOB, biopsy site and time of removal. Complete an SA Pathology Request Form with patient details and treating clinician’s name. Specify tests - Histology, EM, immuno-histochemistry. Clinical history is mandatory – please complete p2. Public hospital theatres RAH - phone ext 23588 Muscle & Nerve Laboratory TQEH - phone ext 26490 Central Pathology FMC - phone ext 64155 Anatomical Pathology LMH - phone ext 29281 Anatomical Pathology WCH - phone ext 16315 Anatomical Pathology MOD - phone ext 2029 Specimen Reception RGH only (refer to private hospital despatch protocol above). You MUST NOTIFY the Muscle & Nerve Lab on 8222 3588 once specimen has been picked up by Taxi. Except for RAH & WCH. URGENT MEDICAL DELIVERY direct sunlight. To: SA IMVS Pathology Specimen Specimen Reception ON ARRIVAL Phone Reception Frome Road, Adelaide, SA 23588 immediately(Muscle & Nerve Contains Specimen FromeFresh Road, Lab) sunlight. Adelaide, NO ICE. DoSA Not Cool. Keep out of direct PUB-0014 v3 After Hours 0435 960 Contains Fresh Specimen ON ARRIVAL Phone 23588 immediately(Muscle & Nerve Lab) 022 NO ICE. Do Not Cool. Keep out of After Hours 0435 960 022 Page 1 of 2 Anatomical Pathology Nerve Biopsy Collection Clinical History The investigations carried out on this tissue sample will be determined by the clinical context of the case hence we require specific clinical information before the biopsy can be further investigated. Delay in receiving clinical information may result in delayed processing and reporting. Please provide details requested below, and send this form with the specimen to the SA Pathology or fax to 8222 3392 prior to biopsy. Family name DOB Ethnicity / Given names / UR  Aboriginal and/or  Torres Strait Islander  Other (Please specify) Presenting complaint Approximate duration of symptoms Cramping after exercise?  Yes  No Relevant past medical history Relevant family history Relevant drug history On steroids at time of biopsy?  Yes  No CK Levels EMG findings Treating Clinician’s Name and Contact Details PUB-0014 v3 Page 2 of 2