Air transport of containers w/ >30 cc's of formalin?

[subbacultcha]

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I am at a large outpatient lab, signing out cases from over five
states, where most of our tissue specimens are small (easily shipped)
biopsies. The notable exception is an American Indian account, which handles large specimens from remote hospitals on the Navajo nation. We don't get many large specimens from them, mostly placentas, uteri, occasional colectomies, maybe 6-10 a week. Our PA had to take an unexpected leave of absence, which left me grossing. I found that these large items were arriving either fresh or with only a splash of formalin -- after two days' worth of transport (by ground and then by air to our city), they were arriving in very sorry shape.

Some investigative work revealed that they are not putting formalin on because there are some nebulous restrictions regarding formalin and air transport - in that specimens must have 30 cc's or less to be flown. Is this true? Has anyone dealt with a similar issue? What are the options... a non-formalin based fixative (not acceptable for breast tissue and ER/PR), changing mode of transport to ground (costly, cumbersome, HUGE delay in TAT), what else? Any ideas, insights would be appreciated.

 

[pathstudent]

The minimum formalin:tissue volume ratio is 10:1 and the ideal is 20:1. Formalin should also be changed every 12 hours for ideal fixation.

But what do you care about quality. YOu work for a large outpatient reference lab who only cares about increasing profit. They can't be wasting money on a few extra ounces of formalin. In fact you should sign that stuff out raw.

Hope that helps.

I am at a large outpatient lab, signing out cases from over five
states, where most of our tissue specimens are small (easily shipped)
biopsies. The notable exception is an American Indian account, which handles large specimens from remote hospitals on the Navajo nation. We don't get many large specimens from them, mostly placentas, uteri, occasional colectomies, maybe 6-10 a week. Our PA had to take an unexpected leave of absence, which left me grossing. I found that these large items were arriving either fresh or with only a splash of formalin -- after two days' worth of transport (by ground and then by air to our city), they were arriving in very sorry shape.

Some investigative work revealed that they are not putting formalin on because there are some nebulous restrictions regarding formalin and air transport - in that specimens must have 30 cc's or less to be flown. Is this true? Has anyone dealt with a similar issue? What are the options... a non-formalin based fixative (not acceptable for breast tissue and ER/PR), changing mode of transport to ground (costly, cumbersome, HUGE delay in TAT), what else? Any ideas, insights would be appreciated.

 

[Art]

I am at a large outpatient lab, signing out cases from over five
states, where most of our tissue specimens are small (easily shipped)
biopsies. The notable exception is an American Indian account, which handles large specimens from remote hospitals on the Navajo nation. We don't get many large specimens from them, mostly placentas, uteri, occasional colectomies, maybe 6-10 a week. Our PA had to take an unexpected leave of absence, which left me grossing. I found that these large items were arriving either fresh or with only a splash of formalin -- after two days' worth of transport (by ground and then by air to our city), they were arriving in very sorry shape.

Some investigative work revealed that they are not putting formalin on because there are some nebulous restrictions regarding formalin and air transport - in that specimens must have 30 cc's or less to be flown. Is this true? Has anyone dealt with a similar issue? What are the options... a non-formalin based fixative (not acceptable for breast tissue and ER/PR), changing mode of transport to ground (costly, cumbersome, HUGE delay in TAT), what else? Any ideas, insights would be appreciated.

Shouldn't you ask the actual carrier, rather than a bunch of yahoos on the internet?

 

[KCShaw]

I doubt I know any more than you've stumbled upon. The 30 mL limit seems to be for hazard class 9 formaldehyde in 10-24.9% concentrations -- which should be distinct from typical 10% neutral buffered formalin, which is only 3.7% formaldehyde and shouldn't have volume restrictions if I'm interpreting correctly. However, looking at the MSDS for 10% neutral buffered formalin from Fisher Scientific indicates that it is hazard class 9. To top it off, FedEx appears to lump formalin/formaldehyde together in a more dangerous class (limited search). While I think the 3.7% solution isn't meant to be considered formaldehyde at all (unregulated for the purposes of transportation), I haven't waded through the regulations from a reputable source and, obviously, can't reliably advise.

Usually there's one person in the entire carrier company (okay..maybe one in each region..) who knows enough about this to actually tell you the right thing, unfortunately it can sometimes be a colossal pain in the slippity-slide to find that person and get accurate information (rather than "I don't know -- therefore, you can't ship it."). If you find them, get their name and number and keep it on hand. I've watched packages with infectious disease issues get bounced back on a daily basis for a week despite daily conversations with the carrier regarding how to handle them and getting slightly different explanations each time.

As for other fixatives, I can't think of any I've personally used for "large" specimens such as you're describing, with the exception of alcohol on pediatric brains, and some people use Bouin's on brains too. For other solutions to the problem, though, unless/until you can definitively sort out the formalin-in-transport issue they could be fixed on-site for X hours prior to being washed and shipped. But it would slow down what already seems to be a slow process.

 

[green mantis]

A couple of the hospitals I work for don't allow formalin, so they use something called ExCell Plus. It's an alcohol-based fixative. I'm not sure if it'll let you get around some of those shipping restrictions. Keep in mind that you can always switch it out for formalin once specimens get to you.

ExCell Plus is advertised as a "safer" alternative to formalin. None of the pathologists in my group really like it because it just doesn't fix as well as formalin. On the plus side, it has minimal scent & doesn't cause eyeburn.


----- Antony

 

[dermpathdoc]

A couple of the hospitals I work for don't allow formalin, so they use something called ExCell Plus. It's an alcohol-based fixative. I'm not sure if it'll let you get around some of those shipping restrictions. Keep in mind that you can always switch it out for formalin once specimens get to you.

ExCell Plus is advertised as a "safer" alternative to formalin. None of the pathologists in my group really like it because it just doesn't fix as well as formalin. On the plus side, it has minimal scent & doesn't cause eyeburn.


----- Antony

It also does not fix some types of cells well...especially eosinophils...so if you are looking for those in say..gastroesophageals reflux or contact dermatitis..good luck.

 

[2121115]

But what do you care about quality. YOu work for a large outpatient reference lab who only cares about increasing profit. They can't be wasting money on a few extra ounces of formalin. In fact you should sign that stuff out raw.

Hope that helps.

Bomb. Dropped.

 

[green mantis]

It also does not fix some types of cells well...especially eosinophils...so if you are looking for those in say..gastroesophageals reflux or contact dermatitis..good luck.

It's a good thing our GI biopsies come in those tiny pre-filled formalin containers.


----- Antony