Therapath provides your practice with 1 testing kit per patient for evaluation of small fiber neuropathy. Kits are shipped to your practice via overnight service. When the kit arrives, remove the kit from the outer packaging. Open up the test box to view the internal components. On top of the Styrofoam cooler you will find a requisition form and shipping information card. Inside the Styrofoam cooler Therapath provides you with 1 punch biopsy kit, 1 return shipping package and 1 bag of fixative vials containing PLP fixative. This fixative needs to be stored at standard refrigeration, 28 degrees Celsius, until.
The time of procedure. At the bottom of the cooler is an ice pack that needs to be frozen until the time of the return shipment. All of the other components should be stored at room temperature until needed. The sterile skin biopsy punch kit contains 2 standard band aids, forceps, a punch tool, scissors, alcohol prep pads, an iodine prep pad and gauze. You will need to provide gloves, 2 lidocaine with epinephrine and an injecting needle. Therapath has established normal values for 3 standard biopsy sites. All three sites are.
Located on the lateral leg. The standard Thigh site is located 20 centimeters distal the iliac spine, at the level of the pubis. The standard Distal Leg or Calf site is located 10 centimeters proximal to the lateral malleolus. The standard Foot site is located on the dorsum of the foot over the extensor digitorum brevis muscle. Prep and clean the chosen biopsy sites with the supplied alcohol and iodine pads. After cleaning the biopsy site, you will use the lidocaine and injecting needle to numb the patient Inject the lidocaine into the subcutaneous tissue surrounding the biopsy site. Keep in.
Therapath procedure tutorial for ENFD and SGNFD testing
Mind not to inject the needle through the biopsy site. With the lidocaine, create a bleb or bubble underneath the dermis. Check that the area is numb performing the biopsy. While waiting for the injected area to numb, cover the patient’s leg with a surgical draping. The next step will require the punch tool, scissors, forceps and the appropriate number of specimen vials. Keep in mind that you will need one labeled vial per sample. Apply pressure to the skin with the punch tool. As you are applying pressure, rotate the tool back and forth so that it punctures the skin.
Insert the tool the full distance of the metal head and remove the tool from the site. With the forceps, carefully grasp the specimen from underneath the epidermis and use the scissors to remove the sample. Should the sample remain in the metal head of the punch tool, use the plastic stylus to eject the sample into a sample vial. This illustration serves as a guide to appropriate sample collection. The epidermis The epidermal nerve fibers The dermis Sweat glands located in the dermis And nerve fibers surrounding the sweat gland.
The illustration now shows the metal head of the sample collection tool penetrating through the epidermis to the dermis to a depth of at least 4 mm. By going to this depth, you are capturing both the available epidermal nerve fibers and sweat gland nerve fibers. Again, it is important to grasp the sample from underneath the epidermis to avoid damaging the nerve fibers. When placing the sample in the PLP fixative vial, ensure that the sample is floating in the fixative and not stuck to the screw threads at the top of the vial.
Therapath provides 2 standard bandaids and gauze. After the procedure, cover the biopsy site with the supplied gauze and bandaid. The patient should leave the biopsy sites covered for 24 hours with your original dressing. Make sure that the vials are properly labeled with the patient’s name. The labels for the vials should be obtained from the requisition form. For shipping the samples back to the laboratory, place the labeled specimen vials in the biohazard bag. Obtain the saved Styrofoam cooler and frozen ice pack. Place the ice pack at the bottom of the cooler and add the Styrofoam barrier to the top of.
The ice pack, place the sample vials on top of the barrier and cover the cooler. Place the cooler inside the kit box add the completed requisition form and any additional paperwork on top of the cooler. Close and secure the box and place it inside the prelabeled shipping pack. To schedule a pickup the same day, call the shipping company customer service number provided on the shipping information card. Biopsies can be scheduled Monday through Friday, as the shipping companies can deliver samples to our laboratory over the weekend. Our lab staff will immediately begin processing the samples and you can expect a pathology.