Therapath Neuropathology

Nerve biopsy procedure

Biopsy kits

Nerve biopsy kits include the following components:

  • Foam insulating container and shipping box
  • Pre-paid shipping label and requisition form
  • 1 plastic splint on which to secure nerve biopsy, with cutting guides
  • Coolant pack (store in a freezer no colder than -20° C)
  • Transport bag holding:
    • Vial 1: Michel’s solution
    • Vial 2: 10% neutral buffered formalin
    • Vial 3: 3% glutaraldehyde in Sorensen’s buffer

Upon receipt, refrigerate (4-8° C) the vial of glutaraldehyde fixative (yellow cap) and store the remainder of the vials at room temperature (22-25° C). The glutaraldehyde vial may be removed from the cold and kept at room temperature for the duration of the biopsy procedure. After addition of biopsy specimens, the entire box containing all vials should be prepared for shipment and kept cool with the provided coolant packs.

Sample Collection

  1. Excise a 3.5 – 4 cm length of peripheral nerve. Lay the nerve in a straight line onto the nerve splint with the end extending to or beyond guide line C (see below). Do not stretch the nerve and handle gently only by the ends.

Sample Preparation

  1. Tie the nerve to the splint with suture thread at the notches. This is made easier by an assistant holding the splint by the “C” end with clean forceps.
  2. With a sharp blade and a gentle sawing motion with minimum pressure, cut and separate each nerve segment at lines A, B, C.
  3. Using forceps:
    • Without squeezing, gently pick up nerve segment 1 and place into Michel’s solution (vial 1, red cap).
    • Wipe the forceps with gauze and similarly place segment 2 into 10% formalin (vial 2, white cap).
    • Place the entire plastic splint with the attached remaining 2.5 cm nerve segment 3 into 3% glutaraldehyde (vial 3, yellow cap) with the nerve end facing the bottom of the vial.
    • Cap all vials tightly.

Preparation for Shipment

  1. Complete the adhesive patient ID labels with patient name and biopsy site. Affix an ID label to each vial and orient the ID labels vertically in the empty space on the vials behind the existing vial label.
  2. Place the tightly capped vials firmly into the vial box. Seal the box of vials and white absorbent pad in the provided biohazard 95kPA air-transport plastic bag, pressing as much air out of the bag as possible before sealing. Bag expansion from excess air may prevent the coolant packs from fitting into the foam box.
  3. Place the sealed 95kPa bag of vials into the center of the foam box, retrieve the 2 coolant packs from the freezer and place one on each side of the vials. Close the foam box lid firmly and seal with the tape band provided.
  4. Enclose the completed requisition form in the plastic bag, place on top of the foam container, and seal the bag and container inside the outer shipping box. Keep the box upright and seal it in the pre-labeled, pre-paid FedEx or UPS UN3373 return pouch.
  5. Call FedEx (800-463-3339) or UPS (800-823-7459) before 2 pm on the day of biopsy to schedule a pickup.