====SOP of FNA====


**1.PURPOSE**
To prepare the Smears as per standard text literature & Manufacture’s guidelines.


**2.STAFF RESPONSIBLE**
Resident doctor

**3.PRINCIPLE**
NA


**4.PERFORMANCE SPECIFICATION**
NA

**5.SAMPLE**
NA

**6.TYPE OF CONTAINER**
NA

**7.EQUIPMENT AND REAGENT USED**

__**EQUIPMENTS**__  
    *Standard disposable 20-24 Gauze, 30-50 mm long needle is suitable for superficial, palpable lesion.
    *For deep seated lesions, 18-22 Gauze, 90 mm disposable lumbar puncture needle with trocar is suitable
    *10 cc Disposable Syringes.
    *Disposable slides.
    *0.2mm cover slip.
    *Diamond pencil for labeling the slides.

__**REAGENTS**__
  *Fixative
  *Acetone free methanol – Extra pure

__**Stains**__
  *H & E. Stain
  *Giemsa Stain
  *PAP Stain 


**8.CALIBRATION PROCEDURE**
  *When new residents come, they observe the procedure of FNAC for 3 days and then they perform FNAC under the observation of a senior resident for 4 days. 
  *After 1 wk of training, they are allowed to perform FNAC independently.

**10. PROCEDURE (STEPS)**
__**PATIENT PREPARATION**__
  *Explain procedure to patient to get his/her written consent and cooperation.
  *Procedure is usually carried out with patient lying supine on a simple examination couch.
  *Disinfect the skin using the spirit swab.
  *Pre aspiration sedation is rarely necessary and the only in deep aspiration in anxious or agitated patients.
 
__**PROCEDURE**__
  *With practice and experience, the operator acquires the ability to feel the consistency of tissue through the needle.
  *Position the needle within the target tissue.
  *Pull the plunger to apply the negative pressure.
  *Move the needle back and forth inside the target, so good part of aspirate is often drawn into the hub of needle.
  *Release the negative pressure while needle remains in target tissue and withdraw the needle.
  *Needle is detached and air is drawn into syringe.
  *Blow sample on microscopy slide and with the help of other slides,spread the material.

__**FINE NEEDLE SAMPLING WITHOUT ASPIRATION**__
  *Usually preferred for thyroid and vascular lesions.
  *It is based on observation that capillary pressure in a fine needle is sufficient to 
  *So needle is held directly with tip, inserted into target lesion, is moved back and forth in several directions for a few seconds depending oncellularity and vascularity of tissue and is then withdrawn.
  *By these techniques, operator gets an excellent feel of consistency of tissues as well as admixture with blood is less than with aspiration.
  *After completing procedure, pressure should be applied over that site to minimize bruising and to decrease the chance of hematoma.
  *In case of central focus of necrosis, haemorrhage or cystic changes in a tumour, FNAC should be done from peripheral area to get representative material.
  *FNAC/ FNA must be repeated if any remaining palpable abnormality after evacuation of the cyst.



**11. QUALITY CONTROL PROCEDURE**
NA

**13. REFERENCE INTERVALS**
 NA

**14. TAT FOR TEST**
Half hour

**15. LABORATORY INTERPRETATION**
 NA

**16. ALERT CRITICAL VALUE**
 NA

**17.SAFETY PRECAUTION**
 Universal safety precaution (Biosafety manual).

**18.VALIDATION OF RESULTS TO BE DONE BY**
 By authorized signatories &Assistant  Technical manager.

**19.REVIEW, RECORDS & RECOMMENDATION**
 As per ISO:15189 Guidelines Clause 4.13 & NABL 112

**20.Reference**
Fine Needle Aspiration Cytology, 4th edition, Svante R. Orell