**USG GUIDED FINE NEEDLE ASPIRATION CYTOLOGY**


**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:**\\  
**7. EQUIPMENT AND REAGENT USED:**\\ 
__EQUIPMENTS:__
  *Standard 18/22 Gauze, 90 mm disposable lumbar puncture needle with trochar.
  *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\\

**9. 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:__
  *A Clear explanation of procedure to patient to get his/her written consent and cooperation.
  *Procedure is usually carried out as per position given by  radiologist  to the patient.
  *Disinfect the skin using the spirit swab.
  *Pre aspiration sedation is sometime necessary and the only in deep aspiration in anxious or agitated patients.
__PROCEDURE:__
  *Experienced radiologist find out lesion where FNAC has to be done.
  *With the help of USG probe, operator  position the needle within the target tissue. 
  *Pull the trochar to apply the negative pressure. 
  *Move the needle back and forth inside the target, so good part of aspirate is often drawn into the 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. 
**11.  TAT FOR TEST:** ½ hour\\
**12.  LABORATORY INTERPRETATION:** NA\\ 
**13.  SAFETY PRECAUTIONS:** Universal safety precaution (Biosafety manual).\\
**14.  VALIDATION OF RESULTS TO BE DONE BY:** By authorized signatories & Assi. Technical manager.\\
**15.  REVIEW, RECORDS & RECOMMENDATION:** As per ISO 15189 Guidelines Clause 4.13 & NABL 112\\ 
**16.  REFERENCE:** Fine Needle Aspiration Cytology, 4th edition, Svante R. 			        Orell