Dr Piyush Tailor

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: Wide mouth sterile container
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.
9.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back and forth in several directions for a few seconds depending oncellularity and vascularity of tissue and is then withdrawn.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.
10.TAT FOR TEST: ½ hour.
11.LABORATORY INTERPRETATION: NA
12.SAFETY PRECAUTIONS: Universal safety precaution (Biosafety manual).
13.VALIDATION OF RESULTS TO BE DONE BY: By authorized signatories &Assi. Technical manager.
14.REVIEW, RECORDS & RECOMMENDATION: As per ISO 15189 Guidelines Clause 4.13 & NABL 112
15.REFERENCE: Fine Needle Aspiration Cytology, 4th edition, Svante R. Orell