Fine needle aspirates (FNA) is a method of obtaining diagnostic material for cytologic (cell) and histologic (tissue) study that causes a minimal amount of trauma to the patient. Aspirates may be obtained from all parts of the body, including the mouth, breast, liver, genital tract, respiratory tract, urine, CSF, and thyroid. Bacteriologic studies may also be done on material obtained during FNA. Unfixed material, left in the syringe or on a needle rinsed in sterile saline, may be taken to the microbiology department for study.
Use local anesthesia in most cases. Aspirate superficial or palpable lesions without radiologic aid but aspirate nonpalpable lesions using x-ray imaging as an aid for needle placement. Use sterile technique.
Insert the needle with syringe attached. Vacuum pressure inside the syringe causes fluid to be drawn up through the needle into the syringe.
Express material obtained onto glass slides, which must either be fixed immediately in 95% alcohol, spray-fixed, or air-dried, depending on the staining procedure used by the laboratory. The remaining material may be placed in a preservative solution, such as 50% alcohol. Check with your laboratory for recommended fixation requirements. Material may also be sent to the laboratory in the syringe.
Record the source of the sample and method of collection so that evaluation can be based on complete information.
Clearly label specimens collected from patients in isolation on the specimen container (patient’s name, date, and test[s] ordered) and on the requisition form with an appropriate warning sticker. Place the specimen container inside two sealed, protective biohazard bags before transport.
See Chapter 1 guidelines for intratest care.
Abnormal results reported as atypical, suspicious for malignancy, and positive for malignancy (in situ vs. invasive) are helpful in identifying:
Infectious processes. The infectious agent may be seen, or characteristic cellular changes may indicate the infectious agent that is present.
Benign conditions. Some characteristic cellular changes may be present, indicating the presence of a benign process.
Malignant conditions, either primary or metastatic. If the disease is metastatic, the findings may be reported as consistent with the primary malignancy.
Pretest Patient Care
Explain the purpose, procedure, benefits, and risks of the test. Even though a local anesthetic agent is used, the procedure causes some discomfort, and this should not be minimized. If the approach involves passing near a rib, warn the patient that the pain may be greater because of the sensitivity of the bone and that this is not a cause for alarm. Unexpected pain may induce a vasovagal or other undesirable response. Explain other risks including infection and hematoma or hemorrhage, depending on the site aspirated.
See guidelines in Chapter 1 for safe, effective, informed pretest care.
Posttest Patient Care
Review test results; report and record findings. Modify the nursing care plan as needed. Monitor for signs of inflammation and use site care infection control measures. Treat pain, which may be common in sensitive areas such as the breast, nipple, prostate, and scrotum. Monitor for specific problems, which vary depending on the site aspirated (e.g., hemoptysis after a lung aspiration).
Counsel about follow-up procedures for infections and malignant conditions.
Follow guidelines in Chapter 1 for safe, effective, informed posttest care.