1
Q
Elements of FNA consent
A
- What is FNA?
- Needle is about the size we use to draw blood or smaller.
- Risks: pain, bleeding, infection.
- Use of lidocaine - any allergy?
- Switch to paperwork, confirm name and DOB
- Have them explain the procedure back to you
- Signature
2
Q
Using lidocaine anesthesia on a non-painful lesion
A
- Use about 0.5 mL lidocaine to start
- Be mindful not to obscure small lesions with your wheel
- Form a wheel, then inject slightly deeper into dermis
- If you do not feel resistance, retract the needle until you do
3
Q
Using lidocaine anesthesia on a painful lesion
A
- Target adjacent to the lesion so that you can take an angled approach through your anesthetized area
- Be generous with lidocaine - you ideally want it to diffuse to your target site
- When injecting, if you do not feel resistance, retract the needle until you do
4
Q
Where are the nerve endings in skin that you are trying to anesthetize with lidoacine?
A
At the DEJ
5
Q
Steps to taking the FNA
A
- Administer lidocaine, being mindful of wheel size relative to lesion and angle of approach
- Palpate the lesion with your non-dominant hand, until you have it in a good position for approach
- With your dominant hand, disinfect the area with an alcohol wipe
- With your dominant hand, insert your needle gently
- Once in the lesion, apply suction and gently move the needle back and forth along the needle tract to sample
- When you feel you are no longer obtaining sample or if the patient exhibits signs of pain, stop and bring the needle to the slides
- Remove the needle, then the plunger. Then re-insert the needle and plunge a drop of material onto your air-dry slide. The rest goes in saline.
- Dab a second slide with the air-dry material, then scrape that with a third slide to spread and immediately place in alcohol (this is your fixed preparation).
- Let the material drip down the first slide and air-dry for 30 seconds or so, until adherent.
- Stain the air-dried slide.
