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Fine Needle Aspiration
Obtaining Specimen

For superficial aspirates, alcohol preparation technique suffices for cleansing of the skin surface. Local anesthetic usually is not necessary. If multiple passes of deep seated lesions are anticipated, anesthetic is recommended. However, be certain not to contaminate the lesion with a large volume of anesthetic solution. Local anesthetic may interfere with the ability to palpate and localize superficial lesions. Sterile technique for deep aspirates is required for cleansing of the skin and local anesthetic is usually required.

a) Assemble the syringe pistol with attached needle and lay out several glass slides with alcohol fixative.
b) Clean the skin at the puncture site with an alcohol pad.
c) Lay the needle point on the skin over the puncture site and determine the angle of approach to the mass. A “fine needle”, 22 gauge or smaller diameter (e.g. 23, 25 gauge) is used.
d) Hold the lesion firmly stationary with the free hand and insert the needle in one swift motion.
e) Determine that the mass has been penetrated either by noting the resistance encountered on puncture or by moving the syringe slightly from side to side while feeling the mass move beneath the finger of the palpating hand.
f) Apply full vacuum pressure to the syringe with the pistol finger.
g) Move the needle back and forth within the mass at slightly different angles while full pressure is maintained.
h) Observe the hub junction of the needle and syringe for the appearance of any sample or continue to make multiple back and forth passes within the mass lesion.
i) Conclude the aspiration at the first appearance of any sample within the syringe or after multiple passes by releasing the trigger of the syringe pistol. Vacuum pressure is applied to the syringe ONLY when the needle is within the mass. If vacuum pressure is applied while withdrawing the needle air and sample will be pulled into the syringe where it will dry and be difficult to retrieve.
j) Withdraw the needle from the mass and place pressure on the puncture with a sterile gauze pad to minimize blood. No vacuum pressure should be applied to the syringe during withdrawal of the needle.
k) Once the needle has been removed from the patient, the needle is detached from the syringe so that the syringe can be filled with air. The needle is then reattached (see Figure 1), and sample is expressed for the needle onto the glass slide. The sample is then delicately smeared between two glass slides (Figure 2).

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