Introduction
FNAC or fine needle aspiration biopsy (FNAB, FNA, or NAB) is a type of biopsy technique to investigate superficial lumps or masses. In this technique, a thin, hollow needle is inserted into the mass for sampling of cells.
Definition
FNAC or FNAB is a technique in which cells or small piece of tissue from a lump, cyst, or mass is aspirated through the needle for the diagnostic procedure.
Purposes for FNAC
- To assess the effect of treatment.
- To obtain tissue for special studies.
Indications
To aspirate or to take biopsy from the following list of organs, FNAC/FNAB is ideal:
- Thyroid gland.
- Neck lymph nodes.
- Neck cysts.
- Salivary glands (i.e., parotid gland, submandibular gland).
- Oral cavity.
- Lump which is palpable.
- Lumps that are found on imaging tests (such as ultrasound) even if they cannot be felt, for example, deep visceral tumors.
Contraindications
- No absolute contraindications.
- Relative contraindication: Coagulopathy disorder.
Advantages
- Inexpensive.
- Little discomfort during procedure.
- Can be done in outpatient settings.
Articles
| Articles | Purposes |
| Sterile gloves (1 pair). | To maintain asepsis. |
| 23-gauge needle with syringe. | To aspirate fluids or take biopsy. |
| Sterile gauze pieces. | To prepare the skin. |
| Sponge-holding forceps (1). | To clean the skin surface. |
| Povidone-iodine solution. | To remove microorganisms from the site of procedure. |
| Slides. | To collect the specimen. |
| Sterile surgical towel. | To drape the site of aspiration. |
| Labels with patient ID (patient’s name and date of specimen collected, name of the procedure, ward name, and bed number) and requisition form. | To label the specimen and send the specimen to the lab. |
| Adhesive plaster. | To secure the dressing. |
Procedure
| Nursing action | Rationale | |
| 1. | Ensure patient’s privacy. | To avoid unnecessary embarrassment to the patient during the procedure. |
| 2. | Wash hands and wear gloves. | To reduce transmission of microorganisms and to maintain asepsis. |
| 3. | Assist the patient into the required position exposing the area of biopsy. | To easily locate the mass. |
| 4. | Assist the doctor in preparing the skin with antiseptic solution and draping with sterile surgical towels. | To maintain aseptic technique and prevent infection. |
| 5. | The skin, underlying fat, and muscle may be numbed with a local anesthetic if needed. | To avoid pain during procedure. |
| 6. | A 23-gauge needle is inserted into the mass after locating the lump or mass correctly by palpation or using ultrasound or CT scan and cells are withdrawn by aspiration. | To collect the specimen. |
| 7. | After getting adequate aspirate, the needle is withdrawn and the aspirate is spread on the glass slide. Make a smear by laying another glass slide on top of the drop of fluid and pulling the slide apart to spread the fluid. Wet smears are placed in 95% ethyl alcohol. | To prevent the damage to the cells. |
| 8. | Cover the site with sterile gauze and fix with adhesive. | To prevent infection. |
| 9. | Check the vital signs. | For early detection of complications. |
| 10. | Shift the patient to observation unit for 3-5 hours. | To observe for development of any complications. |
| 11. | Administer mild analgesics as prescribed by the physician. | To control postprocedural pain. |
| 12. | Aspirin or aspirin substitute should not be given for 48 hours after the procedure. | To prevent bleeding. |
| 13. | Evaluate for any complications such as the following: Infection. Bleeding. Pneumothorax in case of lung biopsy. Bile leakage in case of liver biopsy. Pancreatitis. | Initiates prompt treatment at the earliest. |
| 14. | Document the patient’s name with name of the procedure done, date, type, site of specimen, mode of specimen collection (bottle/slide), color of the specimen, bed number, ward number, and names of the doctor and staff nurse who assisted in specimen collection. Send the specimen to the lab. | Serves as a legal evidence and prevents duplication of work. |
Special Considerations
- Maintain strict aseptic conditions to prevent infection.
- Local anesthesia may be used to minimize discomfort.
- Use thin needles (22-27 gauge) to minimize tissue trauma.
- Ultrasound or CT may be required for deep-seated lesions.
- Ensure sufficient cellular material for accurate diagnosis.
- Apply firm pressure after aspiration.
- Advise on signs of complications like swelling or infection.
- Additional biopsies may be needed for inconclusive results.
- Require extra care due to smaller tissue structures.
- May have fragile tissues requiring gentler techniques.
- FNAC is crucial for tumor characterization and treatment planning.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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