Norm of Cytologic Study of Effusions
No tumor cells or infection.
Usage of Cytologic Study of Effusions
Gout, lymphoproliferative disease, infections of or fistulas into serous cavities, metabolic arthritis, metastatic neoplasms, myeloproliferative disease, rheumatoid arthritis, rheumatoid pleuritis, systemic lupus erythematosus, and pulmonary TB.
Description of Cytologic Study of Effusions
An effusion is an abnormal collection of fluid occurring most commonly in the pericardial sac, abdomen, pleural space, and synovial cavities. Effusions may be transudate caused by hydrostatic pressure differences or exudate caused by tumors or infective processes. Effusion cytology is the microscopic study of the fluid aspirate of the particular effusion and is used to differentiate the cause and type of effusion and to characterize and identify the source of infection or the tumor type.
Professional Considerations of Cytologic Study of Effusions
Consent form IS required for the procedure used to obtain the specimen. See individual procedures for procedure-specific risks and contraindications.
- Check PT and PTT or INR. This procedure may be contraindicated in clients with coagulation defects.
- Obtain the appropriate procedure tray, sterile gloves and drapes, povidone-iodine solution, and 1–2% lidocaine. If a large effusion is to be drained, obtain a heparinized vacuum bottle and tubing with a clamp or stopcock.
- Obtain baseline vital signs.
- For a pericardiocentesis, monitor ECG continuously throughout the procedure.
- For small or loculated effusions, an ultrasonograph- or CT-guided tap will increase the chance of obtaining a specimen.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- Position the client appropriately for the procedure to be performed.
- Cleanse the aspiration site and surrounding skin with povidone-iodine solution and allow it to dry.
- Overlay the aspiration site with sterile drapes.
- Obtain two 3- to 10-mL samples of fluid using a sterile technique by means of arthrocentesis, pericardiocentesis, paracentesis, or thoracentesis. Place one specimen in a heparinized tube and one in a nonheparinized tube for evaluation and cytologic testing.
- For a thoracentesis, a postprocedure chest radiograph MUST be performed to check for a possible pneumothorax.
- Monitor vital signs for indications of bleeding or hemodynamic changes.
- Write the name, date, source of fluid, and symptoms on the laboratory requisition.
- Send the specimen to the laboratory immediately. Refrigerate specimens not examined immediately.
Client and Family Teaching
- This is a sterile procedure that takes up to 1 hour and may include moderate discomfort.
- It is very important to stay as still as possible during the procedure to avoid injury and complications.
- Results are normally available within 72 hours.
Factors That Affect Results
- Results are most accurate when the specimen is examined within 1 hour of collection.
- This method is usually more sensitive than blind biopsy for diagnosis of pleural malignancies.
- The addition of Ki-67 immunostaining appears more sensitive than cytomorphology alone in distinguishing benign from malignant effusions.