The FNNA technique has been described by several authors (6,13,18). This technique is thought to minimize trauma to thyroid tissue and to reduce blood contamination. For this technique, patient preparation is similar to that for FNA. However, no syringe or suction is necessary. The hub of a 27-gauge needle is held in a pencil-grip fashion, and the needle is gently inserted into the nodule and then moved in and out for 5 to 10 seconds (Fig. 4). Aspirate flows into the needle through capillary action, and as soon as aspirate appears in the hub, the needle is withdrawn and attached to a syringe with air inside. Next, the plunger is used to expel the material onto glass slides. The procedure is repeated several times, and the slides are prepared as described above for FNA.
Occasional side effects include allergic reactions to the medicines injected into joints, tape, or the disinfectant used to clean the skin. Infections are extremely rare complications of joint injections and occur less than 1 time per 15,000 corticosteroid injections. Another uncommon complication is post-injection flare - joint swelling and pain several hours after the corticosteroid or hyaluronic acid injection - which occurs in approximately 1 out of 50 patients and usually subsides within several days. It is not known if joint damage may be related to too-frequent corticosteroid injections.
Barry Libman, MS, RHIA, CDIP, CCS, CCS-P, CIC, is recognized for his in-depth knowledge of coding and reimbursement issues for acute care hospitals. An area of particular interest and expertise is Long Term Acute Care Hospital (LTACH) is the founder of both Barry Libman Inc. , a company that provides coding, audit, and educational services to the HIM departments of healthcare institutions, as well as Libman Education, a leading provider of training for the health care workforce. Prior to forming these organizations, he held a number of positions in the health information management field, working for hospitals, insurers, consulting firms, and regulatory bodies. Barry is often called upon to provide education and training on code updates and coding issues. He received the Professional Achievement Award from the Massachusetts Health Information Management Association (MaHIMA), served on the MaHIMA Board of Directors, and served as a representative to the House of Delegates held at the AHIMA national conference. Barry is a graduate of Northeastern University and received a Masters in Healthcare Administration from Simmons College.