CPD Short: attention interventional head and neck sonographers! Have you considered….?

Although many sonographers undertake interventional procedures, in particular, head and neck, there are other things to consider alongside the practical aspects of completing the examination. Here we share six key points to consider.

Six key points:

1. Local anaesthetic - PGD

Current legislation states that statutory regulated diagnostic radiographers are allowed to supply and/or administer medicines using patient specific directions (PSDs) or patient group directions (PGDs). Radiographers can only supply and/or administer medicines under PGDs if doing so benefits the patient without compromising their safety and if they are appropriately trained and competent to do so.

Sonographers who are legally permitted to use one should have a PGD in place for Lidocaine prior to any interventional procedure taking place. See section 6.4 SoR and BMUS (2023) for more details, particularly for sonographers without statutory regulation.

2. Local anaesthetic toxicity

Timely diagnosis and management of local anaesthetic systemic toxicity (LAST) are essential to minimising risks associated with regional anaesthesia. However, LAST is a relatively rare occurrence, and both its recognition and the opportunity for effective intervention can be easily overlooked.

The evolving clinical context presents diagnostic challenges, highlighting the need for ongoing education of physicians, nurses, and allied health professionals on emerging patterns and associated risks. The Association of Anaesthetists has produced guidance on toxicity.

3. Biopsy or FNA?

The primary advantage of Fine Needle Aspiration (FNA) is its safety, especially with small targets, along with the ability to obtain preliminary cytologic assessment from an on-site cytopathologist. This real-time feedback helps ensure sample adequacy. The main disadvantage of FNA is the small sample size, which can lead to nondiagnostic results. FNAs are generally performed with narrow-gauge needles (22–25 ga) and core needle biopsies (CNB) are performed with larger gauge needles (16–20 ga). The main advantage of CNB is the increased diagnostic yield, particularly for evaluating salivary gland lesions and cervical lymph nodes. The choice between FNA and CNB depends on factors such as the specific clinical presentation, the operator’s experience, institutional protocols, and real-time cytopathologic evaluation.

4. Exclusion criteria – contraindications include, but not limited to

Lack of consent
Known bleeding diathesis
Known anticoagulation use

5. Multidisciplinary team (MDT) participation

“Evidence suggests that MDT working can lead to improved job satisfaction for professionals and practitioners as a result of greater autonomy, skill enhancement and knowledge sharing. In addition, shared projects, a focus on the patient/ service user and being able to celebrate together can all help to improve morale.” (NHS England, 2021)

Any sonographer carrying out interventional techniques should participate in the relevant MDT.

6. Self audit

The Royal College of Radiologists (RCR) (2014) suggest that “70% of all FNA should be diagnostic on cytology assessment.” The RCR offers a user friendly audit framework for FNA samples, emphasising the importance of regular auditing foranyone carrying FNAs. This guidance highlights best practices and identifies opportunities for improvement, ensuring high standards in sample collection. Additionally, the framework can be adapted for auditing various procedures.

Reflection prompts:

Before starting an interventional procedure:
Is it legal to use a PGD based on your professional background?
Have you checked for patient allergies and blood thinning medication?
Do you have a recognised radiologist mentor for support?
What are you own limitations?
Is this examination within your scope of practice?
What are the potential signs of local anaesthetic systemic toxicity?
What are your local exclusion criteria for FNA or CNB? Are they the same, regardless of procedure?
What audit is undertaken within your department for FNA and CNB procedures? Who is involved in the audit and what are the outcomes in relation to published norms?

CPD Short: attention interventional head and neck sonographers! Have you considered….?

Six key points:

Reflection prompts:

Further reading:

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