Consumables and equipment

Conduct at clinic—Role of the ROSE

1. Prior to attendance, relevant patient history must be obtained by the individual performing ROSE to ensure the correct assessment criteria is applied in clinic.
2. Staff attending the clinic must be dressed smartly and abide by the codes of professional conduct. Confidentiality and an awareness of what is being said in front of the patient is important at all times.
3. On arrival at the clinic greet the team and the patient (likely to be nervous) explaining who you are in accordance with the WHO recommendations and check list.

• Discuss the case with the clinician
• The area of interest and sampling
• Route to sampling (contaminant information)
• Relevant imaging
• Clinical history
• Clinical suspicion of malignancy
• Record this information
• Don’t allow this information to bias your assessment of the sample
• Be aware of the diagnostic pitfalls and risks – recent radiotherapy, contamination due to route of needle, inflammatory changes, pancreatitis.

1. Know the criteria for assessment (see ROSE SSA criteria section) before you are handed the sample – likelihood of malignancy and node versus mass sampling.
2. Communicate clearly with confidence at every stage – VERY IMPORTANT for developing trust between clinician and the individual performing ROSE

• Key communication points include:
  • The presence of blood in the syringe in aspiration
  • The feedback regarding the volume of sample obtained
  • The feedback regarding the description of sample obtained
  • The feedback regarding more or less suction being required for the next pass
  • The ROSE assessment – inadequate, diagnostic and or enough material
  • Ensure the clinician gives you sufficient time to assess the sample
• Good communication helps to ensure that the sample is collected in the best way for ease of preparation and secures sufficient time to assess the sample.

1. Be confident but aware of your limitations – patient safety is paramount. The service should have a histopathologist competent in ROSE, that can be contacted in the laboratory by phone for advice or to attend the clinic in the unlikely event that they are required.
2. Feedback clearly in written communication to the reporting pathologist and review the case with the consultant/ROSE team.
3. The individual conducting the ROSE must be able to cope with sensitive and distressing nature of work, whilst remaining calm under pressure.

• Patient tolerance – Situations can arise where an adequate/sufficient amount of sample is not obtained due to patient complications, response to medicines and lack of tolerance to the procedure.
• Staff attending the clinic must be made aware during their training of the rare occurrence of severe risks to the patient and the potential for adverse events that could occur in the clinical setting. In an adverse event support for the staff involved should be provided where required (debrief and occupational health referral)

Health and safety considerations:

1. Ensure you are not standing too close to the clinician on removal of the EUS/EBUS guide wire. Risk of injury to eyes.
2. When walking around the endoscopy clinic be aware of the trip hazards – wires from equipment and suction tubes
3. Ensure you wear the appropriate personal protective equipment
4. Awareness of sharps and local needle stick injury policy
5. Awareness of local infection control policy

Terminology for adequacy assessment

Professionalism is required in the clinical setting as well as an awareness of terminology and communication between colleagues in front of the patient.

The patient may not be aware of all the clinical aspects of their pathology yet.