Pre‐procedure

ActionRationale

1. 1.Show
   Inform patient that the intention is to try to elicit nipple discharge for specimen.
   To reduce anxieties and manage expectations. E
2. 2.Show
   Ask patient to remove upper clothes, including bra, behind curtain or screen. Provide a gown for use.
   To enable ease of visible inspection and palpation. E

   Provide gown to maintain personal dignity (RCN [127], C).
3. 3.Show
   Wash hands with soap and water, dry hands and apply apron and non‐sterile gloves.
   To minimize risk of infection or cross‐contamination (RCN [132], C).

Procedure

1. 4.Show
   Gently squeeze the nipple between the thumb and index finger with constant pressure.
   In order to elicit discharge, which will come from ducts immediately behind nipple (Derbis and Scott‐Connor [31], E).
2. 5.Show
   If discharge is seen, make a note of colour and whether it originates from a single duct or multiple.
   In order to inform overall clinical impression, assist in diagnosis and assist cytologist in their assessment. E
3. 6.Show
   Take a clean slide and smear the discharge onto the slide with a single wiping motion.
   To transfer discharge cleanly from nipple to slide (Derbis and Scott‐Connor [31], E).
4. 7.Show
   Apply a second clean slide onto the stained slide and apply gentle and constant downward pressure as you glide the clean slide over the stained one.
   To achieve monolayer of cells if cells are present. Clumping of cells will obscure results (Derbis and Scott‐Connor [31], E).

Post‐procedure

1. 8.Show
   Immediately fix slides with fixative by flooding slide with 95% alcohol solution.
   To preserve cell architecture for assessment (Derbis and Scott‐Connor 2011, E).
2. 9.Show
   Give the patient some tissue to wipe the breast.
   To help preserve dignity. E
3. 10.Show
   Label the slides with correct patient demographic information, what the slide is of, and which side discharge is from as well as date.
   To ensure results are ascribed to correct patient (Derbis & Scott‐Connor [31], E).
4. 11.Show
   Remove and dispose of apron and gloves.
   To ensure safe disposal and avoid injury to other members of staff or the public (DH [35], C; HSE [68], C).
5. 12.Show
   Complete request form.
   To ensure results are ascribed to correct patient and to inform cytologist of clinical picture. E
6. 13.Show
   Ensure patient is aware of plans to get results.
   To manage anxiety and expectations. E