My observations of this procedure have always been with sterile technique. Granted, I haven't actually done any yet (still a student). I'm very blessed, though, as there is a P.A. at the clinic where I work who directs me to lay out instruments and hand them to him as though we were in a surgery/sterile setting for all invasive procedures (even the "clean" ones), so I'll learn more. In fact, ALL of the docs at my clinic are great....more mentors than anything. This is a far cry from other clinics I've observed, where the docs don't even bother to learn the names of the nurses, let alone the lowly med techs.