AB-Interventional Flashcards
What is the primary advantage of using ultrasound in procedures?
To have continuous real-time visualization of the biopsy needle, allowing for adjustment of the needle as needed pg. 495
What is included in a time out?
- Ask patient to recite his or her full name
- Patient’s ID or history number is confirmed
- Type and location of procedure
- Date of birth
- All equipment and supplies are present
- Patient agrees to procedure
- Workbook and PP
What are some post biopsy complications?
Minor:
- Post-procedural pain/discomfort
- Vasovagal reactions (A sudden drop in heart rate and blood pressure leading to fainting)
- Hematomas
Major:
- Bleeding
- Hemorrhage
- Pneumothorax
- Pancreatitis
- Biliary leakage
- Peritonitis
- Infection
- Possible death
pg. 503-504
During a biopsy, a spring loaded gun is used to get a ___ sample.
Core pg. 498
What gage size of needle is used for a thyroid?
25
What is the most common organ biopsied?
Liver??
What is a specific complication of a renal biopsy?
Perinephric hematoma and hematuria
pg. 519
How is the patient positioned for a thoracentesis?
Pt sits on the side of the bed and is leaning on a bedside table with pillow for comfort. This opens up the space between the ribs to be able to get the needle in to drain the fluid.
The most common indication for a biopsy is to..
Confirm malignancy in a mass p 496
Contraindications for a biopsy
-Uncorrectable bleeding disorder
-Lack of a safe needle path
-An uncooperative patient
p 496
What tests are used to measure the time it takes for the blood to form a clot?
- PT
- PTT
- INR
What is PT?
Prothrombin time
Is used to evaluate factors found in the extrinsic pathway, which may be affected by patients on Coumadin. Normal values are typically between 10 and 13 seconds
p 497
This test is used to determine the clotting tendency of blood, in liver damage, to assess vitamin K status, and to measure the warfarin dosage.
p 33
What is PTT?
Partial thromboplastin time
It is used to evaluate the effects of heparin, aspirin, and antihistamines on the blood-clotting process. Normal values are typically between 60 and 70 seconds.
p497
What is INR?
International normalized ratio
Method developed to standardize prothrombin time results among laboratories by accounting for the different thromboplastin reagents used to determine PT. Values of less than 1.4 are needed to ensure a safe procedure.
*Workbook and p497
______ is essential in the clotting process
Vitamin K
Useful tricks to help visualize the needle tip
-Move the needle up and down in a bobbing motion
-Bobbing or jiggling the stylet inside the needle
-Scanning and angling the transducer in a superior and inferior motion. (helpful when the needle is bent out of the plane of the sound beam)
-Using harmonics or compound imaging
-A last resort is to remove the needle and start again, closely watching the displacement of the tissue as the needle advances
p 515
What part of the kidney is usually biopsied?
The upper pole of the kidney is biopsied to avoid possible lacerations of the main renal vessels and ureter
p 519
Limitations of ultrasound guidance
- Not all masses can be visualized with ultrasound because they may be isoechoic to normal tissue
- Bowel gas may move in and obscure the mass before or even during the procedure; overlying bowel may not be able to be displaced
- Needle tip may be difficult to see or may deviate from the projected path because of bending or deflection of the needle
- Inexperience of ultrasound personnel
- Comfort level of the radiologist and or sonologist with other imaging modalities
- Need to use fixed angles when needle guides are used on the transducer
*Workbook
What size gauge needle is used with a fine needle aspiration?
20-25 gauge needle is used to obtain cells from within the mass
p 498
What is the role of the cytopathology team?
They look at the slides to determine if the material is diagnostic.
Benefits:
-Increases the percentage of successful biopsies
-Helps to minimize the number of passes
-Reduces overall procedure time
p503
Preprocedural image
The “timeout” image
It documents date and time, and then the needle tip documentation images
p509
Renal parenchymal biopsies are requested on patients with..
- Proteinuria
- Nephrotic syndrome
- Renal failure
For biopsies, the left kidney is preferred because the spleen is well above the left kidney and allows for a safer approach
p518
What risk is there with a spleen biopsy?
-Bleeding
-Hemorrhage
Spleen is highly vascular
p520
What organ will be biopsied in a patient with elevated AFP?
Liver
-A biopsy of the hypo echoic area in a cirrhotic liver may be requested to differentiate it from a regenerating liver nodule
p517
Biopsies are used to confirm if a mass is..
- Benign
- Malignant
- Infectious
What are the two methods in performing ultrasound guided procedures?
-Free hand technique, which is performed without the use of a needle guide on the transducer
-Use of needle guides
p499
What are the benefits of using a needle guide?
- Faster learning curve
- Faster placement of the needle
- Assurance that the needle is going through the anesthetized area when multiple passes are required
- Workbook
_______ approach should be used to prevent the possibility of a pneumothorax or damage to the intercostal arteries
Subcostal
*Workbook
Advantages of using ultrasound guidance
- Real time visualization of the tip of the needle at all times
- Fast
- Patient position can be easily changed
- Staff is by the patient throughout entire exam to offer comfort
- No radiation
- Economic – allows for no tie up of CT/MRI equipment
- New technologies including fusion, needle guides for transducers
How many days should a patient be off of aspirin to reduce the risk of post procedural bleeding?
5 to 7 days
