HA Ch. 19 Flashcards
Defect in blood-clotting mechanisms
Coagulopathy
Method of performing an ultrasound-guided procedure without the use of a needle guide on the transducer
Free-hand technique
Diminished blood volume
Hypovolemia
Method developed to standardize prothrombin time (PT) results among laboratories be accounting for the different thromboplastin reagents used to determine PT
International normalized ratio
Collecting air or gas in the pleural cavity
Pneumothorax
Laboratory test that measures levels of this antigen in the body, elevated levels of which could indicate prostate cancer
Prostate-specific antigen
Decreased systolic and diastolic blood pressure below normal
Hypotension
Laboratory test that can be used to evaluate the effects of heparin, aspirin, and antihistamines on the blood-clotting process by detecting clotting abnormalities of the intrinsic and common pathways
Partial thromboplastin time (PTT)
Surgical puncture of the chest wall for removal of fluids: usually done by using a large-bore needle
Thoracentesis
Concerning the action of stimuli from the vagus nerve on blood vessels: vasovagal syncope is a brief loss of consciousness caused by sudden drop in heart rate and blood pressure, which reduces blood from the brain
Vasovagal
AFP
Alpha-fetoprotein
FNA
Fine needle aspiration
INR
International Normalized Ratio
PSA
Prostate Specific Antigen
PT
Prothrombin Time
PTT
Partial Thromboplastin Time
Discuss the main advantages of using ultrasound for biopsy guidelines
The main advantage of using ultrasound for guidance is continuous real-time visualization of the biopsy needle, which allows adjustment of the needle as needed. Moreover, as the biopsy specimen is being obtained, the needle tip can be watched in real-time to ensure that it does not slip outside the mass. Ultrasound also has the advantage of allowing different patient positions and approaches to be considered for safest access to the mass. Subcostal approaches can allow the use of steep angles with the needle directed cephalad, which can help reduce the risk of a pneumothorax or bleeding from an injury to an intercostal artery. Another benefit is the ability to comfort and reassure the patient, as the sonologist, sonographer, and nurse are all near the patient during the procedure. Other advantages include the ability to perform the biopsy in a single breath hold, portability, lack of radiation, decreased costs, and shorter procedure times
List the limitations of ultrasound guidance
Not all masses can be visualized with ultrasound because they may be isoechoic to normal tissue. In the abdomen, bowel gas may move in and obscure the mass before or even during the procedure; overlying bowel may not be able to be displaced. The needle tip may be difficult to see or may deviate from the projected path because of bending or deflection of the needle. Other disadvantages of using ultrasound to guide procedures include the inexperience of ultrasound personnel, the comfort level of the radiologist and/or sonologist with other imaging modalities, and the need to use fixed angles when needle guides are used on the transducer.
The most common indication for a biopsy is to confirm ________________ in a mass
Malignancy
Identify the contraindications of a biopsy
Contraindications may include an uncorrectable bleeding disorder, lack of a safe needle path, and an uncooperative patient
Which laboratory test is used to evaluate the effects of heparin, aspirin, and antihistamines on the blood-clotting process?
PTT (Partial Thromboplastin Time)
Biopsies are used to confirm if a mass is
Benign, malignant, or infectious
A(n) ____________ uses an automated, spring loaded device, termed a biopsy gun, to provide a core of tissue for histologic analysis
Core biopsy
FNA uses a(n) ____________ needle to obtain cells from a mass
Thin
One method of ultrasound-guided intervention is called the ___________ technique and is performed without the use of a needle guide on the transducer
Free-hand
Identify the benefits of using a needle guide
Faster learning curve, faster placement of the needle and assurance that the needle is going through the anesthetized area when multiple passes are required
The patient must be informed of the potential __________ , alternate methods of obtaining the same information, and what would be the course of the disease if the biopsy were not performed and the correct treatment could not be planned
Risks
The national patient safety standards (www.jcaho.org) mandate that a “timeout” be performed before beginning any procedure. Explain what a “timeout” is and what its purpose is.
A member of the biopsy team should ask the patient to recite his or her name. The patient’s ID or history number is confirmed, along with the type and location of the procedure. This is documented usually at the bottom of the consent form. The word “timeout” may also be typed on the screen and an image documented to be part of the ultrasound examination. This is helpful because there will be preprocedural image, the “timeout” image, which documents date and time; and then needle tip documentation images
Complications from an ultrasound-guided biopsy are usually minor and may include _________, ____________ reactions, and ____________
Postprocedural pain or discomfort, vasovagal reaction, hematomas
It is important to determine how much the mass moves with ___________ and also how well and how long the patient can hold his or her breath
Respiration
Describe how to see the needle tip in ultrasound
Move the needle up and down in a bobbing motion. Bob or jiggle the stylet inside the needle. Angle the transducer in a superior and inferior motion. This is helpful when the needle is bent out of the plane of the sound beam. Use harmonics or compound imaging. A last resort is to remove the needle and start again, while closely watching displacement of the tissue as the needle advances.
Whenever possible, a(n) _______________ approach should be used to prevent the possibility of a pneumothorax or damage to the intercostal arteries
Subcostal
Typically the ___________ pole of the kidney is biopsied to prevent possible lacerations of the main renal vessels and ureter
Upper
Patients may be marked for a thoracentesis or have the procedure under sonographic guidance. Patients should be scanned in the ___________ position that the procedure will be performed in, which is usually in an upright position, through the back.
Same
