Sterile Technique for Biopsy Procedures Flashcards
Types of ultrasound guidance
liver biopsies, thorocentesis, paracentesis, breast core biopsies, breast cyst aspirations, breast needle localizations, fine needle thyroid aspirations, hip aspirations, PICC line insertions, Perma Cath insertions
Liver biopsies
This is normally done for any type of hepatitis to know what form of treatment will work best for the patient
Done as an outpatient
After the procedure, the patient normally stays 2hrs to watch for any complications
Patient’s vital signs are monitored by Radiology nurse
Patient is NPO
Full assessment by nursing done before procedure
Informed consent obtained
Patient to have labs done before procedure-PT, PTT, INR
Patient in supine position
Radiologist speaks with the patient, explains procedure, answers any questions
With the Radiologist present, the Sonographer locates the left or right lobe of the liver and marks the proper location. The depth is measured from the anterior image to the liver. An image is saved for documentation.
When everyone involved with the procedure is present, a Time Out is done to verify patient’s name, DOB, all equipment and supplies are present, patient agrees with procedure
The skin is cleaned with Chloroprep solution and numbed using lidocaine
An 18 gauge core needle is used and 2 samples are obtained and put into a formalin container
Results are ready in 24-48hrs
Thorocentesis
Done for pleural effusions when patients become SOB, or fluid needs to be tested for diagnosis
These are always done one side/day, due to chance of developing a pneumothorax
Patients with cancer, post op CABG, liver failure, and congestive heart failure seem to be most common reasons
Patient is NPO
Full assessment by nursing done before procedure
Informed consent obtained
Patient is in a sitting position, with legs over the edge of the cart
Arms are placed forward on a bedside table
Radiologist speaks with the patient, explains procedure, answers any questions
With the Radiologist present, the Sonographer locates the left or right pleural fluid and marks the proper location. The depth is measured from the anterior image to the fluid. An image is saved for documentation
When everyone involved with the procedure is present, a Time Out is done to verify patient’s name, DOB, all equipment and supplies are present, patient agrees with procedure
The skin is cleaned with Chloroprep solution and numbed using lidocaine
A Yueh Centesis catheter is placed in the back and attatched to an evacuated 1000ml bottle
Fluid is removed until the drainage stops
A chest x-ray is obtained to check if any fluid remaining or if a pneumothorax has formed
Paracentesis
Done for ascites to remove peritoneal fluid
Most common reasons for fluid build up is cancer, liver failure (cirrhosis), and CHF
These can be very large volume up to 15 liters
This procedure offers patients great relief
Can be therapeutic and/or diagnostic
Patient is NPO
Full assessment by nursing done before procedure
Informed consent obtained
Patient is in a supine position
Radiologist speaks with the patient, explains procedure, answers any questions
With the Radiologist present, the Sonographer locates the fluid in the RLQ, LLQ and marks the proper location. The depth is measured from the anterior image to the fluid. An image is saved for documentation.
When everyone involved with the procedure is present, a Time Out is done to verify patient’s name, DOB, all equipment and supplies are present, patient agrees with procedure
The skin is cleaned with Chloroprep solution and numbed using lidocaine
A Yueh Centesis catheter is placed in the skin and attached to an evacuated 1000ml bottle
Fluid is removed until drainage stops
Breast core biopsy, cyst aspiration, and needle localization
Outpatient procedure
Done to see if a solid mass is benign or malignant
If malignant, what type of cancer is it?
Cyst aspirations done for patient relief or to make sure fluid is able to be aspirated and not a solid. If no fluid is able to be obtained-proceed with a core biopsy
Needle localization is done for patients going to surgery. The wire is left in place and the surgeon is able to locate the mass easily
Fine needle thyroid aspirations
Performed if there is a solid nodule over 1.5cm
Most thyroid nodules are benign
25 gauge needles are used, usually 5 passes to obtain enough cells
Cytology technologist is normally present to make slides for the Pathologist to diagnose and looks under the microscope to make sure there are sufficient samples
Informed consent obtained
Patient is in a supine position with a pillow placed under the shoulders to extend the neck as far as possible
Radiologist speaks with the patient, explains procedure, answers any questions
With the Radiologist present, the Sonographer locates the nodule and marks the skin
5 passes are made into the nodule and each one is documented
PICC Lines
Peripherally inserted central catherter
Can be used for a prolonged period of time, e.g. for long chemotherapy regimens, extended antibiotic therapy or total parenteral nutrition
Inserted in a peripheral vein, such as the cephalic vein, basilic vein, or brachial vein and then advanced through increasingly larger veins, towards the heart until the tip rests in the distal superior vena cava
Inserted in a sterile suite
Sonographer must glove and gown
Ultrasound machine is thoroughly wiped down and covered with a sterile drape
Ultrasound transducer is draped and sterile gel is applied to the patient’s skin
Largest vein is located and the needle is inserted under ultrasound guidance
Perma catheters
Most often employed in dialysis patients and those who require ongoing nutrition via veins for an indefinite period
Normally placed in the internal jugular vein
Follows the same procedure as the PICC line
Sterile Technique/General Guidelines
Sterile (or ‘aseptic’) technique is first and foremost about minimizing possible sources of infection (nosocomial infection=an infection got while hospitalized)
Sterile means free of bugs that can infect people. Sterility will apply to SELECT surfaces of objects or to substances that will be introduced into a patient’s body. Some objects just don’t have the potential to be made sterile. Hands can be made very clean but not sterile. “Scrubs” from the locker room dispenser are not sterile, nor are surgical masks.
Sterile fields are defined by the sterile surfaces
Onscrubbed surgical personnel (by “scrubbed” meaning hands washed according to O.R. protocol, donning sterile gown, sterile gloves) the sterile surface would extend (approx) from the chest to the waist on the torso and from elbows to the tips of gloved fingers on the upper limb. The rest of the scrubbed person is not sterile and is a possible source of contamination for the sterile area.
On a patient, only the prepared surface of the body and the sterile drape are considered within the sterile field. Note that edges of otherwise sterile surfaces are not sterile, since they must contact (or appose) non-sterile objects. So, the physical edges of a sterile drape-or any surface of the drape below the space defined by the other sterile objects of the field-are not considered sterile.
1) obtain scrubs from the linen cart
2) obtain a surgical hair cap and shoe covers
3) wash hands (note:short fingernails are important) surgical hand scrub
4) put on sterile, surgical gown
5) put on sterile, surgical gloves
Specimen collection and transport notes
Label each specimen with patient name or unique identifier
Use the proper collection method
Use sterile collection devices and media
