ENDOMYOCARDIAL BIOPSY

ENDOMYOCARDIAL BIOPSY – Purpose, Findings, Interfering Factors, Client Preparation, Procedure, After Care and Complications (NURSING PROCEDURE)

Endomyocardial biopsy is an invasive procedure requiring cardiac catheterization. It permits sampling of right or left ventricular tissue

PURPOSE

An endomyocardial biopsy is usually performed to determine if a transplanted heart is being rejected
To diagnose myocarditis or doxorubicin (adriamycin) induced cardiomyopathy
To determine the cause of restrictive heart disease

FINDINGS

INTERFERING FACTORS

CLIENT PREPARATION

Instruct the client about the purpose and procedure
Inform the client that the table rotates and that the physician may ask the client to change positions or cough
Explain the client that when the dye is given, a feeling of warmth or flushing or a metallic taste may be tensed
Assist the precatheterization evaluation: blood test, including a prothrombin time test and a partial thromboplastin time test; an electrocardiogram; and chest X-ray
Obtain client’s height and weight
Assess the client fear and anxiety. Correct any misconceptions and reassure the client that the nurse, physician and technicians to assist during the procedure will be continuously present
If contrast dye is going to be used, check all allergies
Keep the client nothing per oral after midnight, except if the catheterization is planned for late in the afternoon. In that case, a clear liquid breakfast may be given
Withhold the cardiac drugs as per the physician order
Prepare catheter site according to laboratory protocols. The femoral artery is commonly used for the percutaneous of the catheter. Usually, both side of the groin are prepared
Premedication is given as ordered to reduce the client’s anxiety. In some catheterization laboratories, the client is premediated to decrease the risk of allergic reaction to the contrast dye
Instruct the client to void before going to the catheterization laboratory

PROCEDURE

The procedure involves a cardiac catheterization
A catheter with a jaw like tip id inserted under fluoroscopy, and several small tissue samples are obtained
A right or left ventricular sample may be taken. For clients at high risk, such as those with a history of left ventricular thrombus or infarction, a right ventricular biopsy may be performed

AFTER CARE

Observe the insertion site of bleeding. Palpate around the punctured site to detect bleeding into tissue
If bleeding is present, exert pressure just proximal to the puncture site with a gloved hand for a minimum of 15 minutes
Monitor vital signs and cardiac monitor according to hospital protocol
Check the distal pulse for artery patency
Report immediately if any significant changes in vital signs, rhythm and circulation or occurrence of chest pain
Assess post-procedure laboratory values, such as blood count, prothrombin time, electrolytes and creatine
Instruct the client about strict bed rest for 12-24 hours and to keep affected extremity straight for 12 hours
Encourage plenty of oral fluids
Record type of cardiac catheterization done and client’s tolerance of the procedure

COMPLICATIONS