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

  • Doxorubicin-induced cardiomyopathy
  • Cardiac amyloidosis
  • Cardiac fibrosis (especially radiation injury)
  • Changes cardiomyopathy
  • Myocarditis
  • Rejection of transplanted heart
  • Scleroderma
  • Toxoplasmosis
  • Tumor infiltrates
  • Vasculitis

INTERFERING FACTORS

  • Bleeding disorders
  • Severe thrombocytopenia
  • Systemic anticoagulation
  • Uncooperative client

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

  • Accidental biopsy of papillary muscle or chordate tendineae
  • Hemopericardium
  • Cardiac perforation
ENDOMYOCARDIAL BIOPSY – Purpose, Findings, Interfering Factors, Client Preparation, Procedure, After Care and Complications (NURSING PROCEDURE)
ENDOMYOCARDIAL BIOPSY – Purpose, Findings, Interfering Factors, Client Preparation, Procedure, After Care and Complications (NURSING PROCEDURE)

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