LIVER BIOPSY – Definition, Purpose, Indication, Contraindication, General Instruction, Preliminary Assessment, Preparation of Patient and Environment, Articles Needed, Procedure, After Care and Complication
DEFINITION
It is the removal of a bit of liver tissue particularly for histological examination.
PURPOSE
- Diagnostic pour pose
- Morphologic studies
- Biochemical studies
- Bacteriologic studies
- Immunologic studies
- To get information regarding progression of disease
- Response to therapy
INDICATION
- Cirrhosis of liver
- Hepatic malignancies
- Granulomas
- Reticuloendothelial disease, e.g. leukemia
CONTRAINDICATION
- Bleeding disorders e.g. thrombocytopenia
- Infection in liver, peritoneum, biliary
- Severe form of hepatocellular jaundice
- Gross ascites
- Suspected hemangioma of liver
Site: needle is inserted at eighth and ninth intercostal space
Position:
- Position the patient on the right side near to the edge of bed
- After procedure, position patient supine
GENERAL INSTRUCTION
- Aseptic technique to be followed
- Investigate clotting time, bleeding time and prothrombin time
- Explain the need of procedure in a simple way
- Watch for complications during and after the procedure
- Keep two units of blood available for emergency care
- After procedure, patient should take 24 hour strict bed rest
PRELIMINARY ASSESSMENT
- Check the doctors order for specific instructions
- Check age, sex, name and diagnosis of patient
- Check investigation report from laboratory
- Check patient’s ability to obey orders
- Check patient’s self-care ability
- Check if all articles are available in the unit
PREPARATION OF PATIENT AND ENVIRONMENT
- Explain the procedure to minimize fear and anxiety
- Provide privacy
- Position the patient
- Teach the patient breathing exclusive
- Vitamin K is injected to prevent hemorrhage
- Informed consent is obtained from the patient
- Shave the area and clean it with antiseptic agent
- Arrange articles at bedside
- Monitor vitals before, during and after the procedure
- Maintain NPO, hours before procedure
ARTICLES NEEDED
An unsterile tray:
- Solutions – surgical spirit, Tr. Benzoin, iodine
- Mackintosh with towel
- K-basin
- Paper bag
- Xylocaine 2%
Sterile Tray Containing the Following
- Formalin 10% solution in a container
- Sponge holding forceps
- Dissecting forceps
- Small 2 bowls to receive solutions
- Keep patient NPO for 4 hours
- Wash hands thoroughly
- Recording and reporting
- Documentation
COMPLICATION
- Pain due to irritation of liver cells
- Hemorrhage
- Damage to neighboring organs
- Peritonitis
- Infection to the needle site
- Shock
- Pneumothorax
