Pleural biopsy
Pleural biopsy
Pleural biopsy is a medical procedure that pleural fluid contains exudate
and other procedures for example thoracocentasis has failed to reveal the cause
of pleural effusion.Biopsy is taken from the pleura and it is usually performed
when the doctor is suspecting malignancy.
INDICATIONS
Pleural biopsy is indicated in the following condition:
* Pleural effusion with exudate
* Suspected pleural malignancy
* Tuberculosis
* Sarcoidosis
* Systemic lupus erythematosis (SLE)
CONTAINDICATIONS
Pleural biopsy is not performed in patients with coagulopathy or
anticoagulation, empyema and low volume pleural effusion.It should not be done
without the consent of the patient.
EQUIPMENTS
Set up the bedside trolley before starting the procedure.The equipemnts
used in the pleural biopsy are as follows:
* Sterile gloves
* Sterile drapes
* Pink prep solution (2% Chlorexidine in isopropyl alcohol)
* Local anesthetic (2% xylocaine)
* Scalpel ( 11 number)
* Cope needle or Abram's needle
* 50 cc syringe
PROCEDURE
1-Place the patient sitting upright and leaning forward on the table at an
angle of 45 degree.
2-Place sterile drape on the patient.
3-Clean the skin with antiseptic solution (pink prep solution).
4-Introduce local anesthetic in the skin.
5-Make an incision through the ribs large enough for entering the cope
needle.
6-With the stylet, enter the cope needle (attached with 50 cc needle) over
the top of the lower rib into the pleural space.You will feel a 'give' when
needle will enter the pleural space.
7-Ask your patient to say 'ooooh' for deep expiration.
8-In the meantime, remove the stylet and inner tube simultaneously.
9-Withdraw the needle carefully, angling it so that the side aperture snags
the pleura.Obtain the sample by moving the inner cannula forward and twisting
it.
10-Take the sample from the needle attached to the syringe.
11-Place samples in 10% formalin for histology and in saline for culture
and immunofluorescence.
12-Apply pressure bandage to the area after completion of the procedure.
COMPLICATIONS
A number of complications may arise due to pleural biopsy.They are as follows:
* Hemorrhage
* Empyema
*Pneumothorax
* Hemothorax
* Skin swelling over chest (due to extravasation of pleural fluid)
* Tumor seeding
PATIENTS EDUCATION
Explain the procedure and its possible complications to the patient.Tell
the patient to report immediately in case of any complication.Take the consent
of the patient before performing the procedure.
Category: General Health, Medicine
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