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Consent should include standard risks (infection, bleeding, damage to adjacent structures, non-diagnosis)  as well as risks specific to the procedure being performed. "Please call or present to the ED in the event of any perceived complication".

Cancer samples in formalin. Infection samples in saline. Unsure? Both.

Meditech Stuff

• Surgical Pathology = SURGICAL PATHOLOGY SPECIMEN (PATH)

• Culture = CULTURE MISCELLANEOUS & GM ST (MIC)

• Operative Note = Op/Inv Proc Note - Brief TEXT

Consent should include standard risks (infection, bleeding, damage to adjacent structures, non-diagnosis) as well as the possibility of pneumothorax necessitating chest tube placement. Also mention that hemoptysis is expected after the biopsy. "Please call or present to the ED in the event of any perceived complication".

Apex -> Minimal motion with breathing, Base -> Lots of movement with breathing. Practice breathing instructions while consenting. Specifically, I talk about the difference between "hold your breath", "pause your breathing", and "Blow out and hold it". For noncooperative patients, I don't ask anything of them and just watch the needle move with the respiratory cycle and scan/advance the needle when it is most in the scan plane.

• Hold = take a breath and hold it in

• Pause = stop right where you are

• Blow = expire and hold it 

Shortest path that does not cross fissures. Aim away from the mediastinum when possible.

Small lesions will get lost in perilesional hemorrhage. You may only get one shot.

If there is a pneumothorax after completing the biopsy while the needle is still in place, retract the needle with the inner stylet removed and try to suction out the air.

On the post scan, look for air in the cardiac ventricles. If present place the patient LEFT LATERAL DECUBITUS, TRENDELENBURG position (Durant's maneuver) to keep the air in the right ventricle.

ALWAYS get an immediate and 2 hours post procedural CXR.

Consent should include standard risks (infection, bleeding, damage to adjacent structures, non-diagnosis). Also mention that right shoulder pain is expected after the biopsy. "Please call or present to the ED in the event of any perceived complication".

Shortest path that has ~1cm intervening normal liver parenchyma. Aim away from the porta hepatis when possible. 

Lesions can be very hard to see without contrast. Brain window can help make them more visible on the preprocedural images, however metallic artifact often obscures the lesion during the procedure. Consider adjunct intraprocedural US or IV contrast.

Use Gelfoam after the biopsy.

Instruct patient to remain with biopsy side down to aid in hemostasis.

Consent should include standard risks (infection, bleeding, damage to adjacent structures, non-diagnosis). Also mention the possibility of subcapsular hematoma/page kidney. "Please call or present to the ED in the event of any perceived complication".

Random biopsies -> Aim for the inferior pole. Use a 15G coax/16G biopsy kit to preserve the glomeruli. Targeted biopsies -> Standard 17G/18G set.

Pathology needs to be present for random biopsies to check for glomeruli.

Use Gelfoam after the biopsy.

Instruct patient to remain with biopsy side down to aid in hemostasis.