B-10: Biopsy, Lung

• Indications
  • Lung, pleural or mediastinal mass
• Contraindications
  • Uncorrected coagulopathy
  • Pulmonary hypertension (relative)
  • Bullous disease (relative)
• Patient Evaluation
  • Ability to lie still in required position, hold breath, and cooperate during procedure
• Preprocedure Orders
  • Routine
• Tools
  • Aspiration: Chiba. Franseen , Westcott, or similar 20-22ga.
  • Core: Temno, QuickCut, ASAP or similar. Usually 21ga.
• Entry site
  • Per lesion location
• Technique
  • Fluoroscopic or CT guided depending on patient and lesion
• Post-procedure Note
  • Note type and size of needle used, number of passes made, apparent quality of specimen
  • Note any pneumothorax or hemoptysis
  • Note preliminary path results if available with caveat that final path is pending
• Post-procedure Order
  1. Bed rest x 4 hours
  2. Check entry site(s) for bleeding and check and record VS (HR, BP, RR):
     • q 15 min x 2, then
     • q 30 min x 4, then
     • q 1 hour x 4, then
     • q 4 hours if stable.
  3. Call H/O for any change in VS
  4. Resume other preprocedure orders
  5. CXR 4 hours post biopsy
  6. Stat CXR if patient develops acute SOB or ipsilateral chest pain

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