B-12: Biopsy - Liver (Percutaneous)

• Indications
  • Liver mass or diffuse liver disease
• Contraindications
  • Uncorrected coagulopathy
  • Moderate to severe ascites
• 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.
  • Use 18ga.ASAP or similar device for diffuse disease
• Entry site
  • Per lesion location. Right mid-axillary line at 9th to 11th interspace for diffuse liver disease
• Technique
  • Focal lesion: Preliminary CT with marker catheter on skin. Confirm proper needle position with CT prior to taking specimen. Post biopsy scan to rule out bleeding.
  • Diffuse disease: Fluoroscopic guidance, leave cannula in tract between biopsy passes. Check for entry into large vessels with contrast injected through cannula. May embolize tract with GWC coils through cannula.
• Post-procedure Note
  • Note type and size of needle used, number of passes made, apparent quality of specimen
  • Note any bleeding or other complications
  • Note preliminary path results if available with caveat that final path is pending
• Post-procedure Orders
  1. Bed rest x 6 hours
     • If anterior or posterior puncture, with patient supine
     • If right sided puncture, with patient in right lateral decubitus position
  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 and Interventional Radiology (6875) for any change in VS
  4. Resume other preprocedure orders

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