Ateneo de Zamboanga University College of Nursing

NUSING SKILLS OUTPUT (NSO) Report No. _7_ BIOPSY I. DESCRIPTION: Skin biopsy is one of the most important diagnostic tests for skin disorders. Punch biopsy is considered the primary technique for obtaining diagnostic full-thickness skin specimens. t requires basic general surgical and suture-tying skills and is easy to learn. !he technique in"ol"es the use of a circular blade that is rotated do#n through the epidermis and dermis$ and into the subcutaneous fat$ yielding a %- to &-mm cylindrical core of tissue sample. Stretching the skin perpendicular to the lines of least skin tension before incision results in an elliptical-shaped #ound$ allo#ing for easier closure by a single suture. 'nce the specimen is obtained$ caution must be used in handling it to a"oid crush artifact. Punch biopsies are useful in the #ork-up of cutaneous neoplasms$ pigmented lesions$ inflammatory lesions and chronic skin disorders. Properly administered local anesthesia usually makes this a painless procedure. II. MATERIALS/ EQUIPMENTS NEEDED: %( gauge needle ris scissors !oothed forceps )*dson+ Sterile punch Skin hook & , & gau-e

III. PROCEDURE .. *fter the patient has been go#ned$ a clinical history has been taken$ and the procedure e,plained$ the area of skin #here the biopsy is to be performed is prepared #ith an alcohol s#ab to insure sterile conditions. /. 'nce the skin has been prepared #ith alcohol$ the ne,t step is to anestheti-e the area to be biopsied by in0ecting a solution of 1idocaine )2C1 .3 and 4pinephrine .5.(($(((+ 0ust under the epidermis )subepidermally+ using a 6 cc !uberculin Syringe. !he in0ection should continue until a 7bleb8 or bubble has formed under the skin greater than %mm in diameter. !he in0ection #ill burn slightly )much like a bee sting+ due to a p2 difference bet#een the skin and the solution. !he slight burning #ill quickly subside and the site #ill become numb. %. *fter the initial 1idocaine in0ection the area to be biopsied should be checked to insure that the skin is properly anestheti-ed. !he point of the syringe is used to poke the area of the bleb or bubble. 9reat care should be taken not to force the needle into the skin. !he test site should be some#here around the periphery of the bleb. :oth of these precautions insure a "iable biopsy for diagnosis later. f the patient e,periences neither pain nor sharp

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sensation$ the biopsy continues. * pressure sensation is normal and e,pected but there should be no pain. f the area requires more anesthesia$ another in0ection )#ith a ne# syringe+ is made until the skin is completely anesthetic. &. *fter the area to be biopsied is anestheti-ed$ the biopsy continues. ;sing a sterile %mm skin punch$ the physician applies pressure and t#isting in a 7drilling8 motion until the blade of the skin punch has pierced the epidermis of the skin. !he blade should be about 6 e,posed. t is normal for the patient to e,perience a pressure and t#isting sensation but no pain. <. *fter the blade has sufficiently 7cored8 or car"ed out a %mm cylinder of skin the skin punch is remo"ed. t is normal for the area to bleed after the punch is remo"ed. 4,cess blood is #iped off #ith sterile / , / gau-e to e,pose the biopsy site. !he entire process resembles the 7cookie cutter8 effect. !he only purpose of the skin punch is to 7core8 the skin and not to remo"e the biopsy$ much like a cookie cutter. =. >hen the skin has been cored and cleared of e,cess blood$ the ne,t step is to remo"e the biopsy from the rest of the skin. 9reat care should be taken not to damage the epidermis by crushing it #ith forceps or by cutting it #ith a scalpel unnecessarily. !he physician uses the forceps to grab the dermis of the cored skin$ pulls up the core to re"eal e,cess dermis and subdermal fat$ and uses the scalpel in one or t#o cutting motions to cut the cored skin free. 7. Notice the position of the scalpel during the e,cision process. !he scalpel is placed under the forceps and is mo"ed in the opposite direction of the forceps pulling on the dermis. !his motion stabili-es the biopsy and aids in pre"enting a 7chopping8 or 7slicing8 affect #hen trying to free the biopsy. !he physician simply utili-es one or t#o strokes of the scalpel to e,cise the biopsy #ith a clean cut. ?. 'nce the biopsy has been remo"ed from the skin there #ill usually be some degree of bleeding #hich should be absorbed #ith sterile / , / gau-e. !he biopsy site is then co"ered #ith a standard band-aid and possibly fortified #ith sterile gau-e and paper tape if the bleeding threatens to soak the band-aid and@or the patientAs clothing. !his 7hole8 in the skin #ill continue to bleed for the rest of the day and may or may not form a scab in a fe# days time. IV. DIAGRAM/ ILLUSTRATIONS:

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V. NURSING RESPONSIBILITIES: 1. BEFORE PROCEDURE Bour physician #ill e,plain the procedure to you and offer you the opportunity to ask any questions that you might ha"e about the procedure. Bou #ill be asked to sign a consent form that pro"ides permission to perform the procedure. Read the consent form carefully and ask questions if something is not clear. Notify your physician if you are sensiti"e to or are allergic to any medications$ late,$ tape$ and anesthetic agents )local and general+. Notify your physician of all medications$ especially about blood thinners such as aspirin or Coumadin.

2. DURING PROCEDURE Skin biopsies are done on an outpatient basis$ and the procedure is typically completed #ithin .<C%( minutes. :iopsies are typically performed in the leg for the diagnosis of sensory neuropathy. Skin is cleaned and in0ected #ith local anesthetic. % mm punch biopsies are performed in the anestheti-ed area. :and-*id is applied to the biopsy site. !he skin heals #ithin /C% #eeks$ minimal scarring may occur at the biopsy site. 'ther risks$ #hich are "ery rare$ include bleeding and infection. 3. AFTER PROCEDURE Some pain around the biopsy site. !his should resol"e$ or at least ease o"er the ne,t t#o or three days. Bour doctor #ill prescribe appropriate pain relie"ing medication. Nurses monitor your condition for some hours and check for bleeding from the biopsy site. Bou may ha"e a blood count test to double-check that you are not bleeding internally from the biopsy site.

Re e!e"#e: http5@@###.aafp.org@afp@/((/@(%.<@p..<<.html http5@@neurology.uth.tmc.edu@specialty-programs@neuromuscular-program@biopsy-skin.html

AUGUST 1$ 2$ 3$ 2%13 D&'e EIREES .OY A. MENDO/A BSN III0D

MS. FLORIBEL SAN LUIS C()")#&( I"*'!+#',!-* I")')&(*

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