NURC GASTROINTESTINAL

HEPATOBILIARY &
NEUROLOGICAL NURSING
Masmunaa Hassan
masmunaa@iium.edu.my
19th September 2017
LIVER BIOPSY
 OBJECTIVE
At the end of this session, you will be able to:
1. Define terms related.
2. Identify the types, indication, contraindication &
limitation of liver biopsy.
3. Determine the pre-procedure & post-procedure
care.
4. Assist liver biopsy procedure.
5. Discuss the health education that should be given to
the client.
 INTRODUCTION

DEFINITION - A procedure that involves

obtaining small piece of liver tissue, which
is the analyzed in the laboratory
The sample is examined by
Microscope
Immunohistochemistry
Determination of iron & copper content
Microbiological culture
 TYPES OF LIVER BIOPSY
Percutanoeus liver biopsy
Transvenously
Transjugular liver biopsy
Directly through abdominal surgery
 INDICATION
1. Evaluation of abnormal hepatic laboratory test
results
2. Confirmation of diagnosis and prognostication
3. Suspected hepatic neoplasm
4. Diagnosis of liver disease
5. Evaluation of infiltrative or granulomatous
disease
6. Following a case of liver transplantation to
evaluate and manage rejection
7. To evaluate unexplained jaundice or suspected
drug reactions
 CONTRAINDICATION
Increased prothrombin time, international
normalized ratio (INR) greater than 1.6
Thrombocytopenia, platelet count less
than 60,000
Ascites (transjugular route preferred)
Difficult body habitus (obesity)
Suspected hemangioma
Uncooperative patient
 LIMITATION
1. Invasive & intimidating
2. Complication are rare but lethal
3. Require hospitalization
4. Biopsy results show significant variability
wrong diagnosis
5. Expensive
 COMPLICATION
Pain / discomfort(0.056-22%)
Pleuritic
Peritoneal
Diaphragmatic
Hemorrhage
Intraperitoneal (0.03-0.7%)
Intrahepatic and/or subcapsular (0.059-23%)
Hemobilia (0.059-0.2%)
Bile peritonitis (0.03-0.22%)
Bacteraemia
Sepsis (0.088%) and abscess formation
Pneumothorax and/or pleural effusion (0.08-
0.28%)
 COMPLICATION
1. Hemothorax (0.18-0.49%)
2. Arteriovenous fistula (5.4%)
3. Subcutaneous emphysema (0.014%)
4. Anaesthetic reaction (0.029%)
5. Needle break (0.02-0.059%)
6. Biopsy of other organs
1. Lung (0.001-0.014%)
2. Gallbladder (0.034-0.117%)
3. Kidney (0.096-0.029%)
4. Colon (0.0038-0.044%)
7. Mortality (0.0088-0.3%)
 PREPARATION / PREPROCEDURE
CARE
Patients should not take medications that can
increase the risk of bleeding:
1. Aspirin or aspirin-containing medications
2. Other nonsteroidal antiinflammatory drugs
(NSAIDS) such as ibuprofen (e.g. Motrin, Advil), and
naproxen (e.g. Aleve).
3. Anticoagulant medications such as warfarin
(Coumadin)
4. Certain medications for people with heart conditions
(such as abciximab [Reopro], dipyridamole
[Persantine], ticlopidine [Ticlid], and clopidogrel
[Plavix])
5. Some herbal therapies (such as fish oil or ginkgo
biloba).
 PREPARATION / PREPROCEDURE
CARE
1. Blood test for blood clotting (PTT,APTT,INR,
hematocrit, platelet count)
2. Patients should carry a list of their medications,
including over-the-counter medications, herbs,
and vitamins.
3. It is common to perform an ultrasound
examination of the liver and gallbladder area
before the biopsy
4. Client already signed consent.
5. NBM 6 hours prior to the procedure.
PREPARATION / PREPROCEDURE
CARE
Explanation regarding the procedure include
1. The purpose
2. Position during & after the procedure
3. Complication may occur
 EQUIPMENT NEEDED
1. Clean trolley 10. Local anaesthetic
2. Sterile gloves - Lidocaine injection 2%
3. Face mask 11. Blade (no. 11)
4. Gown 12. Sterile liver biopsy needle
5. Sterile gauze 13. Adhesive dressing/elastoplast
6. Sterile T&S set 14. Sterile specimen container
7. Antiseptic for skin cleansing with formalin
1. Povidone solution 15. Receiver
2. Alcohol solution 16. General waste
8. Needle 17. Clinical waste
1. 23 G 18. Sand bag
2. 21 G
9. Sterile syringe
1. 5 cc
2. 10 cc
 DOCUMENTATION

NURSES REPORT
1. Note date, time and site of the liver biopsy.
2. Describe how the client tolerated the procedure.
3. Document laboratory tests ordered and when the
specimen was sent.
4. Describe the type of dressing.
5. Record vital signs before and after the procedure.
6. Document the presence of any bleeding at the site.
7. Document the date and time of pain medication or
sedative
 POST-PROCEDURE
1. Monitor vital signs every 15 mins for 2 hours.
2. Assess tachycardia & decreasing blood pressure
(hemorrhage).
3. Check the puncture site & dressing (hematoma).
4. Observe for pain.
5. Lying on the ride side for 2 hours.
6. After 2 hours, elevate the head of the bed 30
degrees & 2 hour later, elevate to 45 degrees.
7. Give vitamin K if prescribed.
8. Assess respiratory status.
9. Assess sign & symptoms of the procedure.
 EVALUATION
1. Assess for pain and bleeding.

2. Inspect the dressing over the puncture site.

3. Assess the puncture site for swelling, tenderness, or erythema.

4. Monitor vital signs and notify the physician if blood pressure

decreases significantly.

5. Observe for severe pain and internal bleeding by obtaining a

blood sample for a hematocrit 6 hours after the biopsy.
 CLIENT
The client should be :-
EDUCATION
taught the rationale for the procedure.

assured that the actual biopsy takes only 5 to 10

seconds.

told about the need for sterile technique.

instructed on the position to be assumed and the

importance of remaining still.

instructed and practice breathing and holding

breathe for the procedure.
 instructed to not eat or drink anything for 6
hours before the biopsy or for 2 hours after the
biopsy.

encourage to take slow deep breaths and use

imagery to promote relaxation. encouraged to
ask questions and verbalize his fears or anxiety.

encouraged to ask questions and verbalize his

fears or anxiety.

assured that the local anaesthesia (LA) will be

given to dull the pain.
 told that he will need to remain in bed for 6 hours
after the procedure.

rested in the first 2 hours in the right lateral position

on the right side.

instructed to report any severe pain, SOB or fever

immediately.

instructed to refrain from coughing or straining for 4

hours after the procedure.

avoided lifting heavy objects or strenuous activities for

1 week.
Acknowledgement:
Sr Rosnani Sarkarsi
THANK YOU