Biopsy Procedures PDF

Complete the content above before moving on. Biopsy Biopsies are the removal and examination, usually microscopic, of tissue or fluid from the living body to establish a precise diagnosis. #1 Cone Biopsy Inverted cone of tissue is excised, as from the uterine cervix. #2 Excisional Biopsy Tissue is r...

Complete the content above before moving on. Biopsy Biopsies are the removal and examination, usually microscopic, of tissue or fluid from the living body to establish a precise diagnosis. #1 Cone Biopsy Inverted cone of tissue is excised, as from the uterine cervix. #2 Excisional Biopsy Tissue is removed by surgical cutting. #3 Incisional Biopsy A biopsy of a selected portion of a lesion. #4 Needle Biopsy Tissue is obtained by puncture of a tumor, the tissue within the lumen of the needle being detached by rotation, and the needle withdrawn. #5 Percutaneous Biopsy Tissue is obtained by simply inserting a needle through the skin. #6 Punch Biopsy Tissue is obtained by a punch, such as in a bone marrow biopsy. Which type of biopsy is tissue obtained by simply inserting a needle through the skin? Percutaneous biopsy Punch biopsy Needle biopsy Cone biospy SUBMIT Complete the content above before moving on. Tympanometry Tympanometry is a test used to assess the mobility of the tympanic membrane in a quick and simple method. It can detect disorders of the middle ear such as fluid (serous otitis media or, acute otitis media), perforated ear drum, cerumen (ear wax) impaction, tympanic membrane scarring, improperly functioning bone conduction or a possible tumor. A tympanogram (the graph the results are recorded on) measures the response to sound and different pressures within the ear as the eardrum moves back and forth. PR E PA R AT I O N PE R F O R MI N G T H E T E ST First, ensure the ear canal is clean. The test will be inaccurate if the ear canal is full of wax, so check with the provider and get permission to clean the ear before completing the test. When preparing the patient for the test, ensure you explain the procedure and what the patient can expect to see and hear. Also realize that some of the sounds may be loud or startling, so they should do their best to remain relaxed. You should advise the patient to sit quietly, avoid speaking or swallowing during the test as it can change the pressure of the middle ear and invalidate the results. This can be a challenge with young children. Have the parent assist you in keeping the child quiet and still while the test is being run. The specific tympanometry machine you use may differ slightly from what is explained here, so ensure you have read about your particular machine, have been trained on it and feel comfortable using it. PR E PA R AT I O N PE R F O R MI N G T H E T E ST You will use a probe that looks similar to many of the tympanic thermometer probes. Attach a clean probe to the earpiece and gently secure it in the ear canal. Push the button and wait for the sign that the test is done. The probe will occlude the ear canal while the machine changes pressures and the test is competed. A graphic will be displayed that shows the mobility of the tympanic membranes response to various air pressures. A normal tympanogram will peak at zero on the “Air Pressure,” displaying a low level reading with a flat graph or one without a peak; the third type may show a distinct peak, but it will be shifted to a negative pressure, thus signaling an estuation tube dysfunction. Make sure you show the graph to the provider before you let the patients leave. Ensure the tympanogram is properly labeled and the patient knows when to return for a follow up appointment if required. Multiple Choice A normal tympanogram will peak at ________on the “Air Pressure,” displaying a low level reading with a flat graph or one without a peak; the third type may show a distinct peak, but it will be shifted to a negative pressure, thus signaling an estuation tube dysfunction. zero one two three SUBMIT Complete the content above before moving on. Minor Surgery Aside from routine outpatient visits, many clinics will perform a multitude of different minor surgeries in the clinic. For most patients, outpatient care for surgical procedures is convenient and less expensive. This section covers important information on preparation and care of the patient along with your responsibilities as a medical technician. We will also discuss information on technician responsibilities before and postsurgical procedure and some common surgical procedures performed on an outpatient basis, as well as some common actions you will take while preparing and assisting procedures. Minor surgery is a surgical procedure for minor problems or injuries that are not considered life-threatening or hazardous. Some common surgical procedures you may assist with are: Vasectomy—male sterilization that consists of bilateral removal of a part of the vas deferens. Cyst removal—removal of an inflamed closed sac in or under the skin lined with epithelium and containing fluid or semisolid material. Laceration repair—surgical repair of jagged or smooth skin tissue by sutures, surgical staples, or medical glue. Lacerations can occur either by surgical means or traumatic injury. Biopsies – removal and examination, usually microscopic, of tissue or fluid from the living body to establish a precise diagnosis. For some patients, minor surgery is a possibility or necessity. To prepare the patient for any type of surgery, there are multitudes of preoperative tasks that must be done. These tasks are taught throughout your five-level upgrade training. As you continue to gain knowledge as a 4N0X1, you will need to comprehend the fundamental reasons why each step is important. As an apprentice, you were taught six basic patient care tasks that are done before performing a procedure: 1 Verify the provider order. 2 Gather all of your equipment. 3 Identify the patient. 4 Explain the procedure to the patient. 5 Use proper body substance isolation (BSI) precautions with personal protective equipment (PPE). 6 Always provide privacy.  Whether the surgery is inpatient or outpatient, there are many variables that must be controlled. For most patients, their basic needs must be met for them to be confident and comfortable to sign consent for surgery. PR E - PR O C E DUR E PO ST- PR O C E DUR E Appropriate surgical consent must be signed by a member not participating in the procedure. This would be a witness. Complete the consent form; escort the patient to the proper procedure room and educate the patient if needed on the procedure. Once the consent is signed, the minor surgery procedure can begin. Informed consent is a process whereby the surgeon or provider explains the surgical procedure to the patient, including all the risks and possible complications of the procedure and/or any anesthetic involved. Obtaining consent is a legal requirement and is the responsibility of the surgeon or provider. The purposes of informed consents are: To ensure the patient understands what’s about to happen, to include any potential negative outcomes, as well as any alternative treatments or procedures To confirm that the patient’s decision was made voluntarily and without pressure To protect the patient against unauthorized procedures To ensure the procedure is performed on the correct body part To protect the surgeon and facility against legal action by patients claiming an unauthorized or incorrect procedure was performed. Each provider normally has a specific way and specific equipment that he or she likes to have set up for various procedures. Talk with the provider before the procedure and ask how he or she prefers to perform the procedure and what supplies and equipment you should ensure are available. It is a good idea to become familiar with all clinic providers equipment requirements; it will help ensure the procedures are performed smoothly and timely. Have all supplies needed in the room. Leaving the room could compromise patient care if an emergency developed. The following items are a list of commonly used supplies and equipment; ensure you familiarize yourself with each one: formalin jars; lidocaine (Xylocaine) 1 percent with or without epinephrine; 1-, 3-, 5-, and 10-cc syringes; 18 and 25 gauge needles; blades; Betadine (check allergies); sterile biopsy procedure kit/suture kit; gauze; alcohol pads; silver nitrate sticks or a disposable cauterizer; sutures or sterile stripes; labels; antibiotic ointment; bandages; and tincture of benzoin. As a part of your responsibilities, you must maintain a good working knowledge of the principles of aseptic techniques, the instruments used in minor surgery, and the procedures for submitting specimens for pathological testing. PR E - PR O C E DUR E PO ST- PR O C E DUR E Be sure to assist the provider during the procedure and in dressing the wound after surgery, if required, and dispose of all sharps into the designated biohazard container. Repeat the patient’s vital signs, and then assist the patient in sitting up and getting down from exam/procedure table. Be available to assist the patient in getting dressed as necessary, and then escort the patient to the waiting room if required. Ensure the patient has wound care instructions, and make any follow-up appointment as necessary. Once this is completed, clean and restock the procedure room so it will be ready for the next procedure. Assisting with Surgical Instruments When assisting a health care provider with minor surgical procedures, you will need to know the various instruments used. There are particular instrument sets packaged and sterilized for many different procedures. All instruments used for minor surgery must be of suitable size, shape, strength, and function based on the procedure being performed. Four basic classifications of instruments you will use for a minor surgery are cutting or dissecting, grasping or holding, clamping or occluding, and exposing or retracting instruments. Let’s further break down each classification of each instrument by clicking on the hotspots in the graphic below.      Cutting or Dissecting There are two divisions of these instruments, knives and scissors. The knives further divide into two types: knives with detachable blades and knives with fixed blades (disposable). The knives with detachable blades are most commonly used during minor surgical procedures. This allows the health care provider a wider range of blade types to perform the necessary cut for the procedure. Disposable knives are readily available through supply channels. There are also different types and sizes of scissors. Scissors used for cutting tissue are curved or straight, blunt or sharp, depending on the type of tissue to be cut. This is when a determination will need to be made whether the scissors you are going to use are of suitable size, shape, and strength for the tissue being cut. For example, you would not use a pair of iris scissors to cut thick subcutaneous tissue but may prefer a pair of long curved Mayo scissors.  Grasping or Holding As their name implies, these instruments are used for holding, grasping, or pulling tissue or vessels. Examples of these instruments are tissue forceps, which have teeth for a firm grasp, and dressing forceps, which have serrations instead of teeth to grasp delicate tissue.  Clamping or Occluding Again, the name of the instrument tells its purpose. These instruments clamp blood vessels and certain types of tissue. If necessary, you also may completely stop the flow of blood from a vein or artery with this type of instrument. An excellent example of this category of instrument is the hemostat.  Exposing or Retracting Exposing or retracting instruments are used to hold back the edges of a wound or cavity to expose an area. Not only do they expose an operative area, but they also hold back superficial tissue to give access and exposure to deeper tissue. The most common examples of these instruments are rake retractors, nasal, and vaginal speculums. Even with the nursing challenges of assisting with minor surgery, treatment and release of the patient does not conclude the duties of the medical technician. Many minor surgeries are performed to make a diagnosis of the tissue taken from the patient. This is not something you as the technician can perform, but it is your responsibility to ensure the specimen is labeled appropriately, recorded, transported to the pathology department, and turned over for processing. Multiple Choice What two types of knives are there to use in the surgery room? Exposing and Extracting Curved and Straight Detached and Fixed Rake and Fixed SUBMIT Complete the content above before moving on. Pathology When biopsies or specimens are taken during a minor surgical procedure, you will need to turn them in to the laboratory or, in larger facilities, the pathology department. These two areas process a large number and type of specimens daily and the only identification to the patient they have is through the label on the container. These departments do not have direct contact with minor surgery patients. As the medical technician assisting with the minor procedure, it is your responsibility to ensure proper labeling of the specimens before the patient is released from your care. On each specimen label, you should have the patient’s name, DoD ID number, date of the minor surgery, the type specimen and location from which the tissue was taken, the health care provider’s name, and your initials. If multiple specimens are taken from the same patient, make sure all tissue specimens are labeled with the correct anatomical location. If you are unsure of the specific location, do not hesitate to ask the health care provider. All pathological specimens are logged into a specimen-tracking log, and then transported and turned into the lab for processing.  The minor surgery process is not complete until the specimen is read and the pathologist gives a diagnosis patient follow-up and results of the pathology report are given to the patient per local protocol. PR E - PR O C E DUR A L PE R F O R MA N C E STA GE PO ST- PR O C E DUR E 1. Verify provider’s orders and correct patient. 2. Obtain baseline vital signs, to include oxygen saturation and their current pain score. 1. If the patient is diabetic, ensure to follow glucose control measures. 2. Observe the patient for their cardiovascular and respiratory status – report any abnormal findings to the provider. 3. Ensure there is a witnessed and informed consent on file; if not, obtain one 4. Determine laterality, if there’s any necessary lab work, and/or history and physical based on provider instruction. 5. Verify correct patient, correct site, and correct procedure. Consider appropriate marking of any incisions with a skin marker. This is the time to execute a “time out” if warranted. A time out involves the immediate members of the procedure team. During a time-out, the team members agree, at a minimum, on the following: correct patient identity, correct site, and correct procedure to be done. When the same patient has two or more procedures, If the person performing the procedure changes, another time-out will be conducted prior to the start of each procedure. It’s important to document the completion of the time-out, which is determined by the organization you work for. 6. If required, ensure patient has followed all food and fluid restrictions, has removed any jewelry, and is appropriately dressed for the procedure. 7. Perform a medication reconciliation. 8. Administer preprocedural medication, if indicated by the provider. 9. Gather supplies and equipment, set up as necessary, and prepare to assist. PR E - PR O C E DUR A L PE R F O R MA N C E STA GE PO ST- PR O C E DUR E Some medical/nursing competencies that you may be expected to assist with are BLS and the recognition of signs and symptoms of adverse reactions, to include seizures and abnormal heart rhythms. You should have a basic pharmacological understanding of local anesthetic agents used and neurological checks. Additionally, you should be familiar with the type of nerve block performed (if any), its therapeutic effects, side effects, associated adverse reactions, and what to do in case of an emergency resulting from the procedure itself or any of its components. You may be expected to assist with the following: Maintaining an aseptic/sterile field Handing the provider supplies/tools upon request Keeping the procedure site clear of blood/secretions Conducting/monitoring vital signs PR E - PR O C E DUR A L PE R F O R MA N C E STA GE 1. Obtain vital signs, including oxygen saturation, temperature, and pain score. 2. Administer oxygen if warranted and directed to. 3. Determine if the patient has recovered adequately for discharge by using the following criteria: Stable vital signs Can stand without dizziness and is able to walk Pain score is at a tolerable level (usually less than three is required) Can tolerate fluids Oriented to time, place, person No indication of respiratory distress Has a responsible, adult escort who can take the patient home and remain with them Understands post-op instructions and takes a copy home C O NT I NU E PO ST- PR O C E DUR E Sigmoidoscopy, Proctoscopy, and Colonoscopy An endoscopic examination is the inspection of a body cavity or hollow organ by means of a lighted instrument. The stomach, esophagus, colon, and rectum can all be examined by using endoscopic instruments. The one procedure you will be involved in the most is the examination of the colon. Click on the tabs below to learn more. PR O C T O SC O PY SI GMO I DO SC O PY C O L O N O SC O PY An endoscopic medical procedure used to examine the anal canal, rectum, and the sigmoid colon. It plays a key role in the treatment and management of rectal and anal diseases and is considered one of the simplest and most commonly performed diagnostic procedures, along with proctosigmoidoscopy and lower intestinal endoscopy. Commonly done for conditions such as hemorrhoids, anal fissures, and rectal polyps. PR O C T O SC O PY SI GMO I DO SC O PY C O L O N O SC O PY An exam used to evaluate the lower part of the large intestine (colon). During a flexible sigmoidoscopy exam, a thin, flexible tube (sigmoidoscope) is inserted into the rectum. A tiny video camera at the tip of the tube allows the doctor to view the inside of the rectum, the sigmoid colon and most of the descending colon — just under the last two feet (about 50 centimeters) of the large intestine. If necessary, tissue samples (biopsies) can be taken through the scope during a flexible sigmoidoscopy exam. Flexible sigmoidoscopy doesn't allow the doctor to see the entire colon. As a result, flexible sigmoidoscopy alone can't detect cancer or small clumps of cells that could develop into cancer (polyps) farther into the colon. PR O C T O SC O PY SI GMO I DO SC O PY C O L O N O SC O PY An exam used to inspect the entire large intestine for changes — such as swollen, irritated tissues, polyps or cancer — in the large intestine (colon) and rectum. During a colonoscopy, a long, flexible tube (colonoscope) is inserted into the rectum. A tiny video camera at the tip of the tube allows the doctor to view the inside of the entire colon. If necessary, polyps or other types of abnormal tissue can be removed through the scope during a colonoscopy. Tissue samples (biopsies) can be taken during a colonoscopy as well. A fiber optic scope enables the provider to see the inside of the colon on a display screen by moving the head of the fiber optic scope around. Watch the video below to learn more about a sigmoidoscopy procedure. What is a flexible sigmoidoscopy Video Transcript.pdf 134 KB Patient Preparation Patients who require a proctoscopy can be performed without a clear liquid prep, although a more thorough exam can be obtained if the patient’s lower bowel is clear of feces. You may be responsible for assisting the patient with an enema if the provider needs the lower bowel to be clear for an exam the same day. Patients undergoing a sigmoidoscopy or colonoscopy must have the bowel clear of fecal material. This is done by providing the patient a cathartic (stool softener), enema, or both the night before the procedure. Patient scheduled for a sigmoidoscopy will normally have a diet restricted to clear liquid the day before the test. Patients scheduled for a colonoscopy are normally placed on a clear liquid diet for 24 hours before the procedure, along with a laxative tablet for three nights before the test. Patients should be told to avoid red or purple liquids and are normally instructed not to have anything to eat or drink at least eight hours before the procedures. Bowel cleansing with laxatives, cathartics, and enemas should be performed within 24 hours before the test. As you can see, these tests need the intestines to be as clean as possible for the provider to adequately view the mucous membranes. If you are assisting, you will be responsible for positioning the patient, preparing the equipment, and helping the physician. You should explain the procedure to patients to lessen their fear and anxiety. These are uncomfortable and tiring procedures for the patients, and they should be allowed to rest before other tests, examinations, or treatments are performed. It is also important to make sure the patient signs a consent form before the procedure.  Sigmoidoscopies and colonoscopies are normally performed in a special lab or in a surgical suite. Proctoscopies can be performed in an exam room. PR O C T O SC O PI E S SI GMO I DO SC O PY C O L O N O SC O PY Have the patient undress from the waist down. Place patient in a side-lying or Sims position. Ensure all supplies and equipment are ready (gloves, drapes, proctoscope, water soluble lubricant, hand towels, chux and a light source such as the one used for pelvic exams). Be prepared to assist the provider with supplies as needed. Hand the patient tissue to wipe excess lubricant or don gloves and assist if needed. Help the patient to a sitting position after the examination, taking care to ensure the patient has a moment to rest so he or she does not become dizzy and fall. Schedule any required follow up. PR O C T O SC O PI E S SI GMO I DO SC O PY C O L O N O SC O PY Encourage the patient to empty his or her bladder just before the test and remove all clothing from the waist down. A signed consent form is required before the examination. Be sure to obtain baseline vital signs. Patients are positioned in a side-lying or Sims position. Drape the patient so that only the anus is exposed. (Provide as much privacy as possible.) Ensure all equipment is working and all required supplies are available. Be prepared to assist provider with supplies as needed. Remind the patient to breathe slowly and try to relax the lower abdominal and rectal muscles as the fiber optic scope is inserted into the anus and slowly introduced into the lower intestine. As you can imagine, this can be uncomfortable for the patient. The provider may also inflate the lower bowel with air to provide a better view of the surrounding tissue. Some abdominal cramping will normally be experienced. Hand the patient tissue to wipe excess lubricant or don gloves and assist if needed. Help the patient to a sitting position after the examination, taking care to ensure the patient has a moment to rest so he or she does not become dizzy and fall. Check vital signs before allowing the patient to leave. Schedule any required follow up. PR O C T O SC O PI E S SI GMO I DO SC O PY C O L O N O SC O PY Patients will be instructed to remove clothing from the waist down and are normally given a gown, open at the back. Once changed, patients will be placed on a gurney or bed with rails up as they will be given sedation to help with relaxation and decrease awareness during the procedure. A long flexible fiber optic scope will be inserted anally and advanced through the large intestine. The same steps are performed as with the sigmoidoscopy, except the procedure will take anywhere from 30–90 minutes and the scope is inserted much farther. Most patients would not be able to tolerate the discomfort from this procedure without sedation. After you explain the procedure to the patient, ensure he or she signs the required consent form. Any iron medication, aspirin, and most anti-inflammatory drugs must be withheld for three days. As before, make sure you obtain baseline vital signs before the procedure. Patients are positioned in a side-lying or Sims position. Drape the patient so that only the anus is exposed. (Provide as much privacy as possible.) Ensure all equipment, to include the fiber optic light, biopsy forceps, suction, water, and air are all working. Ensure all required supplies are available (drape, water soluble lubricant, hand towels, gloves). Be prepared to assist the provider with supplies as needed. The provider may also inflate the lower bowel with air to provide a better view of the surrounding tissue. Some abdominal cramping will normally be experienced during and after the procedure. Monitor vital signs every half-hour for two hours, or as directed by the provider or local protocol. Monitor for rectal bleeding (there may be a small amount of bleeding if polyps or biopsies were taken). Patients will usually be placed on bed rest for six to eight hours after the procedure. Monitor vital signs every half hour for 2 hours and then IAW facility protocols. Monitor for rectal bleeding (slight bleeding is expected if polyps were biopsied and/or removed). Keep patient on bed rest IAW doctors’ orders. Someone must drive patient home. Flexible Sigmoidoscopy Follow the below steps when assisting with a flexible sigmoidoscopy. You will need to first gather all supplies and equipment. Next, perform hand hygiene and verify correct identification of the patient. You will set up the sigmoidoscopy equipment; perform function checks on light and suction unit. Ask the patient if they completed the bowel preparation as instructed. Then ensure patient empties his or her bladder prior to the procedure. Instruct patient to remove all clothing from the waist down and don gown with the ties in the back. Assist patient onto the exam table, and into the left lateral or Sims position. Then drape patient so that only the anus is exposed (when the provider is ready). After the procedure, don gloves and clean the patient’s anal region using tissues and/or wipes. Allow patient to relax before getting up from the table. Remove gloves and perform hand hygiene. Help patient get off the exam table and allow privacy to get dressed. Place any biopsy specimens in fixative and label the containers at the bedside. Send specimens to lab. Once patient leaves the room, prepare for the next patient by cleaning the room and disinfecting the equipment. This is an inspection of the sigmoid colon by means of an endoscope called a sigmoidoscope. Proctoscopies Sigmoidoscopies Colonoscopies Bronchoscopy SUBMIT Complete the content above before moving on. Bronchoscopy A bronchoscopy is a diagnostic procedure in which a fiber optic tube is inserted through the nose or mouth into the lungs. The procedure provides a view of the airways of the lung and allows doctors to collect lung secretions and to biopsy for tissue specimens. If the bronchoscopy is performed through the nose, an anesthetic jelly will first be inserted into one nostril. When it is numb, the scope will be inserted through the nostril until it passes through the throat into the trachea and bronchi. Usually, a flexible bronchoscope is used. The flexible tube is less than ½-inch wide and about two-feet long. As the bronchoscope is used to examine the airways of the lungs, your doctor can obtain samples of your lung secretions to send for laboratory analysis. PR O C E DUR E SE T- UP DUR I N G T H E PR O C E DUR E A F T E R T H E PR O C E DUR E 1. Verify correct patient, date of birth, providers’ orders. 2. Verify that a witnessed and informed consent has been completed. 3. Ensure IV access is present and patency confirmed. 4. Verify that the patient has none of the contraindications that would otherwise halt the procedure: Uncorrectable coagulopathy Severe refractory hypoxemia Unstable hemodynamic status Facial trauma Unstable cervical spine Patients with increased risk are those that had a myocardial infarction within the suspected pregnancy. past six weeks, head injuries, and known or 5. Be prepared to assist in the administration of anesthesia and/or sedation in accordance with unit policies. 6. Prior to the procedure, ensure fluids and food is restricted in accordance with the provider’s orders in order to reduce the risk of aspiration. 7. Ensure patient removes dentures, contact lenses, and any other prostheses before the procedure. PR O C E DUR E SE T- UP DUR I N G T H E PR O C E DUR E A F T E R T H E PR O C E DUR E 1. Monitor patient’s heart rate, rhythm, blood pressure, respirations, respiratory effort, and level of consciousness. 2. Monitor pulse oximetry. 3. Ensure patient remains NPO until patient regains their gag reflex. 4. Observe patient’s perceptions of pain, discomfort, and dyspnea. 5. Immediately report signs of cyanosis, hypoventilation, hypotension, tachycardia or dysrhythmia, hemoptysis, dyspnea, or decreased breath sounds. PR O C E DUR E SE T- UP DUR I N G T H E PR O C E DUR E A F T E R T H E PR O C E DUR E