Today our topic of discussion is Lung Biopsy.
Lung Biopsy
LUNG BIOPSY
This invasive procedure is used to obtain a specimen of pulmonary tissue for a histological examination by using either an open or a closed technique. The open method involves a limited thoracotomy.
The closed technique includes methods such as transbronchial lung biopsy, transbronchial needle aspiration biopsy. Transcatheter bronchial brushing, percutaneous needle biopsy and video-assisted thoracotomy.
Purpose
- To identify or examine the abnormal cellular structure and bacteria of lung tissues
- To identify the pulmonary tumors or parenchymal changes (acidosis).
Indication
- Lung biopsy is indicated to determine the pathology of pulmonary parenchymal diseases
- Carcinomas
- Granulomas
- Infections
- Sarcoidosis
- Client preparation:
- Explain the procedure to the client
- Ensure that informed consent is obtained
- Instruct the client that fasting is usually ordered.
- The client may be kept NPO after midnight on the day of the test
- Administer the preprocedural medications 30-60 minutes before the test as ordered.
- Instruct the client to remain still during the lung biopsy.
- Any movement or coughing could cause laceration of the lung by the biopsy needle
Procedure
- Needle puncture (aspiration) biopsy of the chest lesion is done with fluoroscopy
- After a lesion is identified on a chest film and localized by fluoroscopy, topical anesthesia is administered and the needle is administered and the needle is inserted through the chest wall into the lung tissue and lesion
- A small sample of cell is aspirated for microscopic study, and the needle is withdrawn
- Aspiration biopsy may enable definitive diagnosis of nonmalignant neoplasms, granulomas, other nonmalignant growths
- Transbronchial lung biopsy (Fig. 29.41): This technique is performed via flexible fiberoptic
- bronchoscopy, using cutting forceps
- Fluoroscopy is used to ensure proper opening and positioning of the forceps on the lesions Fluoroscopy also permits visualization of the tug of the lung as the specimen is removed
- Transbronchial needle aspiration: The needle is inserted through the bronchoscope and into the tumor or desired area, where aspiration is performed with the attached syringe The needle is retracted within its sheath, and the entire catheter is withdrawn from the fiberoptic scope
- Transbronchial brushing: A small brush is moved back and forth over the suspicious area in the bronchus or its branches The cells adhere to the brush, which is then removed and used to make microscopic slides
- Percutaneous needle biopsy:In this method for obtaining a closed specimen, the biopsy is obtained after using fluoroscopic X-ray or
- CT scan determination of the desired site
- The procedure is carried out by using a cutting needle or by aspiration with a spinal type needle to obtain a specimen
- Open lung biopsy:
- The client is taken to the operating room general anesthesia is provided and
- The client is placed in the supine or lateral position and an incision is made into the chest wall
- After a piece of lung tissue is removed, the lung is sutured Chest tube drainage is used for approximately 24 hours after an open lung biopsy
- Transcopic lung biopsy
- The lung is collapsed a with a double lumen end tracheal tube placed during induction of general anesthesia
- With the use of a thoracoscope, the lung is grasped and piece is cut off with the use of a cutting/stapling device.
- Large wedge lung resections can be obtained
- The scope and trocars are removed, and small chest tube is left in place
- The tiny incision is closed, and the procedure is completed
- This procedure is performed by the surgeon in 30-60 minutes During the lung biopsy procedure, assess the client carefully for signs of respiratory distress (e.g. shortness of breath, rapid pulse, and cyanosis).
After Care
- After the procedure, examine any sputum closely for evidence of blood Observe for respiratory distress (may indicate pneumothorax)
- Monitor the client’s vital signs, breath sounds, skin color and temperature
- Place the biopsy specimen in appropriate containers for histological and microbial examination
- Assess the client’s breath sound and report any decrease on the biopsy site
- Obtain a chest X-ray film to cheek for complications (e.g. pneumothorax).
Contraindications
- The client with bullae or cysts of the lung
- Clients with suspected vascular anomalies
- Clients with bleeding abnormalities
- Clients with pulmonary hypertension
- Clients with respiratory insufficiency.
- Possible Complications
- Hemoptysis
- Hemothorax
- Pneumothorax
- Empyema.
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