Additional pediatric resources: GeneralPediatrics.com | PediatricEducation.org | SearchingPediatrics.com
Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
Contrast:
None
Technique:
Absolute contraindications: none
Relative contraindications: mod/severe COPD (FEV1 < 1.0 L),
patient on PEEP, adjacent bullae, patient > 3 sec over control,
plt < 50K, possible echinococcal cyst/AVM, patient uncooperative,
coughing, contralat pneumonectomy, pulmonary HTN
Check Hgb, plt, PTT, PT
Get pre biopsy CXR
If you do it under fluoroscopy make sure you have chest CT done
1st
Go over a rib - don't go near IMA which are 1.25 cm lat to lat
sternal border Coaxial 18G-> 22G through it - anchor the 18 G just
above lesion making sure it is through pleura - then when you make
passes through it you don't re puncture the pleura with 22G
Pt to hold breath @ FRC while traversing pleura
Make sure to occlude lumen of 18 G p pass
If under CT take p biopsy slice to r/o pneumothorax - if under
fluoroscopy get upright PA expiratory film
If pneumothorax large or symptomatic, put in 9 Fr CT
Position patient with biopsy side down (dependent positioning) to
decrease rate of pneumothorax and prevent transbronchial aspiration
of blood
Post Lung Bx Orders
Position patient with biopsy side down x 3 hours
Check VS and BS q 15 ' x 4, q 30 ' x 4
CXR PRN
Repeat PA expiratory at 3 hours : if no pneumothorax or if small
stable PTX: d/c
to home; if small PTX: check VS, give O2 via NC, repeat CXR if
symptomatic
D/C Home instructions: no straining or exertion till next AM, go to ER if you develop pleuritic CP/hemoptysis/SOB
Tips on lung biopsy: if you are going for thymoma or lymphoma - get a core, make your outer needle an 18 or 19 G cutting needle
PTX
Treat via 7-9 Fr cath inserted via trocar technique in 2nd
intercostal space in mid clavicular line under fluoroscopy making
sure to angle cath cephalad Cath can be placed from post or lat
position if patient is undergoing CT biopsy in prone position
Catheter is attached to Pleurevac with (-20) cm suction, secure all
connections with tape and put petroleum gauze around cath entry
site
When pneumothorax is gone clamp cath and repeat CXR in 4 hours: no
pneumothorax - remove catheter, recurrent pneumothorax - unclamp cath
and put it back on suction
Views to Take:
Not applicable
References:
See References Chapter.
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