Interventional Procedures

PT

Prothrombin time; used to evaluate the blood clotting process; tells the physician how likely the patient is to have bleeding or clotting problem during or after surgery

PTT

Partial thromboplastin; measures the time it takes a clot to form and is also used to evaluate the effects of heparin therapy

INR

International normalized ratio; developed as a method of standardization; a calculation that adjusts for the variations in PT processing and values so that test results from different labs can be compared; it is not used on patients with liver disease or on heparin; it is evaluated on patients taking anticoagulants such as coumadin

Best approach for thoracentesis and easy access to liver masses (at dome)

Subcostal is the best approach to minimize the risk of pneumothorax

The most common indication(s) for biopsy

1. malignancy confirmation

2. Fluid drainage

Advantages of ultrasound

real-time imaging

The most common place for metastatic disease

The liver

contraindications for a biopsy

1. uncooperative pt

2. uncorrectable bleeding disorder

3. Lack of safe needle pathway

Limitations of ultrasound

1. Not all masses can be visualized on us bc the mass may be isoechoic to normal tissue

2. comfort level between the sonographer and sonologist

AFP

Alpha-fetaprotein is a lab value that will trigger a request for biopsy if abnormal; elevated in the presence of liver lesions

PSA

Prostate- specific antigen; is a lab value that will trigger a request for biopsy if abnormal; elevated to evaluate the prostate for cancer

pts that can not use INR or PT

pts with liver disease and taking heparin

coagulopathy

a defective clotting condition

Albumin

Administered to patients that have had more than 5L of fluid drained. IV albumin is given to decrease the chance of complications

*platelet transfusion may be necessary

FNA

Fine needle aspiration; uses thin gauge needles to obtain cells from within the mass. FNAs are performed using a 20-25 gauge

FNA technique reduces trauma to the cells and decreases the amount of background blood

core biopsy gun

uses an automated spring loaded device to obtain a core of tissue for histologic analysis

*USED FOR DEEPER SAMPLES

Advantages of having a cytopathology team

To determine if the material is diagnostic

minimize number of passes

Time-out

Before beginning any procedure, the pt is required to cite their name and reason for being there

Local anesthetic needle gauge

25 gauge

TRX types

linear-surface

curved linear- deeper tissue

phased array- limited FOV

Post op complications

pain/ discomfort

vasovagal reaction

hematoma

more serious post op complications

hemorrhage

pneumothorax

infection

death

spleen

high risk biopsy area bc it is susceptible to hemorrhage

diaphragm

separates the thoracic cavity and abdominal cavity

Needle type for paracentesis

18-22 gauge