Develop a teaching care plan for Angie who is about to undergo a liver biopsy. Which of the following points do you include?
A. “You’ll need to lie on your stomach during the test.”
B. “You’ll need to lie on your right side after the test.”
C. “During the biopsy, you’ll be asked to exhale deeply and hold it.”
D. “The biopsy is performed under general anesthesia.”
Correct Answer: B. “You’ll need to lie on your right side after the test.”
After a liver biopsy, the patient is placed on the right side to compress the liver and to reduce the risk of bleeding or bile leakage. The risk of fatal hemorrhage in patients without malignant disease is 0.04%, and the risk of nonfatal hemorrhage is 0.16%. In those with malignancy, the risk of nonfatal hemorrhage is 0.4% and 0.57% for nonfatal hemorrhage.
Option A: The patient is usually kept in the right decubitus position. The duration of observation varies across centers ranging from 1 hour to 6 hours. The American Association for the Study of Liver Diseases guidelines recommends observation for 2 to 4 hours. The vital signs are monitored every 15 minutes for the first hour, every 30 minutes for the next hour, and hourly till discharge.
Option C: The patients are made to lie in a comfortable supine position. The right hand is placed under the head in a neutral position. By percussion, the area of maximum dullness is identified over the right hemithorax. This is typically between the 6 and 9 intercostal spaces between the anterior and the midclavicular line.
Option D: The skin is prepped and draped in a sterile fashion. The overlying skin is anesthetized using 1% lidocaine. The peritoneum is also anesthetized by inserting the needle along the upper border of the rib avoiding vascular structures.
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