Post Biopsy Management
There are individual variations in the management of patients
following fine needle aspiration biopsy of lung lesions. However,
one can make some generalizations:
I routinely do the following:
- If the procedure is done with flouro
guidance, it is easy to fluoroscope in the same
sitting to rule out pneumothorax. If the procedure was done with
other forms of localization,
I obtain a portable chest x-ray.
- I order the following vital signs: pulse, blood pressure and
rate every half an hour for three
hours. I instruct the nurse to page me if the respiratory rate
- If there is no pneumothorax,
stop your close vigilance. It
is unlikely for pneumothorax to appear later. If there is
pneumothorax and the patient is still
asymptomatic, observe him for the next two hours and repeat the
chest x-ray (two hour expiratory film).
- If all is well, the patient
discharged with a set of instructions.
- Depending on the patient's symptoms and progession of chest x-ray, a next day chest x-ray may be ordered as a further course of action.
The procedure has become relatively safe. The complications are
minor and manageable. Many
centers have reported the feasibility and safety of the procedure
in an out-patient setting. The
cost of hospitalization has become a matter of great concern. However, admission be be necessary at times.
I admit patients who are at high risk, cannot tolerate minor
complications and in whom immediate medical access is difficult
(i.e., elderly feeble patients,
patients with severe cardiac or pulmonary disease). Usually, it
can be done as an outpatient. The patient should be warned of the
possible need for hospitalization after the procedure. They
should plan on staying for observation for approximately four