LUNG BIOPSY AFTERCARE RISKS
Category: Thoracic Surgery
Abstract : Aftercare Needle biopsy Following a needle biopsy, the patient is allowed to rest comfortably. He or she may be required to lie flat for two hours following the procedure to prevent the risk of bleeding. The nurse checks the patient’s status at twohour intervals. If there are no complications after four hours, the patient can go home once he or she has received instructions about res
Aftercare
Needle biopsy
Following a needle biopsy, the patient is allowed to rest comfortably. He or she may be required to lie flat for two hours following the procedure to prevent the risk of bleeding. The nurse checks the patient’s status at twohour intervals. If there are no complications after four hours, the patient can go home once he or she has received instructions about resuming normal activities.
The patient should rest at home for a day or two before returning to regular activities, and should avoid strenuous activities for one week after the biopsy.
Open biopsy, VATS, or mediastinoscopy
After an open biopsy, VATS, or mediastinoscopy, the patient is taken to the recovery room for observation. The patient receives oxygen via a face mask or nasal cannula. If no complications develop, the patient is taken to a hospital room. Temperature, blood oxygen level, pulse, blood pressure, and respiration are monitored. Chest tubes remain in place after surgery to prevent the lungs from collapsing, and to remove blood and fluids. The tubes are usually removed the day after the procedure. The patient may experience some grogginess for a few hours after the procedure. He or she may have a sore throat from the endotracheal tube. The patient may also have some pain or discomfort at the incision site, which can be relieved by pain medication. It is common for patients to require some pain medication for up to two weeks following the procedure.
After receiving instructions about resuming normal activities and caring for the incision, the patient usually goes home the day after surgery. The patient should not drive while taking narcotic pain medication.
Patients may experience fatigue and muscle aches for a day or two because of the general anesthesia. The patient can gradually increase activities, as tolerated. Walking is recommended. Sutures are usually removed after one to two weeks.
The physician should be notified immediately if the patient experiences extreme pain, light-headedness, or difficulty breathing after the procedure. Sputum may be slightly bloody for a day or two after the procedure. Heavy or persistent bleeding requires evaluation by the physician.
Risks
Lung biopsies should not be performed on patients who have a bleeding disorder or abnormal blood clotting because of low platelet counts, or prolonged prothrombin time (PT) or partial thromboplastin time (PTT). Platelets are small blood cells that play a role in the blood clotting process. PT and PTT measure how well blood is clotting.
If clotting times are prolonged, it may be unsafe to perform a biopsy because of the risk of bleeding. If the platelet count is lower than 50,000/cubic mm, the patient may be given a platelet transfusion as a temporary relief measure, and a biopsy can then be performed.
In addition, lung biopsies should not be performed if other tests indicate the patient has enlarged alveoli associated with emphysema, pulmonary hypertension, or enlargement of the right ventricle of the heart (cor pulmonale). The normal risks of any surgical procedure include bleeding, infection, or pneumonia. The risk of these complications is higher in patients undergoing open biopsy procedures, as is the risk of pneumothorax (lung collapse). In rare cases, the lung collapses because of air that leaks in through the hole made by the biopsy needle.
A chest x ray is done immediately after the biopsy to detect the development of this potential complication. If a pneumothorax occurs, a chest tube is inserted into the pleural cavity to re-expand the lung. Signs of pneumothorax include shortness of breath, rapid heart rate, or blueness of the skin (a late sign). If the patient has any of these symptoms after being discharged from the hospital, it is important to call the health care provider or emergency services immediately.
Bronchoscopic biopsy
Bronchoscopy is generally safe, and complications are rare. If they do occur, complications may include spasms of the bronchial tubes that can impair breathing, irregular heart rhythms, or infections such as pneumonia.
Needle biopsy
Needle biopsy is associated with fewer risks than open biopsy because it does not involve general anesthesia. Some hemoptysis (coughing up blood) occurs in 5% of needle biopsies. Prolonged bleeding or infection may also occur, although these are very rare complications.
Open biopsy
Possible complications of an open biopsy include infection or pneumothorax. If the patient has very severe breathing problems before the biopsy, breathing may be further impaired following the operation. Patients with normal lung function prior to the biopsy have a very small risk of respiratory problems resulting from or following the procedure.
Mediastinoscopy
Complications due to mediastinoscopy are rare. Possible complications include pneumothorax or bleeding caused by damage to the blood vessels near the heart. Mediastinitis, infection of the mediastinum, may develop. Injury to the esophagus or larynx may occur. If the nerves leading to the larynx are injured, the patient may be left with a permanently hoarse voice. All of these complications are rare.
Normal results
Normal results indicate no evidence of infection in the lungs, no detection of lumps or nodules, and cells that are free from cancerous abnormalities. Abnormal results of needle biopsy, VATS, and open biopsy may be associated with diseases other than cancer. Nodules in the lungs may be due to active infections such as tuberculosis, or may be scars from a previous infection. In 33% of biopsies using a mediastinoscope, the biopsied lymph nodes prove to be cancerous. Abnormal results should always be considered in the context of the patient’s medical history, physical examination, and other tests such as sputum examination, and chest x rays before a final diagnosis is made.
Morbidity and mortality rates
The risk of death from needle biopsy is rare. The risk of death from open biopsy is one in 3,000 cases. In mediastinoscopy, death occurs in fewer than one in 3,000 cases.
Alternatives
The type of alternative diagnostic procedures available depend upon each patient’s diagnosis. Some people may be eligible to participate in clinical trials, research programs conducted with patients to evaluate a new medical treatment, drug, or device. The purpose of clinical trials is to find new and improved methods of treating different diseases and special conditions. For more information on current clinical trials, visit the National Institutes of Health’s ClinicalTrials.gov at http://www.clinicaltrials.gov or call (888) FIND-NLM [(888) 346-3656] or (301) 594- 5983.
The National Cancer Institute (NCI) has conducted a clinical trial to evaluate a technology - low-dose helical computed tomography - for its effectiveness in screening for lung cancer. One study concluded that this test is more sensitive in detecting specific conditions related to lung cancer than other screening tests.
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