Biopsies

When patients have elevation of their liver enzymes then an evaluation of the cause must be undertaken. This usually involves a liver biopsy. The biopsies can be done as an outpatient, in which case you will likely not see the patient unless the biopsy shows rejection. It can also be done on inpatients. The biopsies are done at the bedside. We usually do the biopsies first thing in the morning. Plans are usually made the evening before during afternoon rounds. If a biopsy is planned then the following needs to be done.

• Draw labs at 4 AM instead of regular AM lab time. Add a PT/PTT to the normal labs. Remember not to draw the Tacrolimus or Cyclosporine level at this time. It must still be drawn at 7:30 AM.
• Make patient NPO except for meds after 4 AM.
• Place EMLA cream in RUQ at edge of liver at 7 AM
• Order liver biopsy tray to bedside
• Have nurses bring culture media to bedside.
• Order Versed for sedation. We use 0.1 mg/kg as an IV bolus. We will give it immediately prior to biopsy.
• IVF's are usually not needed for this short NPO period.
• After the biopsy is done, several other orders need to be done.
• Patient must stay at bedrest, on right side if possible, for a minimum of 4 hours. This includes not going to X-ray for studies.
• A repeat CBC must be done 4 hours after biopsy.
• Patient must stay on monitor and have frequent vital signs after biopsy.
• Q 15 minutes for 1 hour.
• Q 30 minutes for 1 hour.
• Q 1 hour for 2 hours and then return to normal.
• Pressure must be held at biopsy site for a minimum of 15 minutes.
• Patient may resume regular diet once fully awake and vital signs are normal.