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Ateneo de Zamboanga University

COLLEGE OF NURSING
NURSING SKILLS OUTPUT (NSO)
Week
BIOPSY
I. DESCRITPTION:
A biopsy is

a medical

test commonly

performed

interventional involving sampling of cells or tissues for

by

a surgeon or

examination.

It

is

an
the

medical removal of tissue from a living subject to determine the presence or extent
of a disease. The tissue is generally examined under a microscope by a pathologist,
and can also be analyzed chemically. When an entire lump or suspicious area is
removed, the procedure is called an excisional biopsy. When only a sample of tissue
is removed with preservation of the histological architecture of the tissues cells, the
procedure is called an incisional biopsy or core biopsy. When a sample of tissue or
fluid is removed with a needle in such a way that cells are removed without
preserving the histological architecture of the tissue cells, the procedure is called
a needle aspiration biopsy.
II. INSTRUMENTS/EQUPMENTS NEEDED:

Syringe
CT Scan/ Ultrasound
Anesthesia
Surgical tools (forceps,scissors,scalpel)
Specimen bottle
Vacuum
Skin puncher

III. PROCEDURE (Skin Biopsy)


1. Explain the procedure to the client and schedule the procedure with the help of
the clients physician.
2. Obtain Consent
3. Assess the client for history and baseline data
4. Let the client change clothes and wear gown. Provide privacy
5. Skin prep (Cleaning the area with aseptic solution thoroughly)
6. Once the skin has been prepared with alcohol, the next step is to anesthetize the
area to be biopsied by injecting a solution of Lidocaine (HCL 1% and Epinephrine
1:100,000) just under the epidermis (sub epidermal) using a cc Tuberculin
Syringe. The injection should continue until a bleb or bubble has formed under the
skin greater than 3mm in diameter. The injection will burn slightly (much like a bee
sting) due to a pH difference between the skin and the solution. The slight burning
will quickly subside and the site will become numb.
7. After the initial Lidocaine injection the area to be biopsied should be checked to
insure that the skin is properly anesthetized. The point of the syringe is used to
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poke the area of the bleb or bubble. Great care should be taken not to force the
needle into the skin. The test site should be somewhere around the periphery of the
bleb. Both of these precautions insure a viable biopsy for diagnosis later. If the
patient experiences neither pain nor sharp sensation, the biopsy continues. A
pressure sensation is normal and expected but there should be no pain. If the area
requires more anesthesias, another injection (with a new syringe) is made until the
skin is completely anesthetic.
8. After the area to be biopsied is anesthetized, the biopsy continues. Using a sterile
3mm skin punch, the physician applies pressure and twisting in a drilling motion
until the blade of the skin punch has pierced the epidermis of the skin. The blade
should be about exposed. It is normal for the patient to experience a pressure
and twisting sensation but no pain.
9. After the blade has sufficiently cored or carved out a 3mm cylinder of skin the
skin punch is removed. It is normal for the area to bleed after the punch is removed.
Excess blood is wiped off with sterile 2 x 2 gauze to expose the biopsy site. The
entire process resembles the cookie cutter effect. The only purpose of the skin
punch is to core the skin and not to remove the biopsy, much like a cookie cutter.
10. When the skin has been cored and cleared of excess blood, the next step is to
remove the biopsy from the rest of the skin. Great care should be taken not to
damage the epidermis by crushing it with forceps or by cutting it with a scalpel
unnecessarily. The physician uses the forceps to grab the dermis of the cored skin,
pulls up the core to reveal excess dermis and sub dermal fat, and uses the scalpel in
one or two cutting motions to cut the cord skin free.
11. Notice the position of the scalpel during the excision process. The scalpel is
placed under the forceps and is moved in the opposite direction of the forceps
pulling on the dermis. This motion stabilizes the biopsy and aids in preventing a
chopping or slicing affect when trying to free the biopsy. The physician simply
utilizes one or two strokes of the scalpel to excise the biopsy with a clean cut.
12. Once the biopsy has been removed from the skin there will usually be some
degree of bleeding which should be absorbed with sterile 2 x 2 gauze. The biopsy
site is then covered with a standard band-aid and possibly fortified with sterile
gauze and paper tape if the bleeding threatens to soak the band-aid and/or the
patients clothing. This hole in the skin will continue to bleed for the rest of the
day and may or may not form a scab in a few days time.
13. The biopsy site should be kept clean. The site should not be submerged in water
(i.e. no swimming, hot tubs, baths, etc.) for a few days. The bandage should be
changed at least once a day and should be changed if it should become wet or
damp. Once a substantial scab has formed, or new skin begins to grow over the
area and bleeding has stopped, the bandage can be removed. In the long term,
minimal scaring may occur. In most cases the biopsy site is indistinguishable within
a few months. In a few instances the biopsy site may form a protrusion or bump but
continue to heal normally.
IV. DIAGRAM/ILLUSTRATIONS:

V.NURSING RESPONSIBILITIES

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1. Before procedure

Ensure a consent from the patient

Check/Assess for baseline data and history for any complications or signs and
symptoms for underlying diseases

Check/Monitor Vital signs

Let the client change clothes and wear a gown

Make sure the client is oriented about the procedure to what he should
expect

Guide the client to the procedural room

Make sure the client is comfortable to the appropriate position and provide
privacy

2. During Procedure

Support and reassure the client during procedure

Assist client in positioning

Tell the client to relax

Make sure the anesthesia given is already active before going on

3. After Procedure

Wipe excess blood

Label the specimen completely

Send it to the laboratory

Assess client for signs of infection and do the necessary action

Document everything

Reference:
http://www.cancer.org/treatment/understandingyourdiagnosis/examsandtestdescript
ions/forwomenfacingabreastbiopsy/breast-biopsy-biopsy-types
http://www.mayoclinic.com/health/biopsy/CA00083

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DATE

CLINICAL INSTRUCTOR

Haifa U. Alibasa
BSNIII-C: Group B

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