Steps of the Procedure
- Accurately localize the lesion and plan the approach.
- Screen for contraindications.
- Premedication is not necessary for this procedure. Start the patient on 3-5 liters of oxygen by
nasal cannula. Start an IV to keep the line open.
- Position the patient. If feasible, keep the
side to biopsy higher. This will enable you to take advantage of
gravity in order to minimize
- Prepare the selected site with iodine and alcohol.
- Anesthetize the skin, subcutaneous tissue and pleura with 2%
xylocaine. For fear of inducing
pre-biopsy pneumothorax, be careful not to go too deep.
- Make a small dermatotomy using a size 11 scalpel blade. This
avoids resistance of skin and
bending of the needle.
- Select a size 22 spinal needle. Attempt to insert the needle into
- Ensure placement of the needle into the lesion. Intermittent
fluoroscopy is performed to guide
the advancement of the needle towards the lesion. Assess in both
planes to be sure that the
needle is in the lesion. Do not bend the needle.I insert the needle during quiet breathing. Many prefer to insert
the needle during breath
holding. This usually confuses the beginner and the patient may
sometimes take a deep breath
increasing the likelihood of a tear of the lung.
- Remove the stylet and connect the needle to a 10 cc syringe. Jab
the lesion a few times with
suction. The maneuver increases the change of retrieval of tissue.
- Stay in the chest with the needle for only the length of time
necessary. Withdraw the needle
without suction. The suction is stopped during withdrawal to avoid
picking up blood from the
- Expel the aspirate onto frosted and plain slides for bacteriology.
Make the smears quickly. A
cytologist stains and review the slides immediately for adequacy of
- Repeat the procedure with a new needle if the aspirate is
unsatisfactory and non-diagnostic. This
quick read technique optimizes the number of needle passes.
- Apply a band aid.
- Fluoroscope to evaluate for pneumothorax.