Preparation 

1. For each biopsy, review patient history, allergies, labs, and imaging.

2. Biopsy Preparation Checklist:

   1. Patient sedation

      • Discuss with the attending to confirm sedation plan

      • When the nurses review the requests, they may put in observations on what can be done for each patient

      • If the patient uses CPAP. Make sure they bring their own machine, and ask the CT technologist or nurse to call Respiratory in advance to give them a heads up about the procedure. This step can be a major hang up in terms of proceeding with the biopsy with sedation if it is not known in advance.

      • IMPORTANT: For patients on suboxone/naloxone, nurses will not administer IV sedation,  therefore if these patients cannot be done with local anesthesia only, they will need to be sedated by the Anesthesia staff (this is somewhat common for requests involving infection aspiration/biopsies, such as inpatient discitis biopsies). 

   2. Epic orders (please place those the day before at the latest)

   3. Lesion location (especially if there is more than one)

   4. Patient positioning (prone, supine, decub)

   5. Approach to the lesion

   6. Needle type, gauge, and length (Check CT/Bx Tools of the Trade)

      • If you are using the OnControl, the drill and tray are in the fellow’s office. All other supplies are in Ellison 2)

   7. Suspected diagnosis

   8. If you will use CT fluoroscopy

   9. If you will perform frozen pathology or rapid cytology; the purpose of performing one of these is to make sure that you have a diagnostic sample, which reduces the nondiagnostic and therefore re-biopsy rate. 

i. Make sure you explain this to the patient when you consent them.

ii. For cytology, you should call the cytologist in the mid-morning to give them a heads up about the case (be prepared with the patient medical record number), and then call them again about 10 minutes before you obtain the cytology sample.

3. Also put a note in epic for the techs. See below for how to do this.