In this section
We currently have no regular allocated theatre spot for biopsies at RCH although Renal and Radiology are working on a solution for 2014.
The process for renal biopsies:
Equipment list for theatre staff
-2 blueys-sponge forceps, gauze, iodine for skin prep (chlorhex removes blue marker pen!)-four sterile drapes and four towel clips-sterile probe cover and two rubber bands-sterile gel-drawing up needle, 22G needle and 22G spinal needle if native biopsy-10mL syringe-10mL 0.5% bupivicaine without adrenaline-size 7 scalpel- packet gauze-small tegaderm-2 sterile specimen pots-5mL N/saline
Fill out operation note and post op orders on theatre software: à patient à documentation à edit à type op note. This will print to recovery.
Example operation note:
GA. Time out.
Chlorhex/alcohol/iodine prep with sterile drapes, gown, glove and mask.
USS localisation of lower pole of the left kidney/midpole of the transplant kidney.
0.5% plain marcain infiltrated to capsule under ultrasound guidance – volume:
One pass through lower pole of left kidney under real time ultrasound guidance.
Visualised through cortex on USS.
No post biopsy haematoma.
Tegaderm island dressing.
Usual post-op orders (copy and paste into the theatre system and amend as necessary):
Ideally lie supine or on side for 3 hours if child not distressed. If child upset, agitated, allow them to find a position
of greatest comfort such that they remain still.
May eat and drink once awake. Encourage oral fluids early.
For first 3 hours, use bed pan in bed, thereafter can mobilise gently to toilet if pain permits but must collect all urine
for inspection for visible haematuria.
(heart rate, blood pressure, respiratory rate, capillary refill, pain score, review biopsy site for bleeding):
Collect a sample of every micturition in a specimen container and label with the time, regardless of the presence of visible haematuria. Keep near patient bedside for medical review just in case. Dipsticking is not necessary.
Advise no vigorous activity for 4 weeks; tegaderm dressing to remain on for 7 days.
Registrar to complete renal biopsy discharge pro-forma on Clara prior to patient departure in order to provide post-procedure instructions for the family.